Zambelis Th, Wolgamuth B R, Papoutsi S N, Economou N T
Department of Neurology, University of Athens Medical School, Eginition Hospital, Athens, Greece.
Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland, OH, USA.
Psychiatriki. 2016 Jul-Sep;27(3):222-226. doi: 10.22365/jpsych.2016.273.222.
Α case of a chronic idiopathic form of a severe type of Restless Legs Syndrome (RLS), which developed during pregnancy and persisted after this, misdiagnosed for 34 years as radiculopathy S1, is reported. In spite of the thorough clinical and laboratory investigation, in addition to constant changes of the therapeutic approach, the diagnosis of S1 radiculopathy could not be confirmed, resulting in a chronic clinical course; the latter was characterized by relapses and remissions not attributed or linked in any way to the treatment (various types of). In fact, it was due to a routine workup in a sleep clinic, where the patient was referred because of a coincident chronic insomnia (Restless Legs Syndrome is a known and important cause of insomnia/chronic insomnia), which resulted in a proper diagnosis and treatment of this case. With the use of Restless Legs Syndrome appropriate treatment (Pramipexole 0.18 mg taken at bedtime, a dopaminergic agent and Level A recommended drug for Restless Legs Syndrome) an excellent response and immediate elimination of symptoms was achieved. Restless Legs Syndrome may present with a variety of symptoms (with the most prominent shortly being reported with the acronym URGE: Urge to move the legs usually associated with unpleasant leg sensations, Rest induces symptoms, Getting active brings relief, Evening and night deteriorate symptoms); given the fact that Restless Legs Syndrome presents with a great variety and heterogeneity of symptoms (mostly pain, dysesthesia and paresthesia), which may occur in several other diseases (the so called "RLS mimics"), proper diagnosis of Restless Legs Syndrome usually fails. Restless Legs Syndrome misinterpreted as S1 radiculopathy, to the best of our knowledge, has not been reported yet in the literature. Here, case history, clinical course and common RLS mimics are presented. Different forms of Restless Legs Syndrome manifestations, which are commonly -as in this case- misinterpreted due to their mimicking several pathological conditions, Restless Legs Syndrome prevalence on general population according to various large epidemiological studies and pathogenic hypotheses on the issue of Restless Legs Syndrome are discussed. Finally, by presenting another possible "RLS-mimic" our aim is to highlight the common misdiagnosis of Restless Legs Syndrome, which can mimic a variety of disorders, some of which are very common, such as an S1 radiculopathy, thus raising concern among doctors of various specialties addressed to by Restless Legs Syndrome sufferers, on the importance of proper diagnosis of the syndrome.
报告了一例严重类型的慢性特发性不宁腿综合征（RLS）病例，该病例在孕期发病且产后持续存在，被误诊为S1神经根病长达34年。尽管进行了全面的临床和实验室检查，且不断改变治疗方法，但S1神经根病的诊断仍无法得到证实，导致了慢性病程；后者的特点是复发和缓解，与任何治疗（各种类型）均无关联。实际上，这是由于在睡眠诊所进行的常规检查，该患者因同时患有慢性失眠（不宁腿综合征是失眠/慢性失眠的已知且重要原因）而被转诊至此，从而对该病例进行了正确的诊断和治疗。使用不宁腿综合征的适当治疗方法（睡前服用0.18毫克普拉克索，一种多巴胺能药物，是不宁腿综合征的A级推荐药物）后，症状得到了极好的缓解且立即消除。不宁腿综合征可能表现出多种症状（最突出的症状用首字母缩写URGE表示：腿部有活动的冲动，通常伴有腿部不适的感觉，休息会诱发症状，活动可缓解症状，傍晚和夜间症状会加重）；鉴于不宁腿综合征症状种类繁多且具有异质性（主要是疼痛、感觉异常和感觉迟钝），这些症状也可能出现在其他几种疾病中（即所谓的“不宁腿综合征模仿者”），因此不宁腿综合征的正确诊断通常会失败。据我们所知，被误诊为S1神经根病的不宁腿综合征在文献中尚未见报道。在此，介绍了病例史、临床病程以及常见的不宁腿综合征模仿者。讨论了不宁腿综合征表现的不同形式，这些形式通常（如本病例）由于模仿多种病理状况而被误诊，根据各种大型流行病学研究探讨了普通人群中不宁腿综合征的患病率以及关于不宁腿综合征问题的致病假说。最后，通过介绍另一种可能的“不宁腿综合征模仿者”，我们旨在强调不宁腿综合征常见的误诊情况，它可以模仿多种疾病，其中一些非常常见，如S1神经根病，从而引起不宁腿综合征患者所涉及的各个专科医生对该综合征正确诊断重要性的关注。
