Sleep related movement disorders
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증상은 다리 뿐만 아니라 팔이나 몸통에서도 나타날 수 있다. 따라서 RLS라는 용어가 적절하지 않다는 문제제기에 따라 최근 International Restless Legs Syndrome Study Group(이하 IRLSSG)에서는 Willis-Ekbom disease라는 병명을 제시하였다. RLS/WED (restless leg syndrome/Willis Ekbom disease) 로 표기하는 경우가 많다.
5가지 핵심기준
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URGED
U: Urge to move legs often paired with unpleasant or uncomfortable sensations(다리에 불쾌한 감각을 동반한 다리를 움직이고 싶은 충동) R: Rest or inactivity increases urge to move and accompanying sensations(다리를 움직이지 않을 때 발생하고 움직임에 의해 일시적으로 완화) G: Getting up and moving improves symptoms(일어나서 움직이면 증상완화) E: Evening worsening or nighttime appearance of symptoms(저녁이나 밤에 나타나거나 심해짐) D: Differential diagnosis does not sufficiently explain symptoms(증상을 일으킬 만한 다른 원인이 없음) |
주요 진단기준 비교
Feature | IRLSSG | ICSD-3 | DSM-5 |
5 essential features | Same | Same | Same |
Frequency | Chronic persistent or Intermittent | NA | 3 times per week |
Duration | Persistent or intermittent over 1 year | NA | 3 months |
Clinical significance | Can cause impairment but impairment is not required | Requires impairment with exception of genetic and epidemiological studies | Requires impairment |
Waivers | Frequency and duration may be waivered in childhood, pregnancy, and drug induced RLS | Impairment requirement can be waived in genetic and epidemiological studies | NA |
Recognizes drug induced RLS | Yes | Yes | No |
RLS mimics must be excluded | Yes | Yes | Yes |
Children/adolescent must describe symptoms in own words | Required | Required | Required |
이전에는 Dopamine 제제를 기본으로 해서 다른 제제를 병용하여 처방하는 방식이었지만 최근에는 Alpha-2-delta (α2δ) ligands 항뇌전증제가 RLS의 1차적 치료제로 변화되는 추세이다.
하지불안증후군의 약물치료
Intervention | Medication | Dosage |
1st | Alpha-2-delta ligands
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2nd or 1st | Dopamine agonists
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3rd | Levodopa (could be used as needed)
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Nest | Iron (could be considered concomitantly with 1st to 3rd line medications or earlier when ferritin levels are <75 μg/L
Opiates
Benzodiazepines
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참고자료
[하지불안증후군(Restless Legs Syndrome)]