Abstracts

Rationale: Restless legs syndrome (RLS) is a common neurological movement disorder occurring in approximately 10% of the general population. The prevalence of the moderately severe RLS is 2.7% overall (3.7% for women and 1.7% for men). The prevalence of RLS increases with advancing age and is more common in several neurological disorders. Epilepsy is also a common neurological disorder with significant associated morbidity and impact on quality of life. We report the severity and frequency of primary RLS in patients with temporal lobe epilepsy. Methods: All epilepsy patients seen in the outpatient clinic were screened for movement disorders. Those patients with severe language impairment, cognitive impairment and stroke were excluded from this study population. The epilepsy diagnoses were based on EEG, MRI, functional imaging (in pre-surgical evaluations only), and semiological features. Forty consecutive patients with localization-related temporal lobe epilepsy (TLE) (20 right TLE and 20 left TLE) who met inclusion criteria were seen in the outpatient clinic. Each patient was evaluated with the International Restless Legs Study Group (IRLSSG) questionnaire, NIH RLS diagnostic criteria, ferritin level, and comprehensive sleep screening including polysomnography. Furthermore, patients with obstructive sleep apnea or a definite cause of secondary restless legs syndrome such as low serum ferritin or serum iron levels were also excluded from the study. Results: Restless legs occurred in 11 of 40 (27.5%) these temporal lobe localization-related epilepsy patients overall. RLS occurred more frequently in the right TLE group (8/20, 40%) than the left (3/20, 15%) (p<0.05). The results are summarized in the table. A number of anti-epileptic agents were used in this study population creating an insufficient population for reliable statistical analysis of medication effects, both positive and negative. Conclusions: We identified frequent, moderate to severe RLS in patients with epilepsy. The frequency of restless legs syndrome was much more common than would typically be seen in patients of similar age. The restlessness was typically described as moderately severe. The RLS symptoms were more common and somewhat more severe in the right TLE group than the left TLE group. Interestingly, it is the right TLE group that more frequently exhibits hypermobility in the seizure semiology. It is likely that there are profound differences in the relationships between RLS and various anti-epileptic medications. Several anticonvulsants have been found effective for treating RLS in double-blind, placebo-controlled trials including carbamazepine, gabapentin, pregabalin and clonazepam. Patients being treated with these medications may have reported lower RLS severity levels. More detailed analysis of the impact on quality of life parameters related to RLS on perceived quality of life related to epilepsy is needed.