Monday, November 03, 2014

Restless Legs in Children - Link with ADD ADHD night terrors sleepwalking nightmares? Review Article here....

This article is a great review of RLS in children.  Prevalence at least 2% of children?
- Dr. Rotenberg, Houston TX Sleep Specialist and Neurologist for Children


This is not rare - " 40% of adults suffering from RLS, the initial onset of symptoms will occur before 20 years of age., appears that RLS is common in children and adolescents with an estimated prevalence of 1.9% in school aged children and 2% in adolescents in whom there were no significant gender differences"

Criteria for making the diagnosis of definite RLS in children.6
  • 1. The child meets all four essential adult criteria for RLS (the urge to move the legs, is worse during rest, relived by movement and worse during the evening and at night) and
  • 2. The child relates a description in his or her own words that is consistent with leg discomfort (the child may use terms such as oowies, tickle, spiders, boo-boos, want to run and a lot of energy in my legs to describe the symptoms. Age-appropriate descriptors are encouraged)
  • Or
  • 1. The child meets all four essential adult criteria for RLS and
  • 2. Two of the three following supportive criteria are present.
    1. Sleep disturbance for age
    2. A biologic parent or sibling has definite RLS
    3. The child has a polysomnographically documented periodic limb movement index of 5 or more per hour of sleep.

As in sleep-disordered breathing, RLS and PLMD can lead to both cardiovascular and neurocognitive consequences. Several recent studies have shown that RLS and PLMD in the adult population is associated with a rise in nocturnal blood pressure and hypertension., The mechanism underlying blood pressure changes may be related to autonomic activation in the context of repeated arousals. 
Currently, there are no data available on the cardiovascular consequences of RLS and PLMD in children. 
Cognitive deficits and ADHD have been reported in adults with RLS and PLMD., Several studies have demonstrated the association between RLS and PLMD and ADHD in children. The relationship between ADHD and RLS and PLMD can be explained by several possibilities. Firstly, sleep disruption associated with RLS and PLMD may lead to inattentiveness and hyperactivity. Secondly, RLS and PLMD may be a co-morbidity of ADHD. Thirdly, RLS and PLMD and subset of ADHD may share common dopamine dysfunction or alterations in iron metabolism. Finally, diurnal manifestations of RLS and PLMD may mimic ADHD.
Another co-morbidity of RLS and PLMD consists of the common parasomnias, such as confusional arousals, night terrors, sleepwalking, and nightmares. Several studies have shown that there is an increased frequency of parasomnias in children with RLS and PLMD.,
 The co-existence of RLS and PLMD and parasomnias and the resolution of parasomnias after treatment of RLS and PLMD suggest that sleep disruption associated with RLS and PLMD may trigger or facilitate the appearance of parasomnias.
Keywords: Restless legs syndrome, Periodic limb movement disorder, Dopaminergic medications, Iron therapy, Children, Attention-deficit hyperactivity disorderFULL Article here

No comments: