Cuellar RLS Presentation General Public

33 %
67 %
Information about Cuellar RLS Presentation General Public

Published on November 28, 2007

Author: Laurie


Slide1:  Restless Legs Syndrome: Unraveling the Mystery Dr. Norma Cuellar Assistant Professor University of Pennsylvania School of Nursing Slide2:  Why are you here? Who knows someone with RLS? What do you know about it? Introduction:  Introduction What is RLS? Movement Disorder (#1 ahead of PD) Sleep Disorder (4th leading cause of insomnia) AKA: Ekbom’s Syndrome Affects up to 10% of the population Up to 13% in elderly women Up to 15% in European countries Life long condition that progressively worsens No cure Can be painful History of RLS:  History of RLS 1672: English physician: Sir Thomas Willis “leaping and contractions of the arms and legs causing sleeplessness equivalent to the greatest torture” 1940s: Swedish neurologist: Karl Ekbom Over 60 years ago Still under diagnosed, misdiagnosed Still unaware of the consequences on quality of life. Why? What is happening to my body?:  What is happening to my body? What is dopamine? Neurotransmittor – chemical in the brain What does iron have to do with RLS? Inadequate brain iron metabolism 3 reversible conditions: iron deficiency, ESRD, pregnancy Brain Iron Iron supplementation does not always help RLS DO NOT TAKE IRON SUPPLEMENTS WITHOUT BEING MONITORED BY YOUR PHYSICAN CAN HAVE NEGATIVE SIDE EFECTS! Types of RLS: Primary:  Types of RLS: Primary 50% of cases Genetics component Usually find one other family member with RLS Have symptoms earlier in age with a slower progression of disease Symptoms not as severe Secondary RLS:  Secondary RLS Associated with other health conditions Need to be treated before RLS is diagnosed May be reversible RLS symptoms are later in life with faster progression RLS symptoms in secondary RLS are worse than primary RLS Secondary causes of RLS:  Secondary causes of RLS Heart disease Neuropathy RA DM Thyroid problems Parkinson’s disease Gastric surgery COPD Myelitis Fibromyalgia Folate and magnesium deficiencies Stress When do Symptoms start?:  When do Symptoms start? May occur at any age Childhood: growing pains, ADHD, anxiety disorders Most are affected by middle age 40% report onset of symptoms by 20 Primary RLS Mean age of CORRECT diagnosis is 56 y.o. For the older adult, more women than men How are symptoms described?:  How are symptoms described? Burning Creeping Tugging Pulling Drawing Insects crawling inside the legs Wormy Boring Tingling Pins and needles Prickly Electrical Painful Slide11:  Symptoms usually occur on both sides of the body Occurs deep in legs May be in thighs, arms, or hands May have sudden muscle jerks 80% have PLMS (nocturnal myoclonus) How will my health care provider diagnose my RLS?:  How will my health care provider diagnose my RLS? 4 criteria Need to move the legs with uncomfortable sensations that Worsen at rest Relieved by movement Worsen at night Can’t get to sleep Wake up during night Can’t get back to sleep if you wake up Excessive daytime sleepiness Diagnosis:  Diagnosis No definitive test to rule out RLS Other criteria that supports the diagnosis: Positive family history of RLS Response to dopaminergic therapy PLMD or PLMS Criteria specific for children and the elderly Diagnosis for Children:  Diagnosis for Children Essential Adult Criteria Child should describe leg discomfort If the child cannot describe the leg discomfort, two of the following must be observed Sleep disturbance Family history PSG with 5 or more PLMS per hour Diagnosis for Older Adult:  Diagnosis for Older Adult Cognitively Impaired Older Adults Signs of leg discomfort Excessive motor activity in lower extremities Symptoms worsen at rest Decrease in comfort with activity Serious issues in quality of life in persons in long term facilities Story about man with RLS in nursing home Any diagnosis for any age:  Any diagnosis for any age Must rule out other illnesses Tests to rule out conditions that may cause RLS include anemia, diabetes, renal disease Be prepared to give a good sleep history Handout Sleep disorder testing is not required for diagnosis but helpful in determining severity of sleep disorder (SIT, PSG) Diagnosis:  Diagnosis Neurological Exam Peripheral nerve lesion testing Electromyography (EMB) Nerve Conduction Velocity Tests Vascular Doppler sonogram Vascular examination Diagnosis:  Diagnosis Must take good medical history There are many drugs that may induce symptoms of RLS Handout Treatment:  Treatment Depends on Age of patient Severity, duration, and frequency of symptoms Other health conditions Many patients do not go to their health care providers until symptoms are unbearable Before you are put on medication, what can you try to do? Handout :  Before you are put on medication, what can you try to do? Handout Stop smoking Nutrition cut out caffeine or food that have stimulants weight reduction Exercise Very personalized Slide21:  Sleep Hygiene Social Support Stress Management: RLS Foundation CAM i.e. herbs, natural products, massage, acupuncture – not been tested Treatment: Pharmacological:  Treatment: Pharmacological Same as for primary or secondary RLS Treat underlying condition first! See handout for names of medications for treatment of RLS Dopamine Drugs (antagonists or precursors):  Dopamine Drugs (antagonists or precursors) Levedopa (Sinemet) Use to be first line of therapy drug If patient responds to this, you know they probably have RLS Given in small doses (less than with PD) Augmentation: worsening of symptoms (82% of patients will get this) Rebound: symptoms reappear after 2-6 hours of dosing Dopamine Drugs (Agonists):  Dopamine Drugs (Agonists) First line of therapy in moderate or severe RLS Less side effects Work longer pergolide (Permax) bromocriptine mesylate (Parlodel) pramipexole (Mirapex) ropinirole (Requip) Benzodiazepines:  Benzodiazepines clonazepam (Klonopin) temazepam (Restoril) Sometime patient can just take this alone to help with symptom management Others:  Others Opioids Codeine Anticonvulsants gabapentin (Neurontin) carbamazepine (Tegretol) Presynaptic Alpha2-adrenergic agonists clonidine (Catapress) Guidelines for treatment:  Guidelines for treatment Once started on medications, you should be monitored frequently Often medications stop working in RLS Negative side-effects Your health care provider may use a combination of drugs Start and stop many medications many times Very frustrating to manage Resources:  Resources Restless Legs Foundation We Move NIH Heart, Lung, and Blood Institute (Sleep) National Institute of Neurological Disorders and Stroke See handouts for websites and description of organization My research:  My research Comparison of primary and idiopathic symptoms in older adults on symptom severity, depression, fatigue, sleep, and quality of life Must be diagnosed with RLS by doctor Must be 50 years old or older Must not have any other sleep disorder besides RLS Comparison of Type 2 Diabetics in patients with and without RLS on diabetic control Must have a Hg1Ac in the last 3 months Must be diagnosed with RLS by doctor Interested?:  Interested? Neither study will require any invasive procedures If interested in being a participant of the study, please contact me at number listed on front page of handouts. Slide31:  Questions? Restless Legs Syndrome Dr. Norma Cuellar 215-898-1935 University of Pennsylvania, School of Nursing:  Restless Legs Syndrome Dr. Norma Cuellar 215-898-1935 University of Pennsylvania, School of Nursing A. Introduction B. RLS History of RLS What is RLS? 2 Types of RLS Symptoms How is RLS diagnosed? Need to move the legs with uncomfortable sensations that Worsen at rest Relieved by movement Worsen at night Drugs that cause RLS to get worse Drugs to treat RLS Resources C. Questions Drugs that Cause Symptoms to Become Worse :  Drugs that Cause Symptoms to Become Worse Drugs for nausea and stomach meclizine (Antiver, Bonine) prochlorperazine (Compazine) promethazine (Phenergan) metoclopramide (Reglan) trimethobenzamide (Tigan) Drugs to help you relax or help you think better haloperidol (Haldol) loxapine succinate (Loxitane) thioridazine (Mellaril) molindone (Moban) thiothixene (Navane) fluphenazine (Prolixin) risperidone (Risperdal) mesoridazine besylate (Serentil) quetiapine fumarate (Seroquel) trifluoperazine (Stelazine) chlorpromazine (Thorazine) perphenazine (Trilafon) triflupromazine (Vesprin) olanzapine (Zyprexa) Drugs for anxiety Hydroxyzine (Atarax) Drugs for depression ALL **especially fluoxetine (Prozac)and sertraline (Zoloft) Anti-histamines ALL especially diphenhydramine, including other the counter medications that have combinations with diphenhydramine (benadryl ®) Sleep History:  Sleep History When did the insomnia begin? Is there any other illness that may be causing insomnia (mental or chronic illnesses)? Is the sleep environment conducive to sleep? How often does the patient wake up during the night? How long does it take the patient to go to sleep? Are there symptoms at bedtime or worsening at night? Does the bed partner complain of your sleep patterns? Does the patient snore, gasp, or have apnea during sleep? What hours does the patient work? What are sleep patterns (regular or not)? What type of diet does the patient consumer (related to alcohol, caffeine, tobacco, chocolate)? Are over the counter drugs used? Steroids? Decongestants? Beta blockers? What daytime consequences are there? How is sleepiness during the day? Health Promotion:  Health Promotion Follow a regular sleep routine. Go to sleep at the same time every night. Have a ritual to prepare to go to bed. Know what helps you sleep – it may vary from person to person. Keep a sleep diary. Document when you go to bed and wake up. Identify foods or activities that may keep you from falling to sleep and staying asleep. Identify activities or events that wake you up and the time. Concentrate on sleeping later in the circadian cycle. Since symptoms are worse in the early circadian cycle, go to sleep later so you don’t get frustrated waiting to go to sleep. Engage in regular moderate exercise. Find a level of some form of exercise that does not exacerbate symptoms. Exercise daily if possible, but 5 times a week, at least 30 minutes a day. Determine when is the best time for you to exercise. For some persons with RLS, right before bedtime works well. For some, this may keep them awake. Relaxation techniques may help promote sleep. Take a relaxing baths before bedtime. Some people say cold baths or helpful, some say hot. Find what works for you. Aromatherapy may help with relaxation. Use oils in bath or to scent your sleeping area. Receive a massage before going to sleep. Some persons with RLS rub their legs before going to bed. Use of lotions and oils that promote relaxation with aromatherapy may be beneficial. Listen to music. Find some activity that will help you fall to sleep. Perform tasks that engage mind during sedentary periods. Read a book. Meditate. Pray. Eat a healthy diet. Identify foods that cause symptoms to worsen. This may vary from person to person, i.e. some persons with RLS feel caffeine helps their symptoms. Follow a diet that provides a balance of fruits, vegetables, protein, and breads. Strive to reach a healthy weight through a healthy diet. Cut back on sugar. Drugs used to treat RLS:  Drugs used to treat RLS ClassificationDrugDosageDopaminergic Antagonists or Precursorslevodopa with carbidopa (Sinemet)Start at 10/100, up to 50/200 mg daily at HS Take on empty stomachMay be PRNRebound or AugmentationDopamine AgonistsErgotoline: First line therapy in moderate and severe RLSErgotoline: pergolide mesylate (Permax)Start at .05, up to .5 mg (in divided doses) daily Ergotoline: bromocriptine mesylate (Parlodel)Start at 1.25, up to 7.5 mg daily at HSNonergotoline: pramipexole (Mirapex).125-1.5 mg (in divided doses) daily at HSNonergotoline: ropinirole hydrochloride (Requip).25 – 3 mg (in divided doses) daily at HSBenzodiazepinesclonazepam (Klonopin).25 mg HS initially, increase daily dose by .25 mg each week (to 2.0 mg/day) at HStemazepam (Restoril)15-30 mg at HSOpioids codeine 15 - 30 mg HS and prnAnticonvulsantsgabapentin (Neurontin)100-300 mg HS initially, titrate to maximum dose of 3600 mg tidcarbamazepine (Tegretol)200-600 mg dailyPresynaptic alpha2-adrenergic agonistsclonidine hydrochloride (Catapress).1 mg q HS; increase daily dose weekly by .1 mg not to exceed 1 mg daily Resources:  Resources Restless Legs Syndrome Foundation a nonprofit 501 (c)(3) agency goals are to increase awareness of Restless Legs Syndrome (RLS), to improve treatments, and, through research, to find a cure for persons with RLS provides information to lay persons on support groups and networks National Institute of Neurological Disorders and Stroke mission of NINDS, out of NIH, is to reduce the burden of neurological disease – provides information to persons with neurological conditions including RLS, as well as information on research and funding in this area WE MOVE: Worldwide Education & Awareness for Movement Disorders a nonprofit 501 (c)(3) agency comprehensive resource for movement disorder information and education developed to educate lay persons and health professionals on all movement disorders, provide resources and educational materials, and assist in the establishment and maintenance of support groups

Add a comment

Related presentations

Related pages

Risk management software rl Solutions 6 (aka: rls 6)

Risk management software rl Solutions 6 (aka: rls 6) Author: Barb Tassell Created Date: 7/15/2015 2:35:25 PM ...
Read more

PowerPoint Presentation - Global health

Most common method in RLS. Mycobacterium tuberculosis . ... WHO Treatment of Tuberculosis Guidelines, 2010. In general, ... Presentation of active TB ...
Read more

google sketchup by jazmin xiomara cuellar torres on Prezi

Public & reusable Make a copy Share ... People invited to a presentation do not need a Prezi account; ... descripcion general by jazmin xiomara cuellar ...
Read more

Demosponge by luz cuellar on Prezi - Presentation Software

People invited to a presentation do not need a Prezi account; ... Demosponge (Porifera) They are ... In general appearance they are stony corals.
Read more

Clinical Presentation and Diagnosis of Restless Legs Syndrome

... discusses the symptoms, pathophysiology, epidemiology, and diagnosis of restless legs ... Public Health; Pulmonary ... (2% to 15% of the general ...
Read more

PowerPoint Presentation - SD Regional Chamber

General Services Administration ... O’Rourke (TX), Henry Cuellar (TX), Jeff Denham (CA), Devin . ... PowerPoint Presentation
Read more

Publications -

Reporting results through Publications. ... Cuellar, N. G. (2007). Acupuncture and RLS. ... Caring for the Public's Health.
Read more

Restless Legs Syndrome — NEJM

The Diagnosis. The restless legs syndrome (RLS), also known as Ekbom's syndrome, 1 is a neurologic disorder with a prevalence in the general population of ...
Read more

Top 25 Jennifer Cuellar profiles | LinkedIn

Jennifer Cuellar profiles. ... Marketing Assistant at Integrated General Counsel: ... Placement Student at George Webster Elementary Public School, ...
Read more