WISSENSCHAFT_SYSTEMATISCHER REVIEW

Treatment of Ekbom Disease

Effectiveness of Physical Therapy Interventions

Ulrike H. Mitchell, Kevin Helgeson

Die Welt zu Gast in der pt

Liebe Leserinnen, liebe Leser,

der Countdown läuft, der WCPT-Kongress in Amsterdam steht direkt vor der Tür. Schon im letzten Jahr entschied die Redaktion, Ihnen in der Juniausgabe 2011 etwas Besonderes bieten zu wollen. Die pt 6 soll im Zeichen dieses international bekannten Events stehen und daher eine englischsprachige Forschungsarbeit beinhalten.

Dass wir Professor Mitchell und Professor Helgeson dafür gewinnen konnten, freut uns sehr! Die Wissenschaftler aus Provo forschen unter anderem zum Ekbom-Syndrom und stellen Ihnen hier ihre Erkenntnisse aus einer umfassenden Literaturrecherche vor. Das wichtigste Fazit: Wir Physiotherapeuten können Patienten mit Ekbom-Syndrom helfen. Das Poster der beiden Physiotherapeuten wird übrigens in Amsterdam präsentiert.

Wir wünschen Ihnen viel Spaß bei der Lektüre dieser Forschungsarbeit mit "internationalem Touch", dem sich auch ein englischsprachiges Interview auf Seite 44 anschließt.

Ihre Redaktion

Abstract

Background and Purpose: The role of physical therapists in the treatment of Ekbom disease (EKD), formerly known as restless legs syndrome (RLS) has not been established. The purpose of this systematic review was to assess the efficacy of physical therapy interventions in reducing symptoms associated with EKD and consequently improve quality of life of EKD sufferers.

Methods: A literature search of published articles resulted in 26 potential articles, but 15 did not meet all inclusion criteria. A systematic review of English and non-English articles was conducted using the search terms included restless legs syndrome and rehab or exercise, but not drug or pharma* or ropinirol* or dopamin*.

Results: The systematic review resulted in 24 potential articles, with nine articles meeting all inclusion criteria. Three RTCs met the inclusion criteria, one assessing a 12-week exercise program, one assessing a pneumatic compression device worn daily and one evaluating the efficacy of near-infrared light treatment. Three prospective interventional studies evaluated the efficacy of physical exercise, pneumatic compression device and near infrared light, while three case reports assessed the effectiveness of massage therapy, pneumatic compression device and near infrared light. All of these studies concluded that EKD symptoms significantly decreased after using these interventions.

Discussion and Conclusion: Interventions are directed towards the lower extremities but possibly could lead to a systemic effect. Moderate intensity exercise and some physical therapy interventions are linked to a decrease of symptoms associated with EKD. Patients with EKD will benefit from referrals to physical therapists for management of the condition that includes the identified interventions. More studies are necessary to validate this statement.

Keywords: Ekbom disease, restless legs syndrome, exercise program, pneumatic compression device, massage therapy

* = Truncation replaces the end of a word with a symbol such as * to pick up variant entings. It is a method of broadening a search by retrieving all words with the same stem

Background and Purpose

New name

Restless legs syndrome (RLS) received a new name this year: Ekbom disease (EKD). This was done, in part, to honor Karl-Axel Ekbom, who spent much of his life researching this disorder. EKD has troubled many people over the centuries (1).

This condition is a chronic sensorimotor disorder (2), characterized by a strong urge to move, accompanied or caused by uncomfortable, or even distressing paresthesia of the legs, described as a »creeping, tugging, pulling« feeling (1). The symptoms often become worse as the day progresses, leading to sleep disturbances or sleep deprivation, which further results in impairment of alertness and daytime functions (3).

Etiology

The etiology of EKD is not clear. EKD is familiar in about 50% of patients but may be idiopathic or related to acquired conditions (4). Ekbom (1), who first described and defined this disease in modern days, reported that 24% of people with low serum iron levels (levels below 60 μg/L) exhibit EKD symptoms and that these symptoms decreased when treated with iron injections. More recent research corroborated the association of low serum ferritin levels (< 50 µg/L) with EKD (5-7). Other pathologies, such as diabetes mellitus, end stage renal disease, Vitamin B12 deficiency, folate deficiency (7) or Parkinson’s disease (8) have been connected to EKD.

In the 1940s and 1950s, it was hypothesized that decreased blood flow lead to the symptoms associated with EKD (9). Ekbom (1) believed that vasodilators given to EKD sufferers would decrease the symptoms. The vascular hypothesis was neglected until 2005, when increased vascular blood flow with pneumatic compression devices was shown to decrease significantly EKD symptoms in six patients (9). Another study (10) showed a high prevalence (36%) of EKD in patients presenting with chronic venous disorder. The more recent finding, that dopamine agonists can relieve EKD symptoms, suggests that dopaminergic mechanisms in the central nervous system may play an important role in the etiology of this pathology (11).

All these findings taken together suggest that the etiology might be multifactorial.

Diagnosis

The diagnosis of EKD is clinical and based on a patient’s description of the symptoms. Four criteria are used to substantiate the diagnosis of EKD (12). To meet the criteria patients have to answer four questions affirmatively. The questions explore whether:

1. the patients have an urge to move their legs,
   
2. the symptoms begin or worsen during periods of inactivity,
   
3. the urge to move is at least partially relieved by movement and
   
4. this urge to move is worse in the evening or night (12).

Three supportive features, not essential to the diagnosis of EKD, include: family history, presence of periodic limb movement and the response to dopaminergic treatment (12). The International Restless Legs Scale (IRLS) (see glossary) measures severity of the symptoms and their impact on a person’s life (12). The 10-question scale has 5 response options with an associated score from »0« (no impact or symptoms) to »4« (severe), yielding a maximum score of 40.

Treatment

Treatment options for EKD are limited. Dopaminergic agents, such as ...

	Tab. 1 Excluded studies with reasons for exclusion

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