"Disease focus" - Restless-legs syndrome/Willis-Ekbom Disease (WED): social & economic costs | UCB
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"Disease focus" - Restless-legs syndrome/Willis-Ekbom Disease (WED): social & economic costs

Posted by
Emmanuelle Senior, Global Market Access & Pricing - Movement Disorders & Sleep
An inability to sit still, sleeplessness, and depression: these are just some of the symptoms of restless-legs syndrome (RLS)/Willis-Ekbom Disease (WED), a condition which exacts considerable costs on patients, caregiver and their families, as well as on the wider economy.

Idiopathic restless legs syndrome (RLS) is a common chronic neurological disease, with symptom severity increasing over time1,2.  The disease is believed to be underdiagnosed and affects women more than men1.
Symptoms worsen in the evening and at night. Patients with RLS have an urge to move their legs or arms during periods of rest and inactivity, which is frequently accompanied by unpleasant sensations in the limb3.  This can lead to exhaustion and daytime fatigue, affecting daily activities.

Moderate-to-severe RLS has a significant negative impact on quality of life4,5,6 leading to chronic loss of sleep, fatigue and depression. This negatively impacts on quality of life to a similar level as in other conditions such as hypertension, diabetes, osteoarthritis or depression7. Moderate to severe RLS can severely disrupt sleep to an extent similar to that associated with Parkinson’s disease and stroke8.

Around 90% of patients with RLS also suffer from periodic limb movement disorder during sleep (PLMS). PLMS have been linked with blood pressure increases in these RLS patients9,10. While the direct medical costs per primary patient are low, RLS can clearly lead to high social and indirect costs7. Employed RLS sufferers lost an average of 20% of work productivity – or one day per 40-hour week7. Rates of absenteeism increased according to the severity of the disease reaching up to 9.3% for RLS patients with very severe symptoms7.

Although the underlying cause of the condition is not fully understood, experts believe it is associated with dopaminergic and/or iron metabolism abnormalities in the central nervous system11.
RLS often requires long-term therapy. While mild RLS may be managed with lifestyle changes, moderate to severe RLS requires pharmacological therapies. Moderate-to-severe RLS patients can take medicines that target these systems but patient surveys suggest current oral therapies are insufficient.

Today there is an unmet medical need for people with RLS. Addressing this would help to improve their quality of life by controlling symptoms, thus restoring productivity and allowing patients to fulfil their full potential in the workforce.

1. Allen, R.P. et al. Restless Leg Syndrome Prevalence and Impact. Arch Intern Med 2005;165(11):1286-1292

2. Wenning GK et al. Prevalence of movement disorders in men and women aged 50–89 years (Bruneck Study cohort): a population-based study. Lancet Neurol 2005;4:815–820

3. Allen R.P et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. Sleep Med 2003;4:101-119

4. Abetz L, Allen R, Follet A, Washburn T, Earley C, Kirsch J, Knight H. Evaluating the quality of life of patients with restless legs syndrome. Clin Ther 2004;26(6):925-935.

5. Kushida C, Martin M, Nikam P, Blaisdell B, Wallenstein G, Ferini-Strambi L, Ware JE, Jr. Burden of restless legs syndrome on health-related quality of life. Qual Life Res 2007;16(4):617-624.

6. Allen RP, Earley CJ. Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol 2001;18(2):128-147.

7. Allen RP, Bharmal M, Calloway M. Prevalence and disease burden of primary restless legs syndrome: results of a general population survey in the United States. Mov Disord 2011;26(1):114-120.

8. Happe S, Reese JP, Stiasny-Kolster K, Peglau I, Mayer G, Klotsche J, Giani G, Geraedts M, Trenkwalder C, Dodel R. Assessing health-related quality of life in patients with restless legs syndrome. Sleep Med 2009;10(3):295-305.

9. Walters A. and Rye D. Review of the Relationship of Restless Legs Syndrome and Periodic Limb Movements in Sleep to Hypertension, Heart Disease, and Stroke. Sleep 2009;32(5):589–597.

10. Pennestri MHet al. Blood pressure changes associated with periodic leg movements during sleep in healthy subjects. Sleep Med 2013; 14:555-561- http://dx.doi.org/10.1016/j.sleep.2013.02.005

11. Allen, R. Dopamine and iron in the pathophysiology of restless legs syndrome (RLS)". Sleep Medicine 2004;5(4): 385–391.


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