Objective: To investigate the usefulness of Holter electrocardiogram (ECG) recording of periodic limbs movements (PLM) in hemodialysis patients with restless legs syndrome (RLS) for diagnosis of RLS and evaluation of the effects of dopaminergic agent, pergolide mesylate.
Methods: Two hundred thirty hemodialysis patients were surveyed with a questionnaire for RLS and 29 patients were found to have subjective symptoms of typical RLS. Twenty-nine patients were further examined by a neurologist and 23 of those were diagnosed as having RLS. Nineteen of 23 patients were enrolled in the study and 50-100μg of pergolide before sleep was given for 2 weeks. Efficacy of pergolide was evaluated by a change in subjective symptoms measured by visual analogue scale. Holter ECG recording of PLM was performed under suggested immobilized test at the baseline and 2-week endpoint. The sensitivity and specificity of Holter ECG PLM recordings for the diagnosis of RLS were investigated. Correlation between changes in subjective RLS symptoms and PLM frequency was analyzed.
Results: The sensitivity and specificity of positive Holter ECG PLM recording for RLS diagnosis were 65% and 100%, respectively. Twelve of 19 patients completed the study and 7 discontinued due to adverse events Subjective symptoms were improved by approximately 70% by visual analogue scale in all 12 patients and mean PLM frequency significantly decreased from 31.0±7.5 to 5.6±3.0/30min (p<0.05). A significant correlation between changes in subjective symptoms and PLM frequency were noted (r=0.67, p<0.05). Nausea and gastric discomfort as adverse events were observed in 10 and somnolence in 1 of 19 patients.
Conclusions: Holter ECG PLM recording is useful for diagnosis of RLS and evaluation of drug effects. Pergolide mesylate is effective against subjective symptoms of RLS in hemodialysis patients, although it may cause gastrointestinal side effects.