OBJECTIVES: Restless legs syndrome (RLS) is a frequent comorbid condition associated with distinct unrelated diseases. While the incidence of RLS has not been definitively confirmed, RLS-like symptoms have been reported in a section of Asian population who also had hyperthyroidism. The prevalence of RLS is generally low in Asian populations. Under these circumstances, we hypothesized that in a population where RLS is common, such as in Brazil, RLS could manifest as a comorbid ailment alongside Graves’ disease, a common hyperthyroid condition. METHODS: In a cross-sectional survey, 108 patients who presented with Graves' disease were analyzed for restless legs or associated symptoms. RESULTS: Twelve patients (11.1%) displayed symptoms of RLS prior to the incidence of Graves’ disease. These patients experienced worsening of the symptoms during their hyperthyroid state. Six patients (5.6%) developed RLS, consequent upon the incidence of Graves’ disease as per the consensus of the panel of the experts. Fifteen patients (13.9%) also presented with RLS-like symptoms without any discernible circadian feature of the syndrome. CONCLUSION: Our findings confirm that Graves’ disease might trigger restless legs-like symptoms, while the condition of hyperthyroidism could also be complicated by definite RLS.

OBJETIVO: Temos frequentemente observado que infantes que apresentam choro excessivo e agitação ou cólicas noturnas têm pais com Síndrome de Pernas Inquietas. Nosso objetivo foi determinar se estes infantes são mais propensos a terem pais com a Síndrome de Pernas Inquietas. MÉTODOS. Foram entrevistadas 67 famílias com infantes e crianças em busca de uma história de choro excessivo e agitação durante os primeiros 4 meses de vida. Seus pais foram investigadas para Síndrome de Pernas Inquietas. RESULTADOS: Dentre os 134 pais entrevistados, 39 (29%) tinham doença Willis-Ekbom. Entre as 96 crianças avaliadas 37 (38%) apresentaram choro excessivo e agitação. Destas, 28 (76%) apresentaram pelo menos um dos pais com Síndrome de Pernas Inquietas. Entre as 59 crianças sem choro excessivo e agitação, apenas 14 (23, 7%) apresentaram pelo menos um dos pais com a Síndrome de Pernas Inquietas. A associação entre os eventos (crianças de pais com ou sem Síndrome de Pernas Inquietas) foi medida pelo coeficiente phi (0,510), indicando uma associação mais do que trivial. As crianças com choro excessivo e agitação mostraram-se mais propensas a ter pelo menos um dos pais com a doença Willis-Ekbom (75,7 vs. 27,7, “Odds Ratio” = 10, com intervalo de confiança de 95%, 3,82-26,15). CONCLUSÃO: A evidência gerada por este estudo não é suficiente para concluir que o choro infantil excessivo e agitação é equivalente a um diagnóstico provável da doença Willis-Ekbom parental. No entanto, eles fornecem informações, bem como a motivação necessária para empreender estudos mais extensos sobre bebês com choro excessivo e agitação.

OBJECTIVE: We have frequently observed that infants presenting with excessive crying and fussing, or colic at night have parents with Restless Legs Syndrome. Our objective was to determine if these infants are more likely to have parents with Restless Legs Syndrome (Willis-Ekbom Disease). METHODS: We interviewed 67 families with infants and children, in search of a history of excessive crying and fussing during their first four months of life. Their parents were investigated for Restless Legs Syndrome. RESULTS: Among the 134 interviewed parents, 39 (29%) had Restless Legs Syndrome. Among the 96 children, 37 (38%) presented excessive crying and fussing. Of these, 28 (76%) had at least one parent with Restless Legs Syndrome. Among the 59 children without excessive crying and fussing only 14 (24%) had at least one parent with Restless Legs Syndrome. The association between events (children of parents with vs. without Restless Legs Syndrome) was measured by the phi coefficient (0.510), indicating a more than trivial association. The estimated association was 75.7 vs. 27.7, Odds Ratio = 10 at 95% confidence interval, 3.82-26.15). CONCLUSION: Children with excessive crying and fussing were more likely to have at least one parent with Restless Legs Syndrome. The present evidence is insufficient to conclude that infantile excessive crying and fussing is equivalent to a a probable diagnosis of parental Restless Legs Syndrome. However, they provide information as well as the necessary motivation to undertake more extensive studies of infants with excessive crying and fussing.

OBJECTIVE: Certain drug classes alleviate the symptoms of Willis-Ekbom's disease, whereas others aggravate them. The pharmacological profiles of these drugs suggest that drugs that alleviate Willis-Ekbom's disease inhibit thyroid hormone activity, whereas drugs that aggravate Willis-Ekbom's disease increase thyroid hormone activity. These different effects may be secondary to the opposing actions that drugs have on the CYP4503A4 enzyme isoform. Drugs that worsen the symptoms of the Willis-Ekbom's disease inhibit the CYP4503A4 isoform, and drugs that ameliorate the symptoms induce CYP4503A4. The aim of this study is to determine whether Saint John's wort, as an inducer of the CYP4503A4 isoform, diminishes the severity of Willis-Ekbom's disease symptoms by increasing the metabolism of thyroid hormone in treated patients. METHODS: In an open-label pilot trial, we treated 21 Willis-Ekbom's disease patients with a concentrated extract of Saint John's wort at a daily dose of 300 mg over the course of three months. RESULTS: Saint John's wort reduced the severity of Willis-Ekbom's disease symptoms in 17 of the 21 patients. CONCLUSION: Results of this trial suggest that Saint John's wort may benefit some Willis-Ekbom's disease patients. However, as this trial was not placebo-controlled, the extent to which Saint John's wort is effective as a Willis-Ekbom's disease treatment will depend on future, blinded placebo-controlled studies.