Willis-Ekbom disease

Description

Willis-Ekbom disease (WED) or Restless leg syndrome (RLS) is characterised by:

  1. a ‘compulsive’ restlessness or need to move the legs, often associated with paraesthesiae or dysaesthesiae,
  2. symptoms at rest or disturbing sleep, quickly but temporarily relieved by standing and walking,
  3. nocturnal worsening of symptoms.
  4. Additionally, 75% of patients also experience periodic limb movement disorder characterized by involuntary leg twitching or jerking movements during sleep, which typically occur every 10–60 s throughout the night.

Restless leg syndrome appears to be an enigmatic disorder probably influenced by heterogeneous environmental and genetic factors that may work through a variety of so far ill-defined neurochemical systems. [JMS Pearce 2005]

  • RLS is associated with iron deficiency, pregnancy, phenothiazines, barbiturate withdrawal, diabetes, uraemia, and respiratory failure. Sudden jerks on falling asleep may be observed also in otherwise normal persons. Probably heterogeneous, Ekbom’s syndrome can occur as a familial condition transmitted as an autosomal dominant trait.
  • New conservative and pharmacological approaches to management outlined in 2013 consensus statement

History

1685Thomas Willis records in his posthumous publication The London Practice of Physick (1685):

Wherefore to some, when being abed they betake themselves to sleep, presently in the arms and legs, leapings and contractions of the tendons, and so great a restlessness and tossing of their members ensue, that the diseased are no more able to sleep, than if they were in a place of the greatest torture

Willis: Of the Watching Evil 1685: 404-405 [PDF]

1846Moritz Heinrich Romberg – in his chapter on ‘hyperaesthesia of the nerves of muscular sense‘, Romberg describes the syndrome as ‘Anxietas tibiarum‘.

“Anxietas tibiarum’’, a sense of painful restlessness in the lower extremities, especially in the legs and feet. ‘‘The patient’’ did not know what to do with them (…) though there was relief by change of position

[1853 Vol I translation]

1861 – Theodor Wittmaack (1817-1873) a German physician with neurological interests discussed Anxietas tibiarum (‘timidity of the shins‘) in his textbook of nervous diseases. He related the condition to hysteria.

..a strange but descriptive compulsion to move has invaded the legs of the inflicted person. Every moment sees the legs brought into a different position; drawn up, stretched out, abducted, spread apart and crossed over one another. However, these movements are not sudden or violent, rather they are slow, mindful as if it were of eventually finding the one position that will give the most relief. In every strange description of the nervous tension of hysteria one often also finds this train of involuntary agitation displayed in the legs and feet. The same thing also occurs however elsewhere without one being able to find a definite cause…the condition lasts approximately a quarter of an hour

1923Hermann Oppenheim was the first to define the disease as a neurological illness and to recognize a familial component in his Lehrbuch der Nervenkrankheiten.

Restlessness in the legs is a special kind of subjective paralgesia. It can become an agonizing torture, lasting for years or decades and can be passed on and occur in other members of the family

1944-1946 – Ekbom wrote a series of papers refining RLS. His work distinguished two forms, one with paraesthesiae (Asthenia crurum paraesthetica), the other painful (Asthenia crurum dolorosa). However in 1945 Ekbom settled for ‘restless legs syndrome’.

A clinical study of a hitherto overlooked disease in the legs characterized by peculiar paraesthesia, pain and weakness and occurring in two main forms, asthenia crurum paraesthetica and asthenia dolorosa


Associated Persons

Alternative names
  • Restless legs syndrome (RLS) [Ekbom 1945]
  • Wittmaack-Ekbom syndrome

References

eponymictionary CTA

eponymictionary

the names behind the name

MB BCh BAO Junior Doctor working in Emergency Medicine.

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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