101. Neuroscience For Kids - Restless Legs Syndrome (RLS) This is a description of restless legs syndrome (RLS), restless Legs syndrome National Institute of Neurological Disorders and Stroke; restless Legs http://faculty.washington.edu/chudler/rls.html

Restless Legs Syndrome What is Restless Legs Syndrome (RLS)? It's late in the evening. You lie in bed, ready for sleep. What's that? A burning, creeping sensation inside your legs. It feels as if bugs are crawling inside them! You must move your legs...it's the only way to stop these feelings. This is a description of restless legs syndrome (RLS) , a common neurological disorder that affects 5-15% of the population (approximately 12 million people in the United States). People with RLS experience these unpleasant feelings when they are at rest or lying down, ready to sleep. Therefore, people with RLS may have trouble falling asleep and staying asleep. This can lead to insomnia and sleepiness during the day and then to other problems such as depression and anxiety. Signs and Symptoms of RLS People with RLS have uncomfortable feelings in their legs, especially when they are lying down or resting. Most people are not bothered by RLS when they are moving around. The sensations can also occur when a person is sitting for a long period of time, for example on a plane or car trip or watching a movie. The uncomfortable feelings cause an urge to move and this movement often relieves the discomfort. The exact location of the sensations varies from person to person and occasionally, the unpleasant feelings can occur in the hands and arms. RLS can start anytime, even in childhood. Approximately one-third of people with RLS had their first symptoms before they were 20 years old.

102. Boston.com / Your Life / Health & Fitness / Diseases & Treatments / Restless Leg Many people with restless Legs syndrome also have what s known as periodic limb restless Legs syndrome is a lifewrecker. It often runs in families, http://www.boston.com/yourlife/health/diseases/articles/2003/09/09/restless_legs

var siteurl = 'http://cache.boston.com/bonzai-fba/File-Based_Image_Resource' var image_names = ['news', 'ae', 'business', 'sports', 'travel', 'yourlife', 'cars', 'jobs', 'personals', 'realestate']; Relationships Fashion Family Interact ... Your Life HEALTH SENSE Restless legs cause sleepless nights Restless legs cause sleepless nights By Judy Foreman, 9/9/2003 So, the patient goes to a neurologist. Every night, he tells the doctor, he gets these creepy, crawly feelings in his legs as he starts to drift off to sleep. It's not pain, exactly, but an irresistible urge to move his legs. He gets up, does a few deep knee bends. That helps. But as soon as the patient goes back to bed, the creepy-crawlies start up again. Sometimes, his legs start kicking periodically, too. So, he gets up and walks, for hours, until exhaustion overwhelms his twitchy legs and frazzled psyche. With luck, he gets a few hours of sleep. ADVERTISEMENT "What have I got?" the frustrated patient asks. "I don't know," the doctor replies. "But I've got it, too." Sad to say, this is a true story that a patient once told Dr. John Winkelman, medical director of the Sleep Health Center at Brigham and Women's Hospital.

103. FDA APPROVES REQUIP FOR RESTLESS LEGS SYNDROME FDA APPROVES REQUIP FOR restless LEGS syndrome. restless Legs syndrome is a condition that affects about ten percent of the population. http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01356.html

FDA Home Page Search FDA Site FDA A-Z Index Contact FDA FDA Talk Paper May 5, 2005 Media Inquiries: Susan Cruzan Consumer Inquiries: 888-INFO-FDA FDA Approves Requip for Restless Legs Syndrome Restless Legs Syndrome is a condition that affects about ten percent of the population. The disorder is characterized by an urge to move the legs, usually accompanied by or caused by uncomfortable leg sensations. For most people with the condition, symptoms begin or worsen during periods of rest or inactivity and are partially or totally relieved by movement. Symptoms typically worsen or occur only in the evening or at night, and can disturb sleep. Requip was found to be effective for RLS in three randomized, double-blind placebo controlled studies in adults diagnosed with moderate to severe RLS. The studies measured effectiveness of the drug using the International Restless Leg Syndrome Scale, a patient rated scale that measures different aspects of RLS including severity of muscle movement and discomfort, sleep disturbance, mood and overall effect on quality of life. The Clinical Global Impression-Global Improvement scale was also used. This is an investigator rated scoring of improvement following treatment. All three studies demonstrated a statistically significant difference between the treatment group receiving Requip and the group receiving placebo. Common side effects of Requip reported in clinical trials include nausea, headache, and vomiting. The label for the drug will also include a caution that Requip has been associated with sedating effects, including somnolence (sleepiness), and the possibility of falling asleep while engaged in activities of daily living, including operation of a motor vehicle. Syncope (fainting) or symptomatic hypotension (low blood pressure) may occur, particularly during initial treatment or dosing.

104. Stichting Restless Legs Nederland Website van de Stichting restless Legs. benen, syndrome, slaapstoornis, bewegingsstoornis, slapende, rusteloze, stoornis, restless, legs, nederland, http://www.stichting-restless-legs.org/

Website van de Stichting Restless Legs: onrustige, benen, rusteloos, ekbom, syndroom, prikkende, gevoelige, armen, benen, syndrome, slaapstoornis, bewegingsstoornis, slapende, rusteloze, stoornis, restless, legs, nederland, holland, wormerveer, zaanstreek, stichting, patiënten, vereniging, patients, foundation, community, voorlichting, medicatie, behandeling, treatment, periodic, limb, movement, disorder, folders, plmd, slaapapneu, adhd

105. National Sleep Foundation restless Legs syndrome (RLS) is a neurologic sensorimotor disorder that is characterized by an overwhelming urge to move the legs when they are at rest. http://www.sleepfoundation.org/sleeptionary/index.php?id=23

106. RLS/PLMD An Introduction to restless Legs syndrome (RLS); How Common is restless Legs syndrome? restless Legs syndrome (RLS) is a neurological disorder in which http://www.talkaboutsleep.com/sleep-disorders/archives/rls_pmd_intro.htm

View a Sleep Study Advocacy Sleep Dictionary Sleep Links ... CPAP Machines and CPAP Masks An Introduction To Restless Legs Syndrome (RLS) A sleep disorder is a physical and psychological condition or disturbance of sleep and wakefulness caused by abnormalities that occur during sleep or by abnormalities of specific sleep mechanisms. Although the sleep disorder exists during sleep, recognizable symptoms manifest themselves during the day. Accurate diagnosis requires a polysomnogram, widely known as a "sleep test." It is estimated that some 40 million Americans suffer from chronic, long-term sleep disorders. Another 20 to 30 million Americans suffer from some kind of sleep disorder on an irregular basis. The annual costs in productivity, health care, and safety have been estimated in the billions of dollars. An Introduction to Restless Legs Syndrome (RLS) How Common is Restless Legs Syndrome? When Should I See A Doctor? How Is RLS Treated? ... Opioids and Anticonvulsants An Introduction To Restless Legs Syndrome (RLS) Restless Legs Syndrome (RLS) is a neurological disorder in which patients experience irrepressible sensations in the legs or arms while sitting or lying still. Terms used to describe RLS may include creepy, crawly, pulling, tingling, itching, or gnawing. Often the person with RLS has difficulty being specific about the sensations in their legs. The sensations are rarely described as painful. RLS differs from the "pins and needles" feeling when the blood supply is cut off from a limb ("My foot fell asleep!"). These uncomfortable feelings usually begin in the evening and upon arrival to bed, unless severe, RLS is absent during the morning and early afternoon.

107. Restless Legs Syndrome (RLS) Amp; PLMD Information & Resources Sleep disorder community providing information and resources on restless Legs syndrome (RLS) http://www.talkaboutsleep.com/rls-plmd/

What is Restless Legs Syndrome? Restless Legs Syndrome (RLS) is a neurological disorder in which patients experience irrepressible sensations in the legs or arms while sitting or lying still. Terms used to describe RLS may include creepy, crawly, pulling, tingling, itching, or gnawing. Often the person with RLS has difficulty being specific about the sensations in their legs. Restless Leg Syndrome is often associated with Periodic Limb Movement Disorder (PLMD) RLS/PLMD Featured Articles Restless Legs Syndrome Facts An Introduction to Periodic Limb Movement Disorder Restless Legs Syndrome Information - From the NINDS Restless Legs: It's No Laughing Matter Our RLS/PLMD Community Chats - We host regularly scheduled sleep disorder chats - check out our chat calendar for details! Message Boards - Learn from other people living with RLS/PLMD. Recent RLS/PLMD Message Board Posts PLMD Last post 9/6/05 teeth grinding and restlessness Last post 9/6/05 Any Requip/Neurontin Users willing to share?

108. The Doctors Book Of Home Remedies II Restless Legs Syndrome One in 20 Americans has restless legs syndrome, which may be inherited. In fact, many doctors think restless legs syndrome is an annoyance rather than a http://www.mothernature.com/Library/Bookshelf/Books/48/172.cfm

New customer? Sign Up Current customer? Log In Home Vitamins Minerals ... Learning Center Search Products Library Ways To Shop Brands Health Concern Departments Free Catalog MotherNature.com's Best-of-the-Best Natural Products Catalog Is Here! Click Here to Get Your Free Copy Today. Chapter List For: The Doctors Book of Home Remedies II: Age Spots Aging Eyes Anal Fissures Angina ... The Doctors Book of Home Remedies II From the Rodale book, The Doctors Book of Home Remedies II: Restless Legs Syndrome Restless Legs Syndrome Scientists call this condition Ekbom syndrome, RLS or nocturnal jerking movementsand if you're a sufferer, the poor schmoe you sleep with probably has a few choice monikers for it, too. That's because when your restless legs start running at night, you're likely to give your bedmate a swift kick or two as your legs thrash about seeking relief. But what makes them restless? Maybe your legs seek relief from a cramplike feeling. Or perhaps your thighs feel as though bugs were crawling inside them. Sometimes the pain is deep and throbbing. Other times it feels like pins and needles. The feelings vary but not the scenario: During periods of restespecially as you're going to sleepyour legs get antsy, and moving them is the action that brings relief. And it's not just legs and feet, eitheryour hands may go through those nightly motions as well. One in 20 Americans has restless legs syndrome, which may be inherited. Doctors believe it may be triggered by stress, a nutritional deficiency or some sort of imbalance in brain chemistry. It is not dangerous and doesn't lead to serious neurological disorders. In fact, many doctors think restless legs syndrome is an annoyance rather than a bona fide disease. But here's how to get a leg up on restless legs.

109. New Choices In Natural Healing Restless Legs Syndrome But that’s what happens to people who suffer from restless legs syndrome, restless legs syndrome is sometimes caused by a folate deficiency, http://www.mothernature.com/Library/Bookshelf/Books/21/183.cfm

New customer? Sign Up Current customer? Log In Home Vitamins Minerals ... Learning Center Search Products Library Ways To Shop Brands Health Concern Departments Free Catalog MotherNature.com's Best-of-the-Best Natural Products Catalog Is Here! Click Here to Get Your Free Copy Today. Chapter List For: New Choices in Natural Healing: The Most Natural of Remedies How to Use Acupressure The Many Flavors ... New Choices in Natural Healing From the Rodale book, New Choices in Natural Healing: Restless Legs Syndrome Restless Legs Syndrome After you’ve been running all day, the last thing you want your gams to do is the cha-cha—especially while you’re trying to sleep. But that’s what happens to people who suffer from restless legs syndrome, which causes an irresistible urge to thrash about, usually within 30 minutes after going to bed. What makes legs restless? It’s usually an impulse to relieve the tickling, prickling or burning discomfort triggered by this syndrome. Doctors aren’t sure what causes these sensations, but some suspect that it’s due to an abnormality in brain chemistry that affects nerve signals to the limbs. Others believe that caffeine or nicotine may play a role or that it may be related to anxiety, fatigue, iron deficiency anemia or stress. It tends to run in families, and pregnant women are the most likely candidates. (The problem usually disappears after delivery.) The natural remedies in this chapter—in conjunction with medical care and used with the approval of your doctor—may help ease restless legs syndrome, according to some health professionals.

110. InteliHealth: Restless Legs Syndrome InteliHealth Featuring Harvard Medical School s consumer health information. For more than 550 diseases and conditions, learn What Is It?, Symptoms, http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10252.html

chrome_imgPreload('gifChr_mid_but_home_mo_1','http://img.intelihealth.com/i/C/Chr_mid_but_home-o.gif'); chrome_imgPreload('gifChr_mid_but_comm_mo_2','http://img.intelihealth.com/i/C/Chr_mid_but_comm-o.gif'); chrome_imgPreload('gifChr_mid_but_dental_mo_3','http://img.intelihealth.com/i/C/Chr_mid_but_dental-o.gif'); chrome_imgPreload('gifChr_mid_but_drug_mo_4','http://img.intelihealth.com/i/C/Chr_mid_but_drug-o.gif'); chrome_imgPreload('gifChr_mid_but_askexpert_mo_5','http://img.intelihealth.com/i/C/Chr_mid_but_askexpert-o.gif'); chrome_imgPreload('gifChr_mid_but_medical_mo_6','http://img.intelihealth.com/i/C/Chr_mid_but_medical-o.gif'); chrome_imgPreload('gifChr_mid_but_chats_mo_7','http://img.intelihealth.com/i/C/Chr_mid_but_chats-o.gif'); chrome_imgPreload('gifchr_mid_but_news_mo_8','http://img.intelihealth.com/i/c/chr_mid_but_news-o.gif'); chrome_imgPreload('gifChr_mid_but_privacy_mo_9','http://img.intelihealth.com/i/C/Chr_mid_but_privacy-o.gif'); Advertisement Restless Legs Syndrome What Is It? Symptoms Diagnosis Expected Duration ... Additional Info What Is It? Restless legs syndrome is a movement disorder that causes uncomfortable sensations in the legs. These sensations typically are worse during periods of rest, especially just before sleeping at night, but they may happen during daytime periods of inactivity, such as watching a movie, attending a long business meeting, or flying in a plane.

111. WebMD Health Gateway To CenterWatch restless Legs syndrome (RLS) is a neurological disorder that creates an urge to move restless Legs syndrome You re ready to rest, but your legs aren t. http://www.centerwatch.com/cgi-bin/cl.pl?p=studies/cat430.htm&h=webmdhd.txt&f=we

112. Restless Legs Syndrome- Health Encyclopedia And Reference restless Legs syndrome Symptoms, Treatments and Medications. http://www.healthcentral.com/encyclopedia/408/681.html

Dr. Dean TV Specials Newsletters Home ... Health Tools Search Choose a Health Topic * All Health Topics * Acne Addictions AIDS/HIV Alcohol Abuse Allergies Alternative Medicine Alzheimer's Arthritis Asthma Attention Deficit Disorder (ADHD) Backache Bipolar Affective Disorder Birth Control Blood Blood Pressure Bone/Joint/Tendon Bowel Brain Breast cancer Cancer Cerebral Palsy Cholesterol Cramps Crohn's Disease Cysts Dental/Oral Depression Diabetes Diet, Fitness, Looks Disabled/Special Needs Drug Abuse Ear/Nose/Throat Eating/Appetite Eczema Encephalitis Eye/Vision Fatigue Fever Flu Food Poisoning Foot Gallbladder Gastrointestinal Genetic/Congenital GERD/Heartburn Hair Loss Hair/Scalp Headache Hearing Heart Disease, Stroke Heat/Sunstroke Hepatitis Hernia Herpes High Blood Pressure Hormonal Immune Disorders Immunizations/Vaccines Impotence Incontinence/Bladder Infections Injuries Kidney/Urinary Kids Learning Disabilities Liver Lung Cancer Men Menopause, Postmenopause Migraine Mobility/Balance Multiple Sclerosis Muscle Neural Nosebleeds Pain Parasites Pituitary PMS Pregnancy Prostate Cancer Prostate Disorders Psoriasis Psychological Raynaud's Disease Respiratory Reye Syndrome Rheumatoid Arthritis Schizophrenia Seniors Sensory Sexually Transmitted Disease Skin Sleep Speech Disorders Spinal Thyroid Trauma Weight Loss Women Yeast Infections Home Miscellaneous Anatomy/Biology Neurology Restless Legs Syndrome Health Encyclopedia - Diseases and Conditions A B C D ... Y Restless Legs Syndrome What is the Definition of Restless Legs Syndrome?

113. Restless Legs Syndrome - Amidst A Tangled Web Dan Hersam s homepage and web log (blog) with funny lists, quotes and frequent updates. http://dan.hersam.com/archives/2005/06/29/restless-legs-syndrome

Skip to navigation Amidst a tangled web Friday Sep 09, 2005 - 10:24 MDT home site map contact web log Archives Wednesday - June 29, 2005 restless legs syndrome Have you ever been lying in bed with the feeling that your legs wanted to do something other than relax? RLS Foundation web site. I found a few sales pitches You may be interested to hear that the FDA has approved a new drug to cure restless leg syndrome but it has some pretty unpleasant side effects. RLS FAQ recommends the following. Self-directed activities that counteract your sensations of RLS appear to be very effective, although temporary, solutions to managing the disorder. You may find that walking, stretching, taking a hot or cold bath, massaging your affected limb, applying hot or cold packs, using vibration, performing acupressure, and practicing relaxation techniques (such as biofeedback, meditation, or yoga) may help reduce or relieve your symptoms. You may also find that keeping your mind actively engaged through activities such as reading a gripping novel, performing intricate needlework, or playing video games helps during times that you must stay seated, such as when you are traveling. Two more sites about RLS are wemove.org

114. Restless Legs Syndrome@Everything2.com restless Legs syndrome is also known as Jimmy Legs , under which name it was once featured in an Information from The restless Legs syndrome Foundation http://www.everything2.com/index.pl?node_id=919009

115. Restless Legs Syndrome And Chinese Medicine restless Legs syndrome (RLS) is often thought of as an inexplicable restless legs syndrome is commonly discussed in the field of sleep disorders (1, 2). http://www.itmonline.org/arts/restlessleg.htm

return to itm online RESTLESS LEGS SYNDROME AND CHINESE MEDICINE by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon BACKGROUND The syndrome was first mentioned by an English doctor, Thomas Willis, in 1672. In 1861, a German doctor, Theodor Wittmaack, described it as Anxietas tibiarum (literally anxiety of the lower leg muscles: the tibialis). The Swedish doctor Karl Ekbom in 1945 reported his observations in 34 persons with the condition and used the term "restless legs;" later, he observed 70 additional typical cases. Ekborn founded the department of clinical neurology of Uppsala University in 1956, continuing his studies of restless legs, which was known for some time as Ekbom's Syndrome or Wittmaack-Ekbom Syndrome. Much progress in understanding the disorder has been made recently as new study techniques have been developed. Restless Legs Syndrome may have a genetic component (especially when onset is before age 50), and it is partly related to dopamine activity in the brain affecting function of the cerebral cortex; this is the same neurotransmitter involved in Parkinson's disease. Dopamine agonists (drugs that stimulate the dopamine receptors in the same way dopamine does) and dopamine itself (e.g., l-dopa) are often effective in treating the condition. However, studies suggest that the specific dopamine systems in the brain differ in Restless Legs Syndrome versus Parkinson's disease; the two disorders can coexist when dopamine levels are quite low.

116. Restless Legs Syndrome Delicious Living Magazine s Website provides news, answers and information regarding natural and alternative health and integrative medicine, with detailed http://www.deliciouslivingmag.com/healthnotes/healthnotes.cfm?org=nh&lang=EN&Con

117. Restless Legs Syndrome restless legs syndrome (RLS) is a condition in which your legs feel extremely restless legs syndrome may affect as many as 12 million Americans. http://www.cnn.com/HEALTH/library/DS/00191.html

International Edition MEMBER SERVICES The Web CNN.com Home Page World U.S. Weather ... Autos SERVICES Video E-mail Newsletters Your E-mail Alerts RSS ... Contact Us SEARCH Web CNN.com In association with: RELATED STORIES Chronic fatigue syndrome Fibromyalgia Sleep Sleep apnea Insomnia Restless legs syndrome Snoring ... Narcolepsy INFORMATION CENTERS: Pick a category Health Centers Family Health Men's Health Women's Health Children's Health Seniors' Health Working Life Pain Management Condition Centers Immune System Allergy Alzheimer's Arthritis Respiratory System Cancer Endocrine System Digestive System Heart and Blood Infectious Disease Mental Health Note: All links within content go to MayoClinic.com Diseases and Conditions Restless legs syndrome From MayoClinic.com Special to CNN.com Overview Restless legs syndrome (RLS) is a condition in which your legs feel extremely uncomfortable while you're sitting or lying down. The condition usually makes you feel like getting up and moving around. In doing so, the unpleasant feeling goes away. A number of simple self-care steps and lifestyle changes may benefit you. Medications also help many people with restless legs syndrome.

118. Hospital Practice: Restless Legs Syndrome: What Is It? restless legs syndrome (RLS) is a neurologic disorder characterized by four clinical features Table 1 Diagnostic Criteria for restless Legs syndrome http://www.hosppract.com/issues/2001/05/brphi.htm

Restless Legs Syndrome: What Is It? BARBARA A. PHILLIPS University of Kentucky The condition is surprisingly common and often associated with periodic limb movement disorder. Symptom severity can range from annoying to virtually disabling. Recent advances in definition, evaluation, and treatment have made it possible to provide significant relief to many misdiagnosed, overlooked, or undertreated patients. Dr. Phillips is Professor of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Kentucky College of Medicine, Lexington. She is a recipient of a sleep academic award from the National Institutes of Health. Restless legs syndrome (RLS) is a neurologic disorder characterized by four clinical features: 1) dysesthesias, or uncomfortable sensations in the extremities that are 2) increased with inactivity and relieved with movement, 3) worsened at night, and 4) associated with motor hyperactivity. RLS is identified and diagnosed clinically, much as depression and pain are. Unfortunately, there is no specific biologic marker. Diagnostic criteria from the International Classification of Sleep Disorders are given in Table 1. Table 1: Diagnostic Criteria for Restless Legs Syndrome A.

119. Restless Legs Syndrome: More Than Just The “Jitters” (Tufts Health & Ants marching. Soda water in the veins. Creepycrawly, tingling, twitching deep within the legs. Such are the terms that people use to describe restless http://healthletter.tufts.edu/issues/2003-07/restless_legs.html

Subscribe Today Home Back Issues July 2003 July 2003 July 2003 = Full article available A Bagel or a Donut? Ask Tufts Experts Carbohydrates Vindicated More Research Supports Eating Fish ... What Was Normal Blood Pressure Is Now Considered Too High Related Articles Seven Essential Stretches Was the Statin Prescription Right in the First Place? Iron Deficiency Remains a Concern Abstract The full text of this article is not available online. Order this issue Contact Information Tufts University

120. Restless Legs Syndrome: Sufferers Describe Painful And Distressing Leg Symptoms Requip significantly improves symptoms of restless Legs syndrome (RLS) and is a generally welltolerated treatment, according to the results of a study http://www.immunesupport.com/library/showarticle.cfm/ID/4472/

Immune Support .com Restless Legs Syndrome: Health Watch Newsletter The Latest News Articles The Latest Abstracts The Latest Drug News Search Our Site Home Fibromyalgia Resources Introduction Tenderpoints ... About Us ImmuneSupport.com Requip(R) (ropinirole HCl) significantly improves symptoms of Restless Legs Syndrome (RLS) and is a generally well-tolerated treatment, according to the results of a study presented at the 55th American Academy of Neurology (AAN) annual meeting in Honolulu. The study is the first large, international, randomized, double blind, placebo controlled trial to examine the efficacy, safety, tolerability and patient reported outcomes of Requip for the treatment of RLS. RLS is a potentially debilitating neurological disorder characterized by an uncontrollable urge to move the legs. The condition is characterized by painful or distressing sensations in the legs that are described as creeping or twitching and that occur during rest and are relieved through movement. Because symptoms often appear during rest in the evening or at night, RLS can lead to appreciable sleep disturbances. No medicines have been approved by the U.S. Food and Drug Administration for treatment of RLS. "This is the largest controlled trial of ropinirole in RLS conducted to date and the results affirm the efficacy and tolerability findings from previous small studies. The results are therefore very favorable," said Diego Garcia-Borreguero, a key study investigator and director of the sleep disorders unit within the Department of Neurology at Fundacion Jimenez Diaz in Madrid, Spain. "As a physician who treats patients with RLS, I'm very excited about the improvement of symptoms like the irresistible urge to move and positive impact on sleep in this study."

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z

Page 6     101-120 of 122    Back | 1  | 2  | 3  | 4  | 5  | 6  | 7  | Next 20