[The restless leg syndrome (restless legs)].
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Adult↗
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Results for “Restless sleep”
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Restless legs syndrome in 218 patients: associated disorders.
Background: Restless legs syndrome (RLS) is a disorder characterized by disagreeable sensations in the legs that occur at rest and are relieved by movement. These symptoms, which are worse at night, may result in sleep onset or sleep maintenance insomnia. Most patients are found on polysomnography (PSG) to have periodic limb movements in sleep (PLMS). The disorder, idiopathic in most cases, may be sometimes associated with specific disorders.Methods: Using the Province of Manitoba Health database, we compared the diagnoses made in the 5 years prior to sleep laboratory evaluation of 218 patients (103 men and 115 women) with RLS and 872 matched control subjects from the general population.Results: We found that 43.7% of male RLS patients vs. 10.4% of male controls and 46.1% of female RLS patients vs. 22.8% of female controls had been diagnosed as having psychological/psychiatric (most often depression) disorders (P<0.05). Extrapyramidal disease or movement disorders were previously diagnosed in 17.5% of male RLS patients vs. 0.2% of male controls and in 23.5% of female patients vs. 0.2% of female controls (P<0.05). Many patients had been previously diagnosed with disorders of the musculoskeletal system: 35.9% of male patients vs. 22.8% of male controls and 49.6% of female RLS patients vs. 23.3% of female controls had been diagnosed as having diseases of joints (male; P=ns, female; P<0.05). Disorders of the back were also more frequently diagnosed in RLS patients: 21.4% of male patients vs. 13.1% of male controls and 38.3% of female patients vs. 15.0% of female controls (male; P=ns, female; P<0.05).Conclusions: We conclude that RLS patients are much more likely to have previously been diagnosed with extrapyramidal disorders, musculoskeletal disorders, depression, and painful conditions such as joint and back disorders.
Journal Article↗
Effect of shifting costs to patients on specialty evaluation for sleep disorders.
OBJECTIVE: To determine whether the introduction of out-of-pocket expenses to medical center employees would lead to decreased use of sleep disorder services. PATIENTS AND METHODS: We retrospectively analyzed and compared the clinical and medical accounting data from visits by Mayo Clinic employees to the Sleep Disorders Center from January 1 to March 31, 2003, with that of January 1 to March 31, 2004, le, before and after a January 2004 increase in co-payments for evaluation and testing. RESULTS: The total number of new patients evaluated in the first quarters of 2003 and 2004 was similar (113 vs 119; P = .37). Snoring, restless legs symptoms, hypertension, atrial fibrillation, and prior overnight oximetry testing were more prevalent in 2004 than in 2003 (P = .05, P = .01, P < .001, P = .003, P = .02, respectively). In contrast, insomnia and parasomnia complaints were less common in 2004 (P < .001). The mean apnea-hypopnea index, minimum oxygen saturation, and percentage of time with oxygen saturation less than 90% were all more severe in 2004 (P = .01, P = .001, P < .001, respectively). Sleep-related breathing disorders were more commonly diagnosed in 2004 (83.2% vs 67.2%; P = .02), whereas the diagnoses of nonbreathing disorders declined. CONCLUSION: The insurance policy changes that resulted in larger employee co-payments shifted the spectrum of diagnoses seen at the Sleep Disorders Center toward more symptomatic patients, with more associated comorbidities, and patients who had more severe sleep-related breathing disorders. Total utilization did not decrease.
Academic Medical Centers↗
[Restless legs syndrome. Therapy according to plan].
The restless legs syndrome is characterised by an imperative desire to move lower legs because of paraesthesias or dysesthesias sometimes associated with pain witch occur at rest. The symptoms temporary relief by activity. Worsening of symptoms in the evening or at night are typical. Therefore patients with RLS often have problems with initiating and maintaining sleep. In polysomnographic investigation typical periodic limb movements in sleep (PLMS) can be found. The treatment of choice for RLS is levodopa. In case of augmentation or time shifting transfer to dopamine agonists should be considered. Alternative medications are opioids, benzodiazepines or some antiepileptic drugs (carbamazepine or gabapentin).
Central Nervous System Agents↗
Restless nights, listless days.
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Adolescent↗
Frequent occurrence of myoclonus while awake and at rest, body rocking and marching in place in a subpopulation of patients with restless legs syndrome.
While myoclonus awake and at rest, body rocking and marching in place have been occasionally reported to occur in idiopathic restless legs syndrome (RLS), it has not been previously noted that these clinical features occur frequently in a subpopulation of severely affected older RLS patients seeking medical attention for longstanding symptoms that have become progressively worse over the years. We studied 10 unrelated patients from this subpopulation and polysomnographically documented myoclonus while awake and at rest in 8, and intermittent night-time body rocking and marching in place in 6 by history and videotape. Also occurring frequently were the well-known clinical features of floor pacing, paresthesias, sleep disturbances, periodic movements of sleep (PMS), tendency for the signs and symptoms to be worse at night, and a family history suggestive of RLS.
Aged↗
Chorea and its disorders.
Chorea (Greek for "dance") refers to irregular, rapid, flowing, non-stereotyped and random involuntary movements that often possess a writhing quality, referred to as choreoathetosis. When mild, it may be difficult to differentiate from restlessness. The movements can be strikingly asymmetric, as in hemichorea, or generalized. When chorea is proximal and of large amplitude, it is called ballism. Chorea is worsened by stress and anxiety and subsides during sleep. Movements can interfere with the completion of many daily activities, making fastening a button a substantial effort. Chorea often is incorporated into a purposeful activity in an attempt to disguise it. Motor impersistence is a common associated feature, demonstrated by varying intensity of grip strength (milkmaid's grasp) or by an inability to sustain eye closure or tongue protrusion.
Chorea↗
Pramipexole in the management of restless legs syndrome: an extended study.
STUDY OBJECTIVES: To determine whether pramipexole used over an extended time for restless legs syndrome (RLS) remains effective; whether the dose of the drug needs to be increased; whether augmentation develops; and whether side effects, especially sleepiness, are prominent. DESIGN: Retrospective review of the records of consecutive patients treated with pramipexole for RLS. SETTING: Sleep disorders center in an academic hospital. PATIENTS: 60 consecutive patients treated with pramipexole for RLS. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Pramipexole was completely effective in controlling RLS in 67%, partially effective in 27%, and ineffective in 7% of patients. Eleven patients (18%) discontinued pramipexole after less than 4 months; the remainder were followed for a mean of 27.2 months, during which only 4 others stopped the drug. The median daily dose increased from 0.38 mg after stabilization to 0.63 mg at the end of the study. Forty percent experienced mild side effects, most commonly insomnia, nausea or dyspepsia, and dizziness. Only 5% experienced sleepiness, and none experienced sleep attacks while driving. Augmentation developed in 33%, most in the first year and all by 30 months. Augmentation was not predictable by prior augmentation with other dopaminergic agents. Only 1 patient discontinued pramipexole because of augmentation. CONCLUSIONS: Pramipexole was effective for RLS with continued response with time. Modest escalations in dose occurred, partly due to additional doses prescribed for augmentation. Side effects were common, but generally mild and tolerated. Sleepiness while driving was not a problem. Augmentation occurred in 33% of patients but was treatable with increased doses earlier in the day.
Adult↗
Sleep deprivation and adaptive hormonal responses of healthy men.
To study the effects of sleep deprivation on the pituitary-testis axis physiology, we measured the circulating levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), testosterone (T), androstanedione (A), dihydrotestosterone (DHT), estradiol (E2), and cortisol (C) in eight healthy men as follows: phase I (control), phase II (24-h restless period), phase III (48-h restless period), and phase IV (24-h recovery period). All samples were taken at 8:00 a.m. There was a significant decrease of T, A, DHT, and E2 in phase II but no decrease in FHS, LH, PRL, or C. In phase III there was no further decrease in any androgen, although E2 decreased along with the increase of PRL. In phase IV E2 and PRL tended to return to baseline values, and the androgens were very similar to the controls. FHS, LH, and C showed no change under the effects of phase III. These data extend the adaptive androgenic response and the association of the role of E2 and PRL to restricted or disturbed sleep in men.
Adult↗
[Passion Flower (Passiflora incarnata L.)--a reliable herbal sedative].
Extracts and fluid extracts from the aerial parts from Passiflora incarnata L. are widely used as components of herbal sedatives. Many pharmacological investigations confirm the sedative effects of Passiflorae herba. From some of the studies also anxiolytic effects can be deduced. As Passionflower is mainly used in combinations, clinical studies of the single drug are not available. Based on pharmacological data, the experiences of traditional use and the use in combinations Passiflora extracts are an important factor in the phytotherapy of tenseness, restlessness and irritability with difficulty in falling asleep.
Anxiety↗
133Xe and stable Xe inhalation measurements of cerebral blood flow in health and disease.
Advantages and disadvantages of 133Xe inhalation method for measuring regional cerebral blood flow by external sodium iodide detectors are compared to those of the 35% stable xenon (Xe) inhalation method for measuring local cerebral blood flow using the CT scanner. Clinical applications are reviewed. At present, 133 Xe is the most widely available method. Advantages are established safely, availability of normal values, reasonable cost effectiveness, and wide applicability. Disadvantages are poor resolutions and errors due to lack of knowledge of solubility of xenon in abnormal tissues. Advantages of the Xes CT method are excellent resolution and measurement of tissue solubility of abnormal tissues. Disadvantages are subjective subanesthetic affects in some subjects (including numbness, light headedness, restlessness) and expense of Xes gas).
Aging↗
Some children with growing pains may actually have restless legs syndrome.
STUDY OBJECTIVES: Growing pains may be an important clue to the diagnosis of childhood restless legs syndrome (RLS). However, there are no previous studies to determine whether a subpopulation of children with growing pains meet the diagnostic criteria for RLS. The purpose of this study is to determine if some children with growing pains meet diagnostic criteria for RLS and to compare the polysomnographic characteristics of these children to controls. DESIGN/PARTICIPANTS/MEASUREMENTS: Eleven children from a pediatric neurology clinic with an emphasis on attention-deficit/hyperactivity disorder (ADHD) and with a diagnosis of growing pains were referred. They were interviewed with the parent to determine if their symptoms of growing pains met criteria for definite RLS. Those who met clinical criteria for RLS underwent polysomnography, and the results of their polysomnographic studies were compared to those of a control group (10 children, mean age 9.7 years). SETTING: Academic medical center. RESULTS: Ten (mean age 10.4 years) of the 11 children with growing pains met clinical criteria for RLS. In 4 of 8 families of these 10 children, 1 parent had RLS. Six of the 10 children had ADHD. There were no differences in the polysomnographic findings between the growing-pain and control groups, and none of the children with RLS had what is considered to be a clinically significant number of periodic limb movements of sleep. There were no differences in the polysomnographic findings between the "growing-pain ADHD" and "growing-pain non-ADHD" subgroups. The growing pains were severe enough for the patients and family to ask for treatment in 4 cases, and carbidopa/levodopa was utilized. CONCLUSIONS: Some children diagnosed with growing pains meet diagnostic criteria for RLS, and a family history of RLS is common in these children. In some cases symptoms are severe enough to warrant treatment.
Adolescent↗
Impact, diagnosis and treatment of restless legs syndrome (RLS) in a primary care population: the REST (RLS epidemiology, symptoms, and treatment) primary care study.
OBJECTIVES: To assess the frequency, impact, and medical response to the restless legs syndrome (RLS) in a large multi-national primary care population. METHOD: Questionnaire surveys of matched patients and primary care physicians (PCPs) in five modern industrialized western countries. RESULTS: An RLS screening questionnaire was completed by 23,052 patients: 2223 (9.6%) reported weekly RLS symptoms; 1557 of these patients had medical follow-up questionnaires completed both by themselves and by their physician. An RLS sufferer subgroup (n=551) likely warranting treatment was defined as reporting at least twice weekly symptoms with appreciable negative impact on quality of life. A total of 88.4% of RLS sufferers reported at least one sleep-related symptom. Most reported impaired sleep consistent with a diagnosis of insomnia. Out of 551 sufferers, 357 (64.8%) reported consulting a physician about their RLS symptoms, but only 46 of these 357 (12.9%) reported having been given a diagnosis. PCPs reported that 209 (37.9%) RLS sufferers consulted them about RLS symptoms, but only 52 (24.9%) were given an RLS diagnosis. In most countries, sufferers, regardless of diagnosis, were prescribed therapies not known to be effective in RLS. CONCLUSIONS: RLS significantly impairs patients' lives, often by severely disrupting sleep. The marked under-diagnosis and inappropriate treatment of RLS indicates that PCPs need better education about this condition. Recognizing how often disrupted sleep results from RLS should improve diagnosis.
Drug Therapy↗
[The restless legs syndrome].
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Amyloidosis↗
Low body stores of iron and restless legs syndrome: a correctable cause of insomnia in adolescents and teenagers.
BACKGROUND: It has been shown that restless legs syndrome (RLS) in adults may be linked to abnormalities in iron stores. Whether reduced iron stores play a role in children is not clear. METHODS: We evaluated the status of iron stores and sleep in three teenagers who presented with severe sleep onset insomnia, subjective sleep latency exceeding 60 min and excessive daytime sleepiness. RESULTS: The three teenagers were found to have RLS and laboratory evaluation confirmed reduced body stores of iron with a low percent iron saturation (mean value 9.7%) and a low serum ferritin level (mean value 17 microg/l). None had marked anemia. The three patients were treated with oral iron for 4-5 months. As a group they had an increase in percent iron saturation (from a mean of 9.7 to 22.7%) and serum ferritin (from a mean of 17 to 27 microg/l) and a marked reduction of the symptoms of RLS, with mean subjective sleep latency decreasing from 143 to 23 min, sleep efficiency increasing from 75.7 to 84.0% and the number of periodic movements per hour of sleep decreasing from 20.5 to 10.5. INTERPRETATION: These findings support the hypothesis that abnormal iron stores or metabolism may result in RLS causing insomnia in teenagers. We recommend evaluation of iron status including serum iron, total iron binding capacity and ferritin levels in teenagers with chronic insomnia of unexplained origin even when anemia is mild or absent.
Journal Article↗
Dopamine and the spinal cord in restless legs syndrome: does spinal cord physiology reveal a basis for augmentation?
The pathophysiology of restless legs syndrome (RLS) is incompletely understood. L-DOPA, as the precursor of dopamine, as well as dopamine agonists, plays an essential role in the treatment of RLS leading to the assumption of a key role of dopamine function in the pathophysiology of RLS. Periodic limb movements in sleep are a key feature of RLS. They are generated in the spinal cord. Here we review RLS phenomenology on the basis of known dopaminergic influence on spinal control, which has been studied a great deal in recent decades in animals. In particular, we propose that the differential effects of l-DOPA and opioids on early and late flexor reflexes may be linked to the phenomenon of augmentation.
Afferent Pathways↗
[The use of ropinirol ++ as a treatment for restless leg syndrome].
INTRODUCTION: Restless legs is an unpleasant sensation in the calves that occurs when the individual is sitting or laying down, with an irresistible urge to move the legs. It has been know as a cause of insomnia. We have been using various drugs with a variety of effectiveness. Levodopa is now considered the drug of choice but drug tolerance is likely to develop the risk of drug dependence. Recently, a new drug was developed by Smithkline Beecham called ropinirol which principal indication is the treatment of initial phase of Parkinson's disease. PATIENTS AND METHODS: Base on the idea of the efficacy de la levodopa in patients with restless legs we administered 0.25 mg of ropinirol at bedtime to 15 of our patients diagnosed with restless legs syndrome. None of them had received positive results using the classic treatments during more than five years since they had developed this syndrome. Before the treatment was begun, we discontinued any medications relating to this illness. RESULTS: Beneficial effects were observed after the first administration and has continued until this time, 12 months after the initial treatment. Efficacy was measure by using sleep questionnaires (Spiegel). With only a pill (0.25 mg) at the moment of laying down at bedtime reports a clear improvement in the symptoms, including reducing the periodic leg movements. CONCLUSION: That improvements continue without any secondary side effects and without appearing to have built up any tolerance for the medication. Further research is needed to investigate the long term efficacy and side effects of this new treatment, but at this moment is a valuable and satisfactory tool to treat restless legs syndromes.
Adult↗
Gender differences in the presentation of subjects with restless legs syndrome.
BACKGROUND AND PURPOSE: To better understand the origin of the disproportionate number of women in previous treatment studies of patients with restless legs syndrome (RLS). PATIENTS AND METHODS: We conducted a survey in a self-selected group of patients who responded to print and radio recruiting advertisements regarding a clinical trial for RLS. Subjects completed a questionnaire which solicited information on presenting features of RLS, sleep-related symptoms, co-morbidities and family history. RESULTS: A total of 158 (63% female) subjects with a mean age of 49 (+/-16) years fulfilled the criteria for putative diagnosis of RLS and participated in the study. There was no gender bias as far as duration of RLS, incidence of family history, number of affected days per week, or severity of daytime sleepiness was concerned. There was a subtle gender bias in sleep-related symptoms (involuntary movements when awake, sleep onset difficulties and frequent wakings at night) where a disproportionately high number of women subjects presented with all three symptoms. For any one symptom, or any pair of symptoms, there were no gender differences. Women also were more likely to present with co-existent hypothyroidism. Both male and female subjects were more likely to recall female relatives affected with RLS. CONCLUSIONS: Gender differences associated with symptom load, co-morbidities of RLS and possible patterns of inheritance may contribute to increased numbers of women presenting for treatment of RLS.
Adult↗