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PubMed2004

Sleep complaints in patients with myotonic dystrophy.

The aim of this study was to document the clinical picture of excessive daytime sleepiness (EDS) and of other sleep disturbances, and to study the relationship of daytime sleepiness to anthropometric data, muscular impairment, and CTG trinucleotide repeat expansion in myotonic dystrophy type 1 (DM1). A total of 157 DM1 patients were surveyed using a modified version of the Sleep Questionnaire and Assessment of Wakefulness. Other measurements included muscular impairment rating and the size of the trinucleotide repeat. Factor analysis and reliability estimates were used to produce a daytime sleepiness scale with five items of the questionnaire. Thirty-eight healthy family members were studied as control subjects. It was found that EDS was present in 33.1% of DM1 patients. Severity of daytime sleepiness correlated with the degree of muscular impairment but not with age, gender, body mass index, age at onset of symptoms, duration of illness, and CTG repeat. DM1 patients reported a longer sleep period, a less restorative sleep, and more difficulty falling asleep, being alert in the morning and staying awake after meals than controls, but a similar incidence of narcolepsy auxiliary symptoms. Compared with DM1 patients without EDS, those with EDS reported greater hypnagogic hallucinations, and greater pain associated with nocturnal awakenings and in their legs upon morning awakenings. In sum, both DM1 patients with and without EDS exhibit characteristics of sleep duration and sleepiness comparable with those found in idiopathic hypersomnia. The severity of daytime sleepiness is weakly related to the extent of muscular impairment but not to CTG repeat.

Adult↗

PubMed2004

Long-term safety and efficacy of cabergoline for the treatment of idiopathic restless legs syndrome: results from an open-label 6-month clinical trial.

STUDY OBJECTIVES: To assess the safety and efficacy of cabergoline in the treatment of idiopathic restless legs syndrome (RLS) patients. DESIGN: Open-label intervention study for 26 weeks; no control group. SETTING: 302 patients (73% women, aged 61 +/- 11 years) from 37 German neurologic outpatient departments and private practices. INTERVENTION: Cabergoline was upwardly titrated over 4 weeks to individually optimized dosages. Median treatment duration was 181 days. The median daily dose of cabergoline was 1.5 mg. MEASUREMENTS: Drug safety was assessed by adverse events; efficacy was evaluated with the RLS-6 and the International RLS Rating Scales. RESULTS: In 48% of the study participants, investigators reported adverse events suspected to be drug related. Most adverse events were mild and transient and related to the gastrointestinal system (nausea: 16.6%) or the central nervous system (dizziness: 7.0%, headache: 4.6%). Premature dropout from the study occurred in 54 patients (17.9%), in 17 patients (3.0%) due to a drug-related adverse event. The severity of RLS symptoms at night, at bedtime, and during the day, as well as the International RLS Rating Scale total score improved during therapy. Satisfaction with sleep was increased (all P values < .001). In 5% of all patients, RLS symptoms worsened, and in a further 6.3%, response to therapy was poor. In 9 patients (3.0%) between 1 and 3 criteria for augmentation were noted. CONCLUSIONS: Long-term therapy with cabergoline is a safe and well-tolerated treatment option for the great majority of patients with idiopathic RLS. The treatment was efficacious both for nighttime and daytime symptoms in this indication and may carry a low risk of augmentation.

Cabergoline↗

PubMed1997

Antidepressant withdrawal reactions.

Antidepressants can cause a variety of withdrawal reactions, starting within a few days to a few weeks of ceasing the drug and persisting for days to weeks. Both tricyclic antidepressants and selective serotonin reuptake inhibitors cause similar syndromes, most commonly characterized by gastrointestinal or somatic distress, sleep disturbances, mood fluctuations and movement disorders. Most symptoms related to tricyclic antidepressant withdrawal are believed to be caused by rebound excess of cholinergic activity after prolonged anticholinergic effect on cholinergic receptors. (This situation is analogous to the adrenergic rebound that occurs after beta-blocker withdrawal.) Treatment involves restarting the antidepressant and tapering it more slowly. Alternatively, tricyclic antidepressant withdrawal symptoms often respond to anticholinergics, such as atropine or benztropine mesylate. Three case reports of antidepressant withdrawal are presented, including one featuring akathisia (motor restlessness) related to withdrawal of venlafaxine.

Adult↗

PubMed1986

Dissociation of locomotor impairment from mydriasis evoked by clonidine injected into cat's rostral hypothalamus.

The anterior hypothalamic preoptic area (AH/POA) was examined as a possible site of action of clonidine and other alpha noradrenergic receptor agonists which evoke motor and autonomic changes. Chronically indwelling guide cannulae were implanted stereotaxically in the diencephalon of the cat. Following post-operative recovery, a micro-injection into AH/POA was made in a volume of 1.0 microliter of one of the following compounds: 5.0-50.0 micrograms clonidine, 5.0-50.0 micrograms norepinephrine, 5.0-50.0 micrograms phenylephrine and 5.0-50.0 micrograms methoxamine. The smallest dose of 5.0 micrograms clonidine produced a brief period of restlessness, licking, retching and emesis but a much longer-lasting mydriasis. When the dose of clonidine was raised to 20 micrograms, the cat became behaviorally sedated, after a latency of about 15 min, for a period of up to 1.0-2.0 hr. This was accompanied by a prolonged period of mydriasis and preceded by a short interval of restlessness, licking, retching and emesis. After the highest dose of 50.0 micrograms clonidine was micro-injected in AH/POA, a profound impairment of motor activity, adynomia and restlessness developed within 15-20 min, persisted for 30 to 60 min and was accompanied also by mydriasis with maximal pupillary dilation lasting for up to six hr. When 5.0-50.0 micrograms phenylephrine or 5.0-50.0 micrograms norepinephrine were micro-injected at clonidine-reactive sites in AH/POA, only rarely were brief instances of restlessness, licking, retching and emesis observed; however, methoxamine at all doses tested failed to produce any visible signs of autonomic or motor disturbance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Agonists↗

PubMed1997

Assessment and Management of "Sundowning" Phenomena.

Approximately one quarter of patients with AD-type dementia reportedly exhibit disruptive, restless, and/or confused behavior that tends to be more apparent in late afternoon or early evening. Research has yet to document the phenomenon in a definitive manner to facilitate standardized assessment and clinical trials. Recent work attempting to define precisely the prevalence of abnormal behaviors during different periods of time of day in AD patients is reviewed. Caregiver reports of confusion and aggressive, disruptive behavior have been associated with going to bed early, increased use of sedative-hypnotics, and more severe cognitive impairment. Because there is evidence that the sleep of many AD patients is of poor quality, one might try to treat such patients with behavioral approaches useful in insomnia in other populations. Futhermore, as psychotropic medications can adversely affect sleep and/or have "hangover" effects on daytime cognition, one should carefully manage these medications to optimize care. Advances in assessment of sundowning, combined with longitudinal studies of sleep and circadian rhythm changes associated with dementia progression, should enhance efforts to treat behavioral and sleep disturbances.

Journal Article↗

PubMed1975

A new method for the measurement of itch and the response to treatment.

Two new methods are described for the quantitative measurement of itch: the principle is to measure scratch which is the major objective correlate of itch. The first method is to record whole body movement at night by a vibration transducer on a bed leg; this gives qualitative and quantitative information. The second method is to measure limb movement with movement-sensitive meters; this give only quantitative data but is quicker and more easily carried out. The subjective sensation of itch was found to correlate well with nocturnal scratch, confirming the basic assumption of the method. Itching as measured by scratch occurs throughout the night and increased severity of itch is accompanied by an increase in the number of bouts of itch and not in their duration. Nocturnal restlessness is associated with an increase in leg movement and so can be dissociated from itch-provoked scratch, which is mostly done by the hands. The response of pruritus to treatment was demonstrated by both methods.

Administration, Topical↗

PubMed1996

A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynecologic procedures.

Ondansetron and droperidol are both effective prophylactic antiemetics for gynecologic outpatient procedures. However, increased drowsiness, delayed discharge, and postdischarge restlessness may occur with droperidol, and ondansetron is costly. In this prospective, randomized, double-blind, placebo-controlled study involving 161 women, we compared the efficacy, safety, and cost-effectiveness of ondansetron (4 mg intravenously [i.v.] with droperidol (0.65 mg or 1.25 mg i.v.) in the prevention of postoperative nausea and vomiting (PONV) after outpatient gynecologic surgery. The incidence of PONV, times to achieving preset recovery criteria, and patient-evaluated visual analog scales for sedation, anxiety, pain, and nausea were recorded, along with postdischarge emetic episodes, medications, quality of sleep, and time to resumption of food intake, normal activity, and return to work. A decision analysis tree was used to divide each data set into nine mutually exclusive subgroups, and costs and probabilities were assigned to each subgroup. The cost-effectiveness ratio was determined by summing these weighted costs and dividing by the number of patients free from both PONV and side effects of antiemetic therapy. The incidence of PONV in the hospital and after discharge, the need for rescue antiemetic therapy, and recovery and discharge times were similar for the ondansetron and both droperidol groups but differed significantly from those for the placebo group. The cost-effectiveness ratios for both droperidol 0.65 mg and 1.25 mg groups were significantly lower than those for the ondansetron and placebo groups. We conclude that droperidol 0.625 mg i.v. provides antiemetic prophylaxis comparable to that of ondansetron 4 mg i.v. without increasing side effects or delaying discharge and is most cost-effective.

Activities of Daily Living↗

PubMed1997

Actigraphic monitoring of movement and rest-activity rhythms in aging, Alzheimer's disease, and Parkinson's disease.

Actigraphy, the long-term assessment of wrist movements, is used in several research fields, among which are included sleep and circadian rhythms. Actigraphs record movements using accelerometers. The present paper addresses some basic problems and their solutions in the actigraphic assessment of movement, motor symptoms, circadian rest-activity rhythms, and nocturnal agitation in healthy elderly and elderly suffering from a neurodegenerative disease (i.e., Parkinson's disease or Alzheimer's disease) and summarizes the results of previous and ongoing research. First, we have investigated how to filter the accelerometer signal in order to minimize the contribution of accelerations induced by positional changes in the gravitational field--a strong source of artefacts. A bandpass filter from 0.5 to 11 Hz appropriately assesses movement induced accelerations while minimizing gravitational artefact. The application of a bandpass filter from 0.25 to 2 or 3 Hz, as is used in some of the commercially available actigraphs, results in artefacts and moreover biases the slower part of the movement spectrum. It is therefore far from optimal for research on aging, which is associated with a generalized motor slowing. Second, we have proposed an alternative to traditional methods of signal processing in actigraphy, in order to assess both the duration and intensity of movements, and in order to distinguish Parkinsonian tremor. Based on this algorithm, new types of actigraphs have been designed. Third, we have proposed sensitive variables in order to quantify rest-activity rhythm disturbances in healthy elderly subjects and Alzheimer patients, who often present with symptoms of nocturnal restlessness. Since, in these subjects, research protocols applying enforced phase shifts or time-free environments are unfeasible and not justifiable from an ethical point of view, the variables were specifically designed to assess the functionality of the circadian timing system from actigraphic recordings made in the natural environment of subjects. Examples of the application of actigraphy are given, including studies on symptom fluctuations and medication responses in Parkinson patients, and studies on circadian rhythm disturbances and possible remedies in elderly and Alzheimer patients.

Aged↗

PubMed2003

Modafinil affects mood, but not cognitive function, in healthy young volunteers.

Modafinil is a selective wakefulness-promoting agent with beneficial effects in narcolepsy and conditions of sleep deprivation. In a double-blind study we examined its effects in 30 healthy, non sleep-deprived students (19 men and 11 women, aged 19-23 years), who were randomly allocated to placebo, 100 or 200 mg modafinil and 3 h later completed 100 mm visual analogue scales relating to mood and bodily symptoms, before and after an extensive battery of cognitive tests (pen and paper and CANTAB). There were no significant differences between the three treatment groups on any of the cognitive tests used in this study. There was a significant post-treatment change in the factor measuring 'somatic anxiety' and in individual ratings of 'shaking', 'palpitations', 'dizziness', 'restlessness', 'muscular tension', 'physical tiredness' and 'irritability', which was mainly due to significantly higher ratings of somatic anxiety in the 100 mg group compared with the other two groups. Further changes in mood were revealed after the stress of cognitive testing, with the 100 mg group showing greater increases in the 'psychological anxiety' and the 'aggressive mood' factors (as measured from the Bond and Lader scales).

Adult↗

PubMed2004

Hypnic headache syndrome: excessive periodic limb movements in polysomnography.

We report a patient with hypnic headache syndrome associated with excessive periodic limb movements in sleep, which is a unique finding for this syndrome recorded in polysomnography. She had had daily hypnic headache attacks history for 10 years. Her headache attacks ceased immediately after lithium carbonate therapy and she has been headache-free for 5 months.

Diagnosis, Differential↗

PubMed2002

Review of receptor agonist and antagonist studies relevant to the opiate system in restless legs syndrome.

BACKGROUND AND PURPOSE: Therapeutic studies of the opioids in restless legs syndrome (RLS) are reviewed. PATIENTS AND METHODS: Opioids appear to be a good short and long-term treatment for RLS as shown in open-label, double-blind and long-term follow-up studies. However, the number of studies is more limited than for other therapeutic modalities in RLS such as dopaminergic agents. Furthermore, the one long-term study on the therapeutic effect of opioids on RLS published in full paper form is retrospective; prospective long-term studies are needed. RESULTS: Little addiction and tolerance were noted in any of the studies. Sleep apnea was not induced or exacerbated in short-term studies, but this was not the case in the long-term study. We have recommended that RLS patients treated with chronic opioid therapy be monitored clinically for the development of sleep apnea. Studies consistently show that the opiate receptor blocker naloxone reverses the improvement in RLS induced by the opioids, implicating the endogenous opiate system with its endorphins and enkephalins in the pathogenesis of RLS. Studies are mostly consistent in showing that naloxone does not worsen RLS symptoms in patients not treated with opioids. This result may be related to the differential ability of naloxone to antagonize exogenous opioids as opposed to endogenous opioids at the site of the opiate receptor. Naloxone does not block the therapeutic effect of dopaminergic agents on RLS symptoms, but dopamine receptor blockers do block the therapeutic effects of opioids on RLS symptoms. This suggests that the endogenous opioids act upon dopamine systems to improve the symptoms of RLS. Some of these receptor blocking studies are blinded and, in some cases, the results are dramatic. However, with one exception, there were limited numbers of patients studied with receptor blocking agents. CONCLUSION: The results of such studies therefore need further verification. In addition, future studies should focus on other methodologies, such as opiate receptor PET scanning, that might further implicate the endogenous opiate system in the pathogenesis of RLS.

Journal Article↗

PubMed1994

The epidemiology of a coronary waiting list. A description of all of the patients.

OBJECTIVES: To describe the characteristics and the severity of symptoms amongst patients on the waiting list for possible coronary revascularization. DESIGN: All the patients were sent a postal questionnaire for symptom evaluation. SETTING: All hospitals in western Sweden. SUBJECTS: All patients in western Sweden on the waiting list in September 1990, who had been referred for coronary angiography or revascularization (n = 904) and a sex- and age-matched reference group (n = 809). RESULTS: More than half of the patients had daily attacks of chest pain, whereas 16% reported less than one attack per week or no pain at all. However, other symptoms such as dyspnoea, tachycardia and nervous reactions were also common and 25% of all patients used sedatives. A long waiting time for a given procedure was not associated with more pain but with more nervous symptoms such as restlessness and insomnia (P < 0.0001) and greater use of sedatives and cigarettes (P < 0.05). CONCLUSIONS: We conclude that a long waiting time for possible coronary revascularization is associated with more nervous symptoms but not with more pain.

Adult↗

PubMed1994

[The consideration and execution of the principles of no restraint and open door strategies in Hungarian psychiatry].

In order to understand the problems and dilemmas of Hungarian psychiatry regarding no-restraint, and open-door strategy, it is indispensable to comprehend the 18th century beginnings, the original principles and objectives of this healing approach. The first representatives of this method appeared between the second half of the 18th century, (V. Chiaruggi, Ph. Pinel, W. Tuke), and the first half of the 19th century (E.D. Esquirol, B.A. Morel, V. Magnan, J. Conolly), during the times when the main principles of keeping the mentally ill in asylums were those of security, guarding and separation. There were four reasons which led to the elaboration of restraint itself: (a) overcrowded institutes; (b) high proportion of restless and agitated patients among the sick-population; (c) outnumbered and undereducated medical staff; (d) and that the typical method of contemporary psychiatry preferred to apply sudden, unexpected and drastic effects assuming their healing power. As a result mechanical restraint was developed with a wide variety of means, regarding always as a principal objective to keep the patient isolated from the rest of society, and to obstruct him or her to make any harm either to himself or herself, or to the others. Thus restraint consisted of all forms of coercive and restrictive measures, such as mere physical limitation of motion, meals, relaxation, sleep, intellectual activities, and any other forms of personal liberty there might be. Consequently, the program of no-restraint intended to get rid of all of these measures and to guarantee the greatest possible level of liberty for the patients. This guiding principle of no-restraint appeared in the methods of psychiatric therapy, the objectives for the reorganization of psychiatric institutes, and in the legal actions taken to secure the civil rights of the mentally ill through parliamentary enactment. The realization of open door strategy belongs to the development of no-restraint in a wider sense. Just like in other countries the elaboration of this method--with more or less success--has been started in Hungary at the end of the last century as well, and is still in progress. The cardinal principle of this method is not to keep the doors of mental hospitals or wards by all means open, but to create a social milieu, an atmosphere in which any further harm for the patients that may occur as a result of their residence, are likely to be avoided. The open door strategy stands not for an unlimited but the greatest possible level of liberty for the mentally ill ... To sum up, we can conclude that the introduction of no-restraint systems was beneficial in the history of Hungarian psychiatry for the mentally insane, but only in those cases, when the cardinal principles of this method were adequately understood, and when it had been realized that for whom, when, and in what extent it could be applied. In other words, when the barriers of no-restraint were recognized.

History, 18th Century↗

PubMed1996

Topical anaesthesia in neonatal circumcision: a study of 208 consecutive cases.

OBJECTIVE: To assess the suitability and effectiveness of EMLA cream (a eutectic mixture of lignocaine and prilocaine) as a topical anaesthetic for routine neonatal circumcision. DESIGN: A clinical trial of EMLA cream was conducted on 208 consecutive routine neonatal circumcisions. All circumcisions were performed by the Plastibell technique with prior use of EMLA anaesthetic cream. Results were obtained by intra-operative observation and follow-up questionnaire answered by parents. RESULTS: There was a marked decrease in crying during the procedure. In infants under the age of 7 months, 99.0% fed immediately, 96.0% settled rapidly and remained settled, 96.5% had no disturbance of sleep pattern, 92.5% had little or no pain and 96.0% had no pain or difficulty when urinating. None required stronger analgesia than paracetamol. Infants over the age of 7 months had more difficulty settling; however, their discomfort was no different from that seen in infants of similar age who were circumcised using general anaesthesia. There were no 'serious' complications and only 3.5% had minor complications. There were no side effects or complications attributable to the EMLA cream. CONCLUSION: EMLA anaesthetic cream, properly applied, is a safe and effective method of anaesthesia for circumcision of neonates to 7 months of age. It reduces or eliminates pain, restlessness, agitation and interference with parent bonding. The common practice (in Australia) of suggesting that parents postpone circumcision until the child is suitable for general anaesthesia should be seriously questioned.

Administration, Topical↗

PubMed1989

[Postoperative transitory syndrome and delirium].

In this review we discuss the symptoms, etiology and therapy of reversible organic mental disorders following surgery. Acute confusional states and delirium still pose difficult and unsolved problems in our operative wards and intensive care units. They are a major cause of morbidity and mortality following geriatric surgery. It is necessary to keep a watchful eye for signs of mild cerebral impairment. Slight disorientation, minor fear, depression or delusions can be the first step towards an aggressive or delirious restlessness. Changes in cognitive skills and a reduction in the operative level are useful guidelines. In most cases more than one etiological factor contributes to the psychopathology. The list of possible causes is long and the frequency and importance varies greatly. Preexisting dementia, unrecognized hypoxia, massive surgical procedures, extracorporeal circulation during cardiac surgery, drug and alcohol withdrawal, infections and the use of multiple medications with cerebral side effects can all interfere. A total, but reversible cerebral alteration or sometimes local damage with neurological dysfunction is thought to be part of the pathomechanism. Disorders of the blood-brain barrier, changes in transmitter turnover, disturbances in the circadian rhythm and REM sleep phases are also being considered. When attempting to make a diagnosis, one should look for signs of neurological damage, withdrawal reactions and exclude or verify major or menacing etiological factors. The therapeutic strategy consists of treatment of the underlying organic diseases, consistent and attentive care that provides orientation and support, and carefully selected medication. The change in pharmacokinetics during old age, and the anticholinergic or other confusion-inducing properties in drugs should be remembered. The administration of either minor or major tranquilizers should be in accordance with a clear treatment strategy.

Delirium↗

PubMed1987

Progression of neuropsychological deficits following toluene diisocyanate exposure.

Three wharf workers were acutely exposed to toluene diisocyanate (TDI) during an accidental chemical spill. Toluene is neurotoxic as a solvent, while cyanates can cause nervous tissue injury or death by hypoxia. Chronic symptoms which occurred following the incident included headache, fatigue, concentration problems, irritability, depression, sleep disturbance, memory and sexual dysfunction. Compared with two months post-exposure, at 16 months post-exposure Full Scale IQ dropped an average of 23 points. Results from additional neuropsychological testing at 16 months post-exposure indicated severe deficits in all three subjects in memory, manual dexterity, visuomotor tracking, mental flexibility, ability to detect figure-ground relationships, and word fluency. Nerve conduction velocity testing indicated abnormal peripheral nervous system function in two of the three workers; however, its etiology is not certain. These results may be relevant to the neurotoxicity of methyl isocyanate exposure, such as occurred in Bhopal, India, where an increasing magnitude of depression, anxiety, fatigue, restlessness, and headaches 18 months post-exposure have been reported. In general, continuing decrement in mental function without concomitant environmental exposure should be considered in neuropsychological assessment of chemical toxicity.

Journal Article↗

PubMed1975

Nutrition, behavioral development, and mother-child interaction in young rural children.

In a poor rural community two groups of 17 mother-child units each were studied longitudinally. One group followed the usual feeding habits of the community which result in undernutrition of the child. The other group was provided food supplementation which was sufficient to provide an adequate diet for the child. From the 24th week on, the supplemented children developed a different pattern of interaction with mother and the environment: they slept less, barely used the cradle during the day, played more in the yard, and refused to be carried wrapped up. After the 36th week they received more stimuli and more deferences and rewards, not only from the mother but from the father as well. At 18 months the supplemented children moved about six times as much as the nonsupplemented and exhibited more complex behavior. They were more restless, playful, demanding, disobedient. It is concluded that better nutrition caused an increase in the activity of the child, which made him more demanding, which in turn increased interaction with his mother and established a feedback system, which in turn modified his behavior.

Breast Feeding↗

PubMed2004

Restless legs syndrome: clinical experience with long-term treatment.

BACKGROUND AND PURPOSE: There are limited data on long-term treatment efficacy, and almost none on predictors of treatment response in patients with restless legs syndrome (RLS). To assess: (1) long-term efficacy of RLS treatment in a clinical setting, (2) predictors of a good treatment response, and (3) the value of the RLS-severity score according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG). PATIENTS AND METHODS: Over three years 70 patients (36 men, 34 women; mean age: 59 years; range: 29-79) with RLS were prospectively assessed. Diagnosis of RLS was made according to international criteria Severity of RLS symptoms was were assessed at the outset by the IRLSSG rating scale. Treatment was chosen individually according to clinical judgement. After a mean follow-up time of 16 months (range: 1-106 months) evolution of symptoms was assessed by both overall clinical impression and IRLSSG rating scale. Clinical characteristics and treatment effect were compared between patients never treated for RLS before this study ('naïve'=N-pts) and those with previous treatment ('treated'=T-pts). Predictors of treatment response were sought for comparing patients with good treatment response (good, better or much better on follow-up) and those with bad (B-pts) treatment response. RESULTS: There were 40 N-pts and 30 T-pts. The mean IRLSSG score (hereinafter, IRLSSG) at baseline was 26 (range 12-38). No significant differences were found between N-and T-pts in age, gender, etiology and duration of RLS, positive family history, presenting sleep complaint, IRLSSG, or percentage of patients with periodic limb movements in sleep (PLMS) on polysomnography (PSG). At final follow-up 30 (76%) of 40 N-pts and 23 (77%) of 30 T-pts had a good (G-pts) treatment response. The mean IRLSSG at follow-up was 19 (range:1-36). There was a significant correlation between improvement of overall clinical impression (better or much better on final follow-up) and reduction of IRLSSG (P<0.0001). PLMS were more common in B- than G-pts (100 vs 58% of patients, P=0.02). In all other variables considered the two groups were similar. CONCLUSION: (1) A good long-term treatment response can be obtained and maintained in a clinical setting in about 80% of RLS patients. (2) Patients with RLS and without PLMS may have a better long-term treatment response, and (3) the IRLSSG is a useful tool for assessment of evolution of RLS symptoms over time in individual patients.

Adult↗