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Belke M, Heverhagen JT, Keil B, Rosenow F, Oertel WH, Stiasny-Kolster K, Knake S, Menzler K. DTI and VBM reveal white matter changes without associated gray matter changes in patients with idiopathic restless legs syndrome. Brain Behav 2015; 5:e00327. [PMID: 26442748 PMCID: PMC4589804 DOI: 10.1002/brb3.327] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/26/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND PURPOSE We evaluated cerebral white and gray matter changes in patients with iRLS in order to shed light on the pathophysiology of this disease. METHODS Twelve patients with iRLS were compared to 12 age- and sex-matched controls using whole-head diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) techniques. Evaluation of the DTI scans included the voxelwise analysis of the fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). RESULTS Diffusion tensor imaging revealed areas of altered FA in subcortical white matter bilaterally, mainly in temporal regions as well as in the right internal capsule, the pons, and the right cerebellum. These changes overlapped with changes in RD. Voxel-based morphometry did not reveal any gray matter alterations. CONCLUSIONS We showed altered diffusion properties in several white matter regions in patients with iRLS. White matter changes could mainly be attributed to changes in RD, a parameter thought to reflect altered myelination. Areas with altered white matter microstructure included areas in the internal capsule which include the corticospinal tract to the lower limbs, thereby supporting studies that suggest changes in sensorimotor pathways associated with RLS.
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Affiliation(s)
- Marcus Belke
- Department of Neurology, Philipps-University MarburgBaldingerstrasse, Marburg, 35043, Germany
| | - Johannes T Heverhagen
- Department of Diagnostic Radiology, Philipps-University MarburgBaldingerstrasse, Marburg, 35043, Germany
| | - Boris Keil
- Department of Diagnostic Radiology, Philipps-University MarburgBaldingerstrasse, Marburg, 35043, Germany
| | - Felix Rosenow
- Department of Neurology, Philipps-University MarburgBaldingerstrasse, Marburg, 35043, Germany
- Epilepsy Center Franfurt Rhein-Main, Department of Neurology, Johann Wolfgang Goethe UniversityFrankfurt am Main, Germany
| | - Wolfgang H Oertel
- Department of Neurology, Philipps-University MarburgBaldingerstrasse, Marburg, 35043, Germany
| | - Karin Stiasny-Kolster
- Department of Neurology, Philipps-University MarburgBaldingerstrasse, Marburg, 35043, Germany
- Somnomar, Institute for Medical Research and Sleep Medicine MarburgMarburger Strasse 9a, Marburg, 35043, Germany
| | - Susanne Knake
- Department of Neurology, Philipps-University MarburgBaldingerstrasse, Marburg, 35043, Germany
| | - Katja Menzler
- Department of Neurology, Philipps-University MarburgBaldingerstrasse, Marburg, 35043, Germany
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Marconi S, Scarlatti F, Rizzo G, Antelmi E, Innamorati M, Pompili M, Brugnoli R, Belvederi Murri M, Amore M, Provini F. Is nocturnal eating in restless legs syndrome linked to a specific psychopathological profile? A pilot study. J Neural Transm (Vienna) 2015; 122:1563-71. [DOI: 10.1007/s00702-015-1435-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
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Moon HJ, Chang Y, Lee YS, Song H, Chang HW, Ku J, Allen RP, Earley CJ, Cho YW. A comparison of MRI tissue relaxometry and ROI methods used to determine regional brain iron concentrations in restless legs syndrome. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:341-50. [PMID: 26257527 PMCID: PMC4525804 DOI: 10.2147/mder.s83629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Magnetic resonance imaging relaxometry studies differed on the relaxometry methods and their approaches to determining the regions of interest (ROIs) in restless legs syndrome (RLS) patients. These differences could account for the variable and inconsistent results found across these studies. The aim of this study was to assess the relationship between the different relaxometry methods and different ROI approaches using each of these methods on a single population of controls and RLS subjects. Methods A 3.0-T magnetic resonance imaging with the gradient-echo sampling of free induction decay and echo pulse sequence was used. The regional brain “iron concentrations” were determined using three relaxometry metrics (R2, R2*, and R2′) through two different ROI methods. The substantia nigra (SN) was the primary ROI with red nucleus, caudate, putamen, and globus pallidus as the secondary ROIs. Results Thirty-seven RLS patients and 40 controls were enrolled. The iron concentration as determined by R2 did not correlate with either of the other two methods, while R2* and R2′ showed strong correlations, particularly for the substantia nigra and red nucleus. In the fixed-shape ROI method, the RLS group showed a lower iron index compared to the control group in the substantia nigra and several other regions. With the semi-automated ROI method, however, only the red nucleus showed a significant difference between the two groups. Conclusion Both the relaxometry and ROI determination methods significantly influenced the outcome of studies that used these methods to estimate regional brain iron concentrations.
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Affiliation(s)
- Hye-Jin Moon
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yongmin Chang
- Department of Molecular Medicine, Kyungpook National University and Hospital, Daegu, Republic of Korea
| | - Yeong Seon Lee
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Huijin Song
- Department of Medical and Biological Engineering, Kyungpook National University and Hospital, Daegu, Republic of Korea
| | - Hyuk Won Chang
- Department of Radiology, Keimyung University, Daegu, Republic of Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Richard P Allen
- Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
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Abstract
Neuroimaging studies are of crucial relevance in defining the pathophysiology of restless legs syndrome (RLS). MRI studies showed no structural brain lesions and confirmed a central iron deficiency. Structural and functional studies showed an involvement of the thalamus, sensorimotor cortical areas, and cerebellum in RLS and assessed neurotransmission abnormalities in the dopaminergic and opiate systems. Finally, glutamatergic hyperactivity has been proposed as a cause of disrupted and shortened sleep in RLS. Differences among the results of the studies make it difficult to draw any definitive conclusions, thus, suggesting the need for future research.
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Affiliation(s)
- Federica Provini
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura 3, Bologna 40139, Italy; IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.
| | - Giacomo Chiaro
- Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura 3, Bologna 40139, Italy
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Mapping intrinsic functional brain changes and repetitive transcranial magnetic stimulation neuromodulation in idiopathic restless legs syndrome: a resting-state functional magnetic resonance imaging study. Sleep Med 2015; 16:785-91. [DOI: 10.1016/j.sleep.2014.12.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/11/2014] [Accepted: 12/29/2014] [Indexed: 11/17/2022]
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Wijemanne S, Jankovic J. Restless legs syndrome: clinical presentation diagnosis and treatment. Sleep Med 2015; 16:678-90. [PMID: 25979181 DOI: 10.1016/j.sleep.2015.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/27/2022]
Abstract
Restless legs syndrome (RLS) is a circadian disorder of sensory-motor integration that may be related to genetically determined dysregulation of iron transport across the blood-brain barrier. Dopamine agonists (DAs) have been considered the first-line therapy, but with the growing appreciation of problems associated with long-term treatment, particularly augmentation and impulse control disorder, alpha-2-delta drugs, such as gabapentin, are now considered the first line of treatment in patients with troublesome RLS. Opioids can be considered as an alternative therapy, particularly in patients with DA-related augmentation. In more severe cases, a combination therapy may be required. Intravenous iron therapy may be considered on those patients with refractory RLS.
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Affiliation(s)
- Subhashie Wijemanne
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA.
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Reinhard MA, Regen W, Baglioni C, Nissen C, Feige B, Hennig J, Riemann D, Spiegelhalder K. The relationship between brain morphology and polysomnography in healthy good sleepers. PLoS One 2014; 9:e109336. [PMID: 25275322 PMCID: PMC4183695 DOI: 10.1371/journal.pone.0109336] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/22/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Normal sleep continuity and architecture show remarkable inter-individual variability. Previous studies suggest that brain morphology may explain inter-individual differences in sleep variables. METHOD Thirty-eight healthy subjects spent two consecutive nights at the sleep laboratory with polysomnographic monitoring. Furthermore, high-resolution T1-weighted MRI datasets were acquired in all participants. EEG sleep recordings were analyzed using standard sleep staging criteria and power spectral analysis. Using the FreeSurfer software for automated segmentation, 174 variables were determined representing the volume and thickness of cortical segments and the volume of subcortical brain areas. Regression analyses were performed to examine the relationship with polysomnographic and spectral EEG power variables. RESULTS The analysis did not provide any support for the a-priori formulated hypotheses of an association between brain morphology and polysomnographic variables. Exploratory analyses revealed that the thickness of the left caudal anterior cingulate cortex was positively associated with EEG beta2 power (24-32 Hz) during REM sleep. The volume of the left postcentral gyrus was positively associated with periodic leg movements during sleep (PLMS). CONCLUSIONS The function of the anterior cingulate cortex as well as EEG beta power during REM sleep have been related to dreaming and sleep-related memory consolidation, which may explain the observed correlation. Increased volumes of the postcentral gyrus may be the result of increased sensory input associated with PLMS. However, due to the exploratory nature of the corresponding analyses, these results have to be replicated before drawing firm conclusions.
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Affiliation(s)
- Matthias A. Reinhard
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Wolfram Regen
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Chiara Baglioni
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Jürgen Hennig
- Department of Diagnostic Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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Ruppert E, Kilic-Huck U, Wolff V, Tatu L, Ghobadi M, Bataillard M, Bourgin P. Restless legs syndrome as a first manifestation of a cerebral infarct. J Clin Sleep Med 2014. [PMID: 25142775 DOI: 10.5664/jcsm.4048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The onset of restless legs syndrome (RLS) is usually progressive and the neural substrates underlying its pathophysiology remain to be identified. Here we report on a patient presenting with acute-onset RLS that was symptomatic of a right anteromedial pontine infarction. This case is exceptional because RLS appeared several hours before the occurrence of a regressive dysarthria clumsy-hand syndrome. Additionally, millimetric MRI sections showed that the structures possibly involved in RLS pathogenesis were the corticospinal tract, the pontine nuclei, and the pontocerebellar fibers. Although this is uncommon, clinicians should be aware that RLS characterized by a sudden onset can be a clinical manifestation related to stroke.
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Pan P, Dai Z, Shang H, Xiao P, Dong C, Song W, Zhou G, Zhong J, Shi H. Gray matter anomalies in anterior cingulate cortex as a correlate of depressive symptoms in drug-naïve idiopathic restless legs syndrome. Neuroscience 2014; 277:1-5. [DOI: 10.1016/j.neuroscience.2014.06.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/19/2014] [Accepted: 06/19/2014] [Indexed: 01/18/2023]
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Gray matter alteration in patients with restless legs syndrome: a voxel-based morphometry study. Clin Imaging 2014; 39:20-5. [PMID: 25176196 DOI: 10.1016/j.clinimag.2014.07.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/27/2014] [Accepted: 07/22/2014] [Indexed: 01/18/2023]
Abstract
The purpose of this study was to demonstrate whether or not restless legs syndrome (RLS) is associated with any morphological change in gray matter. Forty-six RLS subjects and 46 controls were enrolled. We performed voxel-based morphometry analysis and compared the results of the two groups. The RLS subjects showed significant regional decreases of gray matter volume in the left hippocampal gyrus, both parietal lobes, medial frontal areas and cerebellum (uncorrected, P<.001). We found that RLS patients showed structural alteration in the brain and alterations in certain parts of the brain in RLS patients are relevant to RLS.
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Moon HJ, Chang Y, Lee YS, Song HJ, Chang HW, Ku J, Cho YW. T2 relaxometry using 3.0-tesla magnetic resonance imaging of the brain in early- and late-onset restless legs syndrome. J Clin Neurol 2014; 10:197-202. [PMID: 25045371 PMCID: PMC4101095 DOI: 10.3988/jcn.2014.10.3.197] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/12/2013] [Accepted: 12/02/2013] [Indexed: 01/13/2023] Open
Abstract
Background and Purpose Previous T2 relaxometry studies have provided evidence for regional brain iron deficiency in patients with restless legs syndrome (RLS). Measurement of the iron content in several brain regions, and in particular the substantia nigra (SN), in early- and late-onset RLS patients using T2 relaxometry have yielded inconsistent results. In this study the regional iron content was assessed in patients with early- and late-onset RLS using magnetic resonance imaging (MRI), and compared the results with those in controls. Methods Thirty-seven patients with idiopathic RLS (20 with early onset and 17 with late onset) and 40 control subjects were studied using a 3.0-tesla MRI with a gradient-echo sampling of free induction decay and echo pulse sequence. The regions of interest in the brain were measured independently by two trained analysts using software known as medical image processing, analysis, and visualization. The results were compared and a correlation analysis was conducted to investigate which brain areas were related to RLS clinical variables. Results The iron index in the SN was significantly lower in patients with late-onset RLS than in controls (p=0.034), while in patients with early-onset RLS there was no significant difference. There was no significant correlation between the SN iron index of the late-onset RLS group and clinical variables such as disease severity. Conclusions Late-onset RLS is associated with decreased iron content in the SN. This finding supports the hypothesis that regional brain iron deficiency plays a role in the pathophysiology of late-onset RLS.
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Affiliation(s)
- Hye-Jin Moon
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yongmin Chang
- Department of Molecular Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yeong Seon Lee
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hee Jin Song
- Department of Medical & Biological Engineering, Kyungpook National University Hospital, Daegu, Korea
| | - Hyuk Won Chang
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Winkelman JW, Schoerning L, Platt S, Jensen JE. Restless legs syndrome and central nervous system gamma-aminobutyric acid: preliminary associations with periodic limb movements in sleep and restless leg syndrome symptom severity. Sleep Med 2014; 15:1225-30. [PMID: 25129262 DOI: 10.1016/j.sleep.2014.05.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/06/2014] [Accepted: 05/14/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous research has demonstrated abnormalities in glutamate and N-acetyl aspartate (NAA) in the thalamus in individuals with restless legs syndrome (RLS) compared with healthy matched controls. However, levels of these transmitters in other RLS-related brain areas and levels of the most common inhibitory neurotransmitter, gamma-aminobutyric acid (GABA), have not been assessed. METHODS This study examined GABA, glutamate, and NAA levels in the dorsal anterior cingulate cortex (ACC), thalamus and cerebellum with the use of proton magnetic resonance spectroscopy ((1)H-MRS) at 4 tesla (4 T) and Megapress difference-editing in 18 subjects with RLS and a matched control group without RLS. Actigraphy was performed on the nights before scans to assess periodic limb movements of sleep (PLMS). RESULTS Levels of GABA, glutamate, and NAA were no different between RLS and control subjects in any of the three voxels of interest. However, GABA levels were positively correlated with both PLM indices and RLS severity in the thalamus and negatively with both of these measures in the cerebellum in RLS subjects. In addition, NAA levels were higher in the ACC in RLS than in controls. CONCLUSION Our preliminary data suggest that known cerebellar-thalamic interactions may modulate the intensity of RLS sensory and motor symptoms. In addition, anterior cingulate cortex may be associated with the affective components of the painful symptoms in this disorder.
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Affiliation(s)
- John W Winkelman
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Departments of Psychiatry and Neurology, Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Boston, MA, USA.
| | - Laura Schoerning
- Departments of Psychiatry and Neurology, Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Sam Platt
- Departments of Psychiatry and Neurology, Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - J Eric Jensen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Brain Imaging Center, McLean Hospital, Boston, MA, USA
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Schulte EC, Kaffe M, Schormair B, Winkelmann J. Iron in Restless Legs Syndrome. Mov Disord Clin Pract 2014; 1:161-172. [PMID: 30363981 DOI: 10.1002/mdc3.12047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/07/2014] [Accepted: 04/18/2014] [Indexed: 12/14/2022] Open
Abstract
A link between restless legs syndrome (RLS) and iron has been recognized for several decades. Yet, the precise role that iron or other components of iron metabolism play in bringing about RLS is still a matter of debate. During the last few years, many new pieces of evidence from genetics, pathology, imaging, and clinical studies have surfaced. However, the way this evidence fits into the larger picture of RLS as a disease is not always easily understood. To provide a better understanding of the complex interplay between iron metabolism and RLS and highlight areas that need further elucidation, we systematically and critically review the current literature on the role of iron in RLS pathophysiology and treatment with a special emphasis on genetics, neuropathology, cell and animal models, imaging studies, and therapy.
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Affiliation(s)
- Eva C Schulte
- Neurologische Klinik und Poliklinik Klinikum rechts der Isar Technische Universität München Munich Germany.,Institut für Humangenetik Helmholtz Zentrum München Munich Germany.,Institut für Humangenetik Klinikum rechts der Isar Technische Universität München Munich Germany
| | - Maria Kaffe
- Neurologische Klinik und Poliklinik Klinikum rechts der Isar Technische Universität München Munich Germany.,Institut für Humangenetik Klinikum rechts der Isar Technische Universität München Munich Germany
| | - Barbara Schormair
- Institut für Humangenetik Helmholtz Zentrum München Munich Germany.,Institut für Humangenetik Klinikum rechts der Isar Technische Universität München Munich Germany
| | - Juliane Winkelmann
- Neurologische Klinik und Poliklinik Klinikum rechts der Isar Technische Universität München Munich Germany.,Institut für Humangenetik Helmholtz Zentrum München Munich Germany.,Institut für Humangenetik Klinikum rechts der Isar Technische Universität München Munich Germany.,Munich Cluster for Systems Neurology (SyNergy) Munich Germany
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Neuroscience-driven discovery and development of sleep therapeutics. Pharmacol Ther 2014; 141:300-34. [DOI: 10.1016/j.pharmthera.2013.10.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 10/25/2013] [Indexed: 01/18/2023]
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Gupta PK, Gupta RK, Garg RK, Rai Y, Roy B, Pandey CM, Malhotra HS, Narayana PA. DTI correlates of cognition in conventional MRI of normal-appearing brain in patients with clinical features of subacute combined degeneration and biochemically proven vitamin B(12) deficiency. AJNR Am J Neuroradiol 2013; 35:872-7. [PMID: 24263693 DOI: 10.3174/ajnr.a3785] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vitamin B12 deficiency may cause neural injury that results in cognitive deficits. The main purpose of our study was to evaluate morphometric and microstructural changes in the brain and relate them to cognition in subacute combined degeneration of the spinal cord and patients with biochemically deficient vitamin B12. MATERIALS AND METHODS Fifty-one patients were recruited and underwent nerve-conduction velocity tests and routine hematologic examinations. Serum vitamin B12 and homocystine levels were also measured. All patients and 46 age- and sex-matched controls underwent cervical spine and brain MR imaging along with cognition tests. MR imaging included conventional scans and DTI. Voxel-based morphometry was performed for determining the WM and GM volumes, based on T1-weighted images. DTI measures that included fractional anisotropy, ADC, radial diffusivity, and axial diffusivity were determined by using tract-based statistics. RESULTS None of the patients showed any abnormality on conventional MR imaging. No significant changes in GM and WM volumes were observed in patients compared with controls. Significant reductions in the fractional anisotropy and an increase in ADC and radial diffusivity values were observed in multiple brain regions in patients compared with controls. These changes were confirmed on the region-of-interest analysis. Neuropsychological scores were significantly different in patients compared with controls and showed significant correlation with fractional anisotropy and radial diffusivity in a few brain regions. CONCLUSIONS Microstructural changes are seen in WM regions on DTI in patients with vitamin B12 deficiency and correlate with cognition scores. DTI can be used for objective assessment of microstructural changes in the brain in vitamin B12 deficiency.
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Affiliation(s)
- P K Gupta
- From the Department of Neurology (P.K.G., R.K.Garg, H.S.M.), King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R K Gupta
- Department of Radiology and Imaging (R.K.Gupta, B.R.), Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - R K Garg
- From the Department of Neurology (P.K.G., R.K.Garg, H.S.M.), King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Y Rai
- Department of Radiodiagnosis (Y.R.)
| | - B Roy
- Department of Radiology and Imaging (R.K.Gupta, B.R.), Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - C M Pandey
- Biostatistics (C.M.P.), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - H S Malhotra
- From the Department of Neurology (P.K.G., R.K.Garg, H.S.M.), King George's Medical University, Lucknow, Uttar Pradesh, India
| | - P A Narayana
- Department of Diagnostic and Interventional Imaging (P.A.N.), University of Texas Medical School at Houston, Houston, Texas
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Nardone R, Höller Y, Brigo F, Tezzon F, Golaszewski S, Trinka E. Transcranial magnetic stimulation and sleep disorders: pathophysiologic insights. Sleep Med 2013; 14:1047-58. [PMID: 24051115 DOI: 10.1016/j.sleep.2013.04.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/28/2013] [Accepted: 04/30/2013] [Indexed: 01/15/2023]
Abstract
The neural mechanisms underlying the development of the most common intrinsic sleep disorders are not completely known. Therefore, there is a great need for noninvasive tools which can be used to better understand the pathophysiology of these diseases. Transcranial magnetic stimulation (TMS) offers a method to noninvasively investigate the functional integrity of the motor cortex and its corticospinal projections in neurologic and psychiatric diseases. To date, TMS studies have revealed cortical and corticospinal dysfunction in several sleep disorders, with cortical hyperexcitability being a characteristic feature in some disorders (i.e., the restless legs syndrome) and cortical hypoexcitability being a well-established finding in others (i.e., obstructive sleep apnea syndrome narcolepsy). Several research groups also have applied TMS to evaluate the effects of pharmacologic agents, such as dopaminergic agent or wake-promoting substances. Our review will focus on the mechanisms underlying the generation of abnormal TMS measures in the different types of sleep disorders, the contribution of TMS in enhancing the understanding of their pathophysiology, and the potential diagnostic utility of TMS techniques. We also briefly discussed the possible future implications for improving therapeutic approaches.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
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Imaging Brain Functional and Metabolic Changes in Restless Legs Syndrome. Curr Neurol Neurosci Rep 2013; 13:372. [DOI: 10.1007/s11910-013-0372-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Rizzo G, Manners D, Testa C, Tonon C, Vetrugno R, Marconi S, Plazzi G, Pizza F, Provini F, Malucelli E, Gramegna LL, Lodi R. Low brain iron content in idiopathic restless legs syndrome patients detected by phase imaging. Mov Disord 2013; 28:1886-90. [DOI: 10.1002/mds.25576] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/29/2013] [Accepted: 05/09/2013] [Indexed: 01/12/2023] Open
Affiliation(s)
- Giovanni Rizzo
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - David Manners
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
| | - Claudia Testa
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
| | - Caterina Tonon
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
| | | | - Sara Marconi
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - Giuseppe Plazzi
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - Fabio Pizza
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - Federica Provini
- Neurology Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
- “IRCCS Istituto delle Scienze Neurologiche di Bologna,”; Bologna Italy
| | - Emil Malucelli
- Department of Pharmacy and Biotechnology; University of Bologna; Bologna Italy
| | - Laura Ludovica Gramegna
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
| | - Raffaele Lodi
- Functional MR Unit; Department of Biomedical and NeuroMotor Sciences (DiBiNeM); University of Bologna; Bologna Italy
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Millichap JG. Thalamic Metabolism and Restless Legs Syndrome. Pediatr Neurol Briefs 2013. [DOI: 10.15844/pedneurbriefs-27-1-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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