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Silvani A, Ghorayeb I, Manconi M, Li Y, Clemens S. Putative Animal Models of Restless Legs Syndrome: A Systematic Review and Evaluation of Their Face and Construct Validity. Neurotherapeutics 2023; 20:154-178. [PMID: 36536233 PMCID: PMC10119375 DOI: 10.1007/s13311-022-01334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Restless legs syndrome (RLS) is a sensorimotor disorder that severely affects sleep. It is characterized by an urge to move the legs, which is often accompanied by periodic limb movements during sleep. RLS has a high prevalence in the population and is usually a life-long condition. While its origins remain unclear, RLS is initially highly responsive to treatment with dopaminergic agonists that target D2-like receptors, in particular D2 and D3, but the long-term response is often unsatisfactory. Over the years, several putative animal models for RLS have been developed, mainly based on the epidemiological and neurochemical link with iron deficiency, treatment efficacy of D2-like dopaminergic agonists, or genome-wide association studies that identified risk factors in the patient population. Here, we present the first systematic review of putative animal models of RLS, provide information about their face and construct validity, and report their role in deciphering the underlying pathophysiological mechanisms that may cause or contribute to RLS. We propose that identifying the causal links between genetic risk factors, altered organ functions, and changes to molecular pathways in neural circuitry will eventually lead to more effective new treatment options that bypass the side effects of the currently used therapeutics in RLS, especially for long-term therapy.
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Affiliation(s)
- Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Ravenna Campus, Ravenna, Italy
| | - Imad Ghorayeb
- Département de Neurophysiologie Clinique, Pôle Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, Université de Bordeaux, Bordeaux, France
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, CNRS, Bordeaux, France
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, EOC, Ospedale Civico, Lugano, Switzerland
- Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Yuqing Li
- Department of Neurology, College of Medicine, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Stefan Clemens
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
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Kalampokini S, Poyiadjis S, Vavougios GD, Artemiadis A, Zis P, Hadjigeorgiou GM, Bargiotas P. Restless legs syndrome due to brainstem stroke: A systematic review. Acta Neurol Scand 2022; 146:440-447. [PMID: 36063288 DOI: 10.1111/ane.13702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022]
Abstract
Restless Legs Syndrome (RLS) is a sleep-related movement disorder, which can also result from brainstem pathology. A systematic review of articles published in the electronic databases PubMed and Web of Science was conducted to summarize the existent literature on RLS associated with a brainstem stroke. We identified eight articles including 19 subjects with RLS due to brainstem ischemic lesion. The symptoms occurred simultaneously with the infarction (66.7%) or few days after (33.3%). The most common location of infarction was pons and less commonly medulla. In most cases (68.4%), symptoms were unilateral. In the majority of those cases (92.3%), the contralateral limb was affected due to a lateral pons infarction. RLS symptoms after infarction improved or resolved in almost 90% of cases within a few days up to 3 months. In almost all patients who received dopaminergic treatment (11 out of 13, 91.7%), the symptoms improved significantly or resolved completely. Screening for RLS has to be considered in patients suffering a brainstem stroke, particularly anteromedial pontine infarction. The appearance of acute unilateral RLS symptoms, usually in association with other sensorimotor deficits, should prompt the clinician to consider a vascular event in the brainstem. RLS in these cases seem to have a favorable outcome and respond well to dopaminergic treatment.
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Affiliation(s)
- Stefania Kalampokini
- Department of Neurology, Nicosia General Hospital and Medical school, University of Cyprus, Nicosia, Cyprus
| | | | - George D Vavougios
- Department of Neurology, Nicosia General Hospital and Medical school, University of Cyprus, Nicosia, Cyprus
| | - Artemios Artemiadis
- Department of Neurology, Nicosia General Hospital and Medical school, University of Cyprus, Nicosia, Cyprus
| | - Panagiotis Zis
- Department of Neurology, Nicosia General Hospital and Medical school, University of Cyprus, Nicosia, Cyprus
| | - Georgios M Hadjigeorgiou
- Department of Neurology, Nicosia General Hospital and Medical school, University of Cyprus, Nicosia, Cyprus
| | - Panagiotis Bargiotas
- Department of Neurology, Nicosia General Hospital and Medical school, University of Cyprus, Nicosia, Cyprus
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Sheng L, Zhao P, Ma H, Qi L, Yi Z, Shi Y, Zhong J, Shi H, Dai Z, Pan P. Grey matter alterations in restless legs syndrome: A coordinate-based meta-analysis. J Sleep Res 2021; 30:e13298. [PMID: 33554365 DOI: 10.1111/jsr.13298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/18/2023]
Abstract
Brain structural abnormalities in idiopathic restless legs syndrome have long been debated. Voxel-based morphometry is an objective structural magnetic resonance imaging technique to investigate regional grey matter volume or density differences between groups. In the last decade, voxel-based morphometry studies have exhibited inconsistent and conflicting findings regarding the presence and localization of brain grey matter alterations in restless legs syndrome. We therefore conducted a coordinate-based meta-analysis to quantitatively examine whether there were consistent grey matter findings in restless legs syndrome using the latest algorithms, seed-based d mapping with permutation of subject images. We included 12 voxel-based morphometry studies (13 datasets, 375 patients and 385 healthy controls). Our coordinate-based meta-analysis did not identify evidence of consistent grey matter alterations in restless legs syndrome. Grey matter alterations via voxel-based morphometry analysis are not therefore recommended to be used as a reliable surrogate neuroimaging marker for restless legs syndrome. This lack of consistency may be attributed to differences in sample size, genetics, gender distribution and age at onset, clinical heterogeneity (clinical course, anatomical distribution of symptoms, disease severity, disease duration, abnormal sensory profiles and comorbidity), and variations in imaging acquisition, data processing and statistical strategies. Longitudinal studies with multimodal neuroimaging techniques are needed to determine whether structural changes are dynamic and secondary to functional abnormalities.
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Affiliation(s)
- LiQin Sheng
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - PanWen Zhao
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - HaiRong Ma
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Liang Qi
- Second People's Hospital of Huai'an City, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - ZhongQuan Yi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - YuanYuan Shi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - HaiCun Shi
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - ZhenYu Dai
- Department of Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China.,Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
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Kocar TD, Müller HP, Kassubek J. Differential functional connectivity in thalamic and dopaminergic pathways in restless legs syndrome: a meta-analysis. Ther Adv Neurol Disord 2020; 13:1756286420941670. [PMID: 32821291 PMCID: PMC7412904 DOI: 10.1177/1756286420941670] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: Restless legs syndrome (RLS) is a sensorimotor disorder with alterations in somatosensory processing in association with a dysfunctional cerebral network, involving the basal ganglia, limbic network, and sensorimotor pathways. Resting state functional magnetic resonance imaging (MRI) is a powerful tool to provide in vivo insight into functional processing and as such is of special interest in RLS considering the widespread pattern of networks involved in this disorder. In this meta-analysis of resting state functional MRI studies, we analyzed the preponderance of functional connectivity changes associated with RLS and discussed possible links to sensorimotor dysfunction and somatosensory processing. Methods: A systematic research using the online library PubMed was conducted and a total of seven studies passed the inclusion criteria of the meta-analysis. The results of these studies were merged and a statistical probability map was generated that indicated the likelihood of functional connectivity changes within the combined cohort, both for increased and decreased connectivity. Results: The meta-analysis demonstrated decreased functional connectivity within the dopaminergic network in participants with RLS compared with healthy controls, including the nigrostriatal, mesolimbic, and mesocortical pathways. Increased functional connectivity was observed bilaterally in the thalamus, including its ventral lateral, ventral anterior, and ventral posterior lateral nuclei, and the pulvinar. Discussion: Sensorimotor dysfunction in RLS seems to be reflected by decreased functional connectivity within the dopaminergic pathways. Network extension in the thalamus can be regarded as an adaptation to somatosensory dysfunction in RLS. This differential functional connectivity pattern extends prior findings on cerebral somatosensory processing in RLS and offers an explanation for the efficacy of dopaminergic treatment.
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Affiliation(s)
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm, 89081, Germany
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Miller JS, Rodriguez-Saona L, Hackshaw KV. Metabolomics in Central Sensitivity Syndromes. Metabolites 2020; 10:E164. [PMID: 32344505 PMCID: PMC7240948 DOI: 10.3390/metabo10040164] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/11/2020] [Accepted: 04/19/2020] [Indexed: 01/09/2023] Open
Abstract
Central sensitization syndromes are a collection of frequently painful disorders that contribute to decreased quality of life and increased risk of opiate abuse. Although these disorders cause significant morbidity, they frequently lack reliable diagnostic tests. As such, technologies that can identify key moieties in central sensitization disorders may contribute to the identification of novel therapeutic targets and more precise treatment options. The analysis of small molecules in biological samples through metabolomics has improved greatly and may be the technology needed to identify key moieties in difficult to diagnose diseases. In this review, we discuss the current state of metabolomics as it relates to central sensitization disorders. From initial literature review until Feb 2020, PubMed, Embase, and Scopus were searched for applicable studies. We included cohort studies, case series, and interventional studies of both adults and children affected by central sensitivity syndromes. The majority of metabolomic studies addressing a CSS found significantly altered metabolites that allowed for differentiation of CSS patients from healthy controls. Therefore, the published literature overwhelmingly supports the use of metabolomics in CSS. Further research into these altered metabolites and their respective metabolic pathways may provide more reliable and effective therapeutics for these syndromes.
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Affiliation(s)
- Joseph S. Miller
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH 43016, USA;
| | - Luis Rodriguez-Saona
- Department of Food Science and Technology, Ohio State University, Columbus, OH 43210, USA;
| | - Kevin V. Hackshaw
- Department of Internal Medicine, Division of Rheumatology, Dell Medical School, The University of Texas, 1701 Trinity St, Austin, TX 78712, USA
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Doan TT, Koo BB, Ogilvie RP, Redline S, Lutsey PL. Restless legs syndrome and periodic limb movements during sleep in the Multi-Ethnic Study of Atherosclerosis. Sleep 2019; 41:5026504. [PMID: 29860522 DOI: 10.1093/sleep/zsy106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Indexed: 01/24/2023] Open
Abstract
Study Objectives To investigate the prevalence of concurrent periodic limb movements during sleep (PLMS) and restless leg syndrome (RLS), as well as the prevalence of PLMS and RLS separately. Additionally, we document these prevalences by age, race/ethnicity, sex, and obesity status. Methods Cross-sectional data from 2041 Multi-Ethnic Study of Atherosclerosis (MESA) Sleep ancillary study participants were used. PLMS (>15 periodic limb movements per hour of sleep) was measured by polysomnography. RLS symptoms were assessed using the 2009 International Restless Legs Syndrome Study Group clinical criteria. Results The prevalence of RLS with PLMS was 6.7%, RLS alone 16.1%, and PLMS alone 21.2%. RLS with PLMS was prevalent in 7.0% of whites, 4.9% of blacks, 10.1% of Hispanics, and 3.3% of Chinese-Americans. In adjusted models, odds of RLS with PLMS was higher for those older than 67 years versus those younger (odds ratio [OR] [95% confidence interval [CI]] = 1.62 [1.09-2.40]). Relative to white participants, the prevalence of RLS with PLMS tended to be lower among blacks (0.56 [0.32-0.96]). The prevalence of concurrent RLS and PLMS did not statistically differ by sex or obesity status. RLS alone was more common in women. Conclusions Approximately 7% of our sample had RLS with PLMS ("electro-clinical RLS"). This condition was more common among older individuals, did not vary by sex, and was less common among blacks. The findings provide some of the first information about the prevalence of concurrent RLS and PLMS in a community-based sample and show distinct sex and race associations for RLS versus electro-clinical RLS.
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Affiliation(s)
- Thu T Doan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Brian B Koo
- Department of Neurology, Yale University School of Medicine, New Haven, CT.,Department of Neurology, Connecticut Veterans Affairs Health System, West Haven, CT
| | - Rachel P Ogilvie
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Boston, MA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Li T, Liu C, Lyu H, Xu Z, Hu Q, Xu B, Wang Y, Xu J. Alterations of Sub-cortical Gray Matter Volume and Their Associations With Disease Duration in Patients With Restless Legs Syndrome. Front Neurol 2018; 9:1098. [PMID: 30619055 PMCID: PMC6304426 DOI: 10.3389/fneur.2018.01098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023] Open
Abstract
Object: The purpose of this study was to uncover the pathology of restless legs syndrome (RLS) by exploring brain structural alterations and their corresponding functional abnormality. Method: Surface-based morphometry (SBM) and voxel-based morphometry (VBM) were performed to explore the alterations in cortical and sub-cortical gray matter volume (GMV) in a cohort of 20 RLS and 18 normal controls (NC). Furthermore, resting-state functional connectivity (RSFC) was also performed to identify the functional alterations in patients with RLS. Results: We found significant alterations of sub-cortical GMV, especially the bilateral putamen (PUT), rather than alterations of cortical GMV in patients with RLS compared to NC using both SBM and VBM. Further sub-regional analysis revealed that GMV alterations of PUT was mostly located in the left dorsal caudal PUT in patients with RLS. In addition, altered RSFC patterns of PUT were identified in patients with RLS compared to NC. Moreover, correlation analyses showed that the GMV of the left caudate and the left ventral rostral PUT were positively correlated with disease duration in patients with RLS. Conclusions: The alterations of subcortical GMV might imply that the primarily affected areas are located in sub-cortical areas especially in the sub-region of PUT by the pathologic process of RLS, which might be used as potential biomarkers for the early diagnosis of RLS.
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Affiliation(s)
- Tian Li
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China.,Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chunyan Liu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Hanqing Lyu
- Radiology Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhexue Xu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bibo Xu
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
| | - Yuping Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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8
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Yang H, Wang L, Li X, Wang K, Hou Y, Zhang X, Chen Z, Liu C, Yin C, Wu S, Huang Q, Lin Y, Bao Y, Chen Y, Wang Y. A study for the mechanism of sensory disorder in restless legs syndrome based on magnetoencephalography. Sleep Med 2018; 53:35-44. [PMID: 30414507 DOI: 10.1016/j.sleep.2018.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
In spite of the relatively high incidence rate, the etiology and pathogenesis of restless legs syndrome (RLS) are still unclear. Long-term drug treatments fail to achieve satisfying curative effects, which is reflected by rebound and augmentation of related symptoms. An electrophysiological endophenotype experiment was done to investigate the mechanism of somatosensory disorder among RLS patients. Together with 15 normal subjects as the control group, with comparable ages and genders to the RLS patients, 15 primitive RLS patients were scanned by Magnetoencephalography (MEG) under natural conditions; furthermore, the somatosensory evoked magnetic field (SEF) with single and paired stimuli, was also measured. Compared to the control group, the SEF intensities of RLS patients' lower limbs were higher, and the paired-pulse depression (PPD) for SEF in RLS patients was attenuated. It was also revealed by time-frequency analysis of somatosensory induced oscillation (SIO) in RLS patients, that 93.3% of somatosensory induced Alpha (8-12 Hz) oscillations were successfully elicited, while 0% somatosensory induced Gamma (30-55 Hz) oscillations were elicited; which was significantly different from the control group. Additionally, in RLS patients exhibit increased excitability of the sensorimotor cortex, a remarkable abnormality existing in early somatosensory gating control (GC) and an attenuated inhibitory interneuron network, which consequently results in a compensatory mechanism through which RLS patients increase their attention-driven lower limb sensory gating control via somatosensory-induced Alpha (8-12 Hz) oscillation. This hyperexcitability, partially due to an electrocortical disinhibition, may have an important therapeutical implication, and become an important target of neuromodulatory interventions.
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Affiliation(s)
- Haoxiang Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Li Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Xin Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Kun Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Xiating Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Zheng Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Chunyan Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Chunli Yin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Siqi Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Qian Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Yan Bao
- Department of Nuclear Magnetic Resonance, Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yuanyuan Chen
- Department of Nuclear Magnetic Resonance, Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China.
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Ding D, Li P, Ma XY, Dun WH, Yang SF, Ma SH, Liu HJ, Zhang M. The relationship between putamen-SMA functional connectivity and sensorimotor abnormality in ESRD patients. Brain Imaging Behav 2017; 12:1346-1354. [DOI: 10.1007/s11682-017-9808-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Brain MR Contribution to the Differential Diagnosis of Parkinsonian Syndromes: An Update. PARKINSONS DISEASE 2016; 2016:2983638. [PMID: 27774334 PMCID: PMC5059618 DOI: 10.1155/2016/2983638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/08/2016] [Accepted: 09/01/2016] [Indexed: 12/26/2022]
Abstract
Brain magnetic resonance (MR) represents a useful and feasible tool for the differential diagnosis of Parkinson's disease. Conventional MR may reveal secondary forms of parkinsonism and may show peculiar brain alterations of atypical parkinsonian syndromes. Furthermore, advanced MR techniques, such as morphometric-volumetric analyses, diffusion-weighted imaging, diffusion tensor imaging, tractography, proton MR spectroscopy, and iron-content sensitive imaging, have been used to obtain quantitative parameters useful to increase the diagnostic accuracy. Currently, many MR studies have provided both qualitative and quantitative findings, reflecting the underlying neuropathological pattern of the different degenerative parkinsonian syndromes. Although the variability in the methods and results across the studies limits the conclusion about which technique is the best, specific radiologic phenotypes may be identified. Qualitative/quantitative MR changes in the substantia nigra do not discriminate between different parkinsonisms. In the absence of extranigral abnormalities, the diagnosis of PD is more probable, whereas basal ganglia changes (mainly in the putamen) suggest the diagnosis of an atypical parkinsonian syndrome. In this context, changes in pons, middle cerebellar peduncles, and cerebellum suggest the diagnosis of MSA, in midbrain and superior cerebellar peduncles the diagnosis of PSP, and in whole cerebral hemispheres (mainly in frontoparietal cortex with asymmetric distribution) the diagnosis of Corticobasal Syndrome.
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Rizzo G, Li X, Galantucci S, Filippi M, Cho YW. Brain imaging and networks in restless legs syndrome. Sleep Med 2016; 31:39-48. [PMID: 27838239 DOI: 10.1016/j.sleep.2016.07.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 01/18/2023]
Abstract
Several studies provide information useful to our understanding of restless legs syndrome (RLS), using various imaging techniques to investigate different aspects putatively involved in the pathophysiology of RLS, although there are discrepancies between these findings. The majority of magnetic resonance imaging (MRI) studies using iron-sensitive sequences supports the presence of a diffuse, but regionally variable low brain-iron content, mainly at the level of the substantia nigra, but there is increasing evidence of reduced iron levels in the thalamus. Positron emission tomography (PET) and single positron emission computed tomography (SPECT) findings mainly support dysfunction of dopaminergic pathways involving not only the nigrostriatal but also mesolimbic pathways. None or variable brain structural or microstructural abnormalities have been reported in RLS patients; reports are slightly more consistent concerning levels of white matter. Most of the reported changes were in regions belonging to sensorimotor and limbic/nociceptive networks. Functional MRI studies have demonstrated activation or connectivity changes in the same networks. The thalamus, which includes different sensorimotor and limbic/nociceptive networks, appears to have lower iron content, metabolic abnormalities, dopaminergic dysfunction, and changes in activation and functional connectivity. Summarizing these findings, the primary change could be the reduction of brain iron content, which leads to dysfunction of mesolimbic and nigrostriatal dopaminergic pathways, and in turn to a dysregulation of limbic and sensorimotor networks. Future studies in RLS should evaluate the actual causal relationship among these findings, better investigate the role of neurotransmitters other than dopamine, focus on brain networks by connectivity analysis, and test the reversibility of the different imaging findings following therapy.
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Affiliation(s)
- Giovanni Rizzo
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy; Unit of Neurology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Xu Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sebastiano Galantucci
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Yong Won Cho
- Department of Neurology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, South Korea.
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Lindemann K, Müller HP, Ludolph AC, Hornyak M, Kassubek J. Microstructure of the Midbrain and Cervical Spinal Cord in Idiopathic Restless Legs Syndrome: A Diffusion Tensor Imaging Study. Sleep 2016; 39:423-8. [PMID: 26446110 DOI: 10.5665/sleep.5456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 09/19/2015] [Indexed: 01/18/2023] Open
Abstract
STUDY OBJECTIVES Diffusion tensor imaging (DTI) allows the study of white matter microstructure in the central nervous system. The aim of this study was to examine the DTI metrics of the cervical spinal cord and the brainstem up to the midbrain in patients with idiopathic restless legs (RLS) compared to matched healthy controls. METHODS DTI analysis of the cervical spinal cord and the brainstem up into the midbrain was performed in 25 patients with idiopathic RLS and 25 matched healthy controls. Data analysis in the brain was performed by voxelwise comparison of fractional anisotropy (FA) maps at group level. Cervical spinal cord data analysis was performed by slicewise analysis of averaged FA values in axial slices along the spinal cord. RESULTS Voxelwise comparison of FA maps in the brainstem showed significant microstructural alterations in two clusters in the midbrain bilaterally. Slicewise comparison of the FA maps in the cervical spinal cord showed a trend for lower FA values at the level of the second and third vertebra area in the patient sample. CONCLUSIONS The imaging data suggest that significant alterations in the midbrain in RLS can be visualized by DTI and might correlate to a macroscopically subtle process with changes of the tissue microstructure in the corresponding tracts. An additional area of interest is regionally clustered in the upper cervical spinal cord with a tendency toward altered diffusion metrics. These results might be addressed by further studies, e.g., at higher magnetic field strengths.
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Affiliation(s)
| | | | | | - Magdolna Hornyak
- Department of Neurology, University of Ulm, Ulm, Germany.,Neuropsychiatrisches Zentrum Erding/München, Erding, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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Adisetiyo V, Helpern JA. Brain iron: a promising noninvasive biomarker of attention-deficit/hyperactivity disorder that warrants further investigation. Biomark Med 2015; 9:403-6. [DOI: 10.2217/bmm.15.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Vitria Adisetiyo
- Center for Biomedical Imaging, Department of Radiology & Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street MSC 323, Charleston, SC 29425, USA
| | - Joseph A Helpern
- Center for Biomedical Imaging, Department of Radiology & Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas Street MSC 323, Charleston, SC 29425, USA
- Department of Neuroscience, Medical University of South Carolina, 96 Jonathan Lucas Street MSC 323, Charleston, SC 29425, USA
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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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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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Adisetiyo V, Jensen JH, Tabesh A, Deardorff RL, Fieremans E, Di Martino A, Gray KM, Castellanos FX, Helpern JA. Multimodal MR imaging of brain iron in attention deficit hyperactivity disorder: a noninvasive biomarker that responds to psychostimulant treatment? Radiology 2014; 272:524-32. [PMID: 24937545 DOI: 10.1148/radiol.14140047] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To comprehensively assess brain iron levels in typically developing control subjects and patients with attention deficit hyperactivity disorder (ADHD) when psychostimulant medication history is accounted for. MATERIALS AND METHODS This prospective study was approved by the institutional review board, and informed consent was obtained. Brain iron was indexed noninvasively by using magnetic resonance (MR) imaging relaxation rates (R2, R2*, R2') and magnetic field correlation (MFC) in the globus pallidus, putamen, caudate nucleus, and thalamus for 22 patients with ADHD (12 medication-naïve patients and 10 with a history of psychostimulant treatment) and 27 control subjects (age range, 8-18 years). Serum iron measures were also collected. Subgroup differences were analyzed with data-appropriate omnibus tests followed by post hoc pairwise comparisons; false discovery rate correction was conducted to control for multiple comparisons. RESULTS Medication-naïve ADHD patients had significantly lower striatal and thalamic MFC indexes of brain iron than did control subjects (putamen, P = .012; caudate nucleus, P = .008; thalamus, P = .012) and psychostimulant-medicated ADHD patients (putamen, P = .006; caudate nucleus, P = .010; thalamus, P = .021). Conversely, the MFC indexes in medicated patients were comparable to those in control subjects. No significant differences were detected with R2, R2*, R2', or serum measures. CONCLUSION Lower MFC indexes of striatal and thalamic brain iron in medication-naïve ADHD patients and lack of differences in psychostimulant-medicated patients suggest that MFC indexes of brain iron may represent a noninvasive diagnostic biomarker that responds to psychostimulant treatment.
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Affiliation(s)
- Vitria Adisetiyo
- From the Center for Biomedical Imaging (V.A., J.H.J., A.T., R.L.D., J.A.H.), Department of Radiology and Radiological Science (V.A., J.H.J., A.T., R.L.D., J.A.H.), Department of Psychiatry and Behavioral Sciences (K.M.G.), and Department of Neurosciences (J.A.H.), Medical University of South Carolina, 68 President St, Bioengineering Building, 2nd Floor, Charleston, SC 29425; Center for Biomedical Imaging, Department of Radiology (E.F., F.X.C.), Child Study Center, Department of Child and Adolescent Psychiatry (A.D.M., F.X.C.), and Department of Physiology and Neuroscience (F.X.C.), New York University School of Medicine, New York, NY; and Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY (F.X.C.)
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Oran M, Unsal C, Albayrak Y, Tulubas F, Oguz K, Avci O, Turgut N, Alp R, Gurel A. Possible association between vitamin D deficiency and restless legs syndrome. Neuropsychiatr Dis Treat 2014; 10:953-8. [PMID: 24899811 PMCID: PMC4039397 DOI: 10.2147/ndt.s63599] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND AIM Restless legs syndrome (RLS) is a distressing sleep disorder that occurs worldwide. Although there have been recent developments in understanding the pathophysiology of RLS, the exact mechanism of the disease has not been well elucidated. An increased prevalence of neurologic and psychiatric diseases involving dopaminergic dysfunction in vitamin D-deficient patients led us to hypothesize that vitamin D deficiency might result in dopaminergic dysfunction and consequently, the development of RLS (in which dopaminergic dysfunction plays a pivotal role). Thus, the aim of this study was to evaluate the relationship between vitamin D deficiency and RLS. METHODS One hundred and fifty-five consecutive patients, 18-65 years of age, who were admitted to the Department of Internal Medicine with musculoskeletal symptoms and who subsequently underwent neurological and electromyography (EMG) examination by the same senior neurologist, were included in this study. The patients were divided into two groups according to serum 25-hydroxyvitamin D (25(OH)D) (a vitamin D metabolite used as a measure of vitamin D status) level: 36 patients with serum 25(OH)D levels ≥20 ng/mL comprised the normal vitamin D group, and 119 patients with serum 25(OH)D levels <20 ng/mL comprised the vitamin D deficiency group. The two groups were compared for the presence of RLS and associated factors. RESULTS The two groups were similar in terms of mean age, sex, mean body mass index (BMI), and serum levels of calcium, phosphate, alkaline phosphatase (ALP), and ferritin. The presence of RLS was significantly higher in the vitamin D deficiency group (χ (2)=12.87, P<0.001). Regression analysis showed vitamin D deficiency and serum 25(OH)D level to be significantly associated with the presence of RLS (odds ratio [OR] 5.085, P<0.001 and OR 1.047, P=0.006, respectively). CONCLUSION The present study demonstrated a possible association between vitamin D deficiency and RLS. Given the dopaminergic effects of vitamin D, 25(OH)D depletion may lead to dopaminergic dysfunction and may have a place in the etiology of RLS. Prospective vitamin D treatment studies are needed to confirm this relationship and to evaluate the efficacy of vitamin D as a treatment for RLS patients.
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Affiliation(s)
- Mustafa Oran
- Department of Internal Medicine, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Cuneyt Unsal
- Department of Psychiatry, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Yakup Albayrak
- Department of Psychiatry, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Feti Tulubas
- Department of Biochemistry, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Keriman Oguz
- Department of Neurology, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Okan Avci
- Department of Internal Medicine, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Nilda Turgut
- Department of Neurology, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Recep Alp
- Department of Neurology, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
| | - Ahmet Gurel
- Department of Biochemistry, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey
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Santin J, Mery V, Elso MJ, Retamal E, Torres C, Ivelic J, Godoy J. Sleep-related eating disorder: a descriptive study in Chilean patients. Sleep Med 2013; 15:163-7. [PMID: 24424097 DOI: 10.1016/j.sleep.2013.10.010] [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: 07/22/2013] [Revised: 10/07/2013] [Accepted: 10/11/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to describe a group of adults diagnosed with sleep-related eating disorder (SRED) at the Sleep Medicine Center of the Pontificia Universidad Catolica de Chile. METHODS We performed a descriptive study of 34 consecutive patients who met the criteria of the International Classification of Sleep Disorders for SRED evaluated during a 3-year period who did not have an eating disorder according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. All patients had a structured clinical interview performed by a sleep specialist and completed the Beck Depression Inventory (BDI). Polysomnography (PSG) was performed when clinically indicated for ruling out other sleep-related disorders (18 patients; 52.9%). Patients' demographic and clinical data, comorbidities, and treatment response also were analyzed. RESULTS Most patients were women (n=23; 67.6%). The average age at the time of diagnosis was 39±13.8 (17-67 years) and the latency since symptom onset was 8.3±8.8 years. Most patients had several episodes per night (average, 2.6±1.6; 1-8) and all except one patient had partial or total amnesia of these events (n=33; 97%). Comorbidities were frequent and included insomnia (n=20; 58.8%), restless legs syndrome (RLS) (n=16; 47%), sleep-disordered breathing (SDB) (n=9; 26%), psychiatric disorders (n=13; 38.2%), and overweight or obesity (n=14; 41.1%). Most patients were hypnotic users (n=21; 61.7%) and reported weight-centered anxiety (n=23; 67.6%). Twenty patients (58.8%) were treated with topiramate, 17 of whom had adequate symptomatic responses. CONCLUSION Our SRED patients showed female preponderance, amnesia during the episodes, association with other sleep disorders, use of hypnotics, weight-centered anxiety, and positive response to topiramate. The presence of anxiety focused on weight in most patients may be an important element in the emergence of this behavior during sleep.
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Affiliation(s)
- Julia Santin
- Centro Médico del Sueño, Division of Neurosciences, Pontificia Universidad Catolica de Chile, Chile.
| | - Victoria Mery
- Centro Médico del Sueño, Division of Neurosciences, Pontificia Universidad Catolica de Chile, Chile
| | - María José Elso
- Centro Médico del Sueño, Division of Neurosciences, Pontificia Universidad Catolica de Chile, Chile
| | - Eva Retamal
- Centro Médico del Sueño, Division of Neurosciences, Pontificia Universidad Catolica de Chile, Chile
| | - Catalina Torres
- Centro Médico del Sueño, Division of Neurosciences, Pontificia Universidad Catolica de Chile, Chile
| | - José Ivelic
- Centro Médico del Sueño, Division of Neurosciences, Pontificia Universidad Catolica de Chile, Chile
| | - Jaime Godoy
- Centro Médico del Sueño, Division of Neurosciences, Pontificia Universidad Catolica de Chile, Chile
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