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Al-Kassmy J, Alsalmi M, Kang W, Huot P. Anticonvulsant Agents for Treatment of Restless Legs Syndrome: A Case Report With Lamotrigine and a Review of the Literature. Neurologist 2024; 29:173-178. [PMID: 38250816 DOI: 10.1097/nrl.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Restless Legs Syndrome (RLS) is a neurological disorder primarily treated with pregabalin and gabapentin, followed by dopamine agonists later in the process due to the risk of augmenting RLS symptoms. In addition, clinical reports have disclosed varying degrees of success employing other agents in patients unresponsive to traditional agents. Here, we present a patient who had success in the reduction of RLS symptoms with lamotrigine, a broad-spectrum anticonvulsant. Previously, lamotrigine had been used in 2 trials with successful treatment of RLS. CASE REPORT We present a 58-year-old right-handed lady with long-standing history of smoking, hypertension, dyslipidaemia, prediabetes, gastro-esophageal reflux disease, asthma, strabismus, uterine cancer, severe and debilitating course of RLS accompanied by unexplained deterioration. The patient initially demonstrated abnormal sensation in all her limbs, which worsened with radiotherapy treatment, and was eventually diagnosed with RLS based on the diagnostic criteria. Subsequent examinations were unremarkable and revealed no further explanation for the deterioration of the RLS symptoms. While the complexity of the patient's medical history had exposed her to a variety of medications, she reported that only lamotrigine, in addition to her original regimen of methadone and pramipexole, offered significant symptomatic relief. It must be noted that no adverse side effects, including impulse-control disorder, were reported by the patient. CONCLUSIONS We present a case of a woman whose deteriorating symptoms of RLS were successfully alleviated by the administration of lamotrigine. This is only the third case in the literature to have successfully utilized lamotrigine as a treatment option for RLS.
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Affiliation(s)
- Jawad Al-Kassmy
- Royal College of Surgeons in Ireland, School of Medicine, Dublin, Ireland
| | - Mohammed Alsalmi
- Department of Neurosciences, Division of Neurology, Movement Disorder Clinic, McGill University Health Centre
| | - Woojin Kang
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro)
| | - Philippe Huot
- Department of Neurosciences, Division of Neurology, Movement Disorder Clinic, McGill University Health Centre
- Neurodegenerative Disease Group, Montreal Neurological Institute-Hospital (The Neuro)
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Restless legs syndrome and cognitive function among adults: a systematic review and meta-analysis. J Neurol 2023; 270:1361-1370. [PMID: 36472687 DOI: 10.1007/s00415-022-11484-2] [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: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Changes in the cognitive function of patients with restless legs syndrome is a growing area of research. Although several studies have been performed to investigate the association between restless legs syndrome (RLS) and cognitive function, the outcomes are still controversial. The meta-analysis aimed to elucidate the relationship between RLS and cognition, including global cognition and various cognitive domains including memory, attention, executive function, and spatial cognition. METHODS We searched the MEDLINE, EMBASE, and Web of Science databases from inception to November 2022 to screen eligible records. The means and standard deviations of cognitive test scores were obtained to calculate the standard mean difference and 95% confidence intervals. RESULTS A total of 1437 records were collected from the initial search and 16 records involving 4635 individuals were ultimately included in the systematic review and meta-analysis. Our data suggest negative associations between RLS and global cognition (SMD, - 0.42; 95% CI - 0.72 to - 0.11; I2 = 76.6%) and attention (SMD, - 0.43; 95% CI - 0.73 to - 0.12; I2 = 85.3%). No significant differences in memory (SMD, - 0.01; 95% CI - 0.31 to 0.28; I2 = 68.0%), executive function (SMD, - 0.10; 95% CI, - 0.30 to 0.11; I2 = 52.1%), or spatial cognition (SMD, - 0.17; 95% CI - 0.38 to 0.03; I2 = 58.5%) were observed between the RLS and control groups. Moreover, the strength of the results was modified by age but not by sex or region. CONCLUSIONS Our findings suggest that RLS is negatively correlated with cognitive function, particularly global cognition and attention. However, the causal relationship, considering more confounders, is worthy of further exploration.
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Colzato LS, Zhang W, Brandt MD, Stock AK, Beste C. Cognitive profile in Restless Legs Syndrome: A signal-to-noise ratio account. CURRENT RESEARCH IN NEUROBIOLOGY 2021; 2:100021. [PMID: 36246509 PMCID: PMC9559071 DOI: 10.1016/j.crneur.2021.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/05/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022] Open
Abstract
Restless legs syndrome (RLS) is a common neurological disorder characterized by a sensorimotor condition, where patients feel an uncontrollable urge to move the lower limbs in the evening and/or during the night. RLS does not only have a profound impact on quality of life due to the disturbed night-time sleep, but there is growing evidence that untreated or insufficiently managed RLS might also cause cognitive changes in patients affected by this syndrome. It has been proposed that RLS is caused by alterations in the signal-to-noise ratio (SNR) and in dopamine (DA) neurotransmission in the nervous system. Based on this evidence, we propose the “SNR-DA hypothesis” as an explanation of how RLS could affect cognitive performance. According to this hypothesis, variations/reductions in the SNR underlie RLS-associated cognitive deficits, which follow an inverted U-shaped function: In unmedicated patients, low dopamine levels worsen the SNR, which eventually impairs cognition. Pharmacological treatment enhances DA levels in medicated patients, which likely improves/normalizes the SNR in case of optimal doses, thus restoring cognition to a normal level. However, overmedication might push patients past the optimal point on the inverted U-shaped curve, where an exaggerated SNR potentially impairs cognitive performance relying on cortical noise such as cognitive flexibility. Based on these assumptions of SNR alterations, we propose to directly measure neural noise via “1/f noise” and related metrics to use transcranial random noise stimulation (tRNS), a noninvasive brain stimulation method which manipulates the SNR, as a research tool and potential treatment option for RLS. Restless legs syndrome (RLS) is a common neurological disorder. RLS is caused by alterations in the SNR ratio and in DA neurotransmission. The SNR- DA hypothesis how RLS affects cognitive performance is presented.
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Affiliation(s)
- Lorenza S. Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
- University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany
| | - Wenxin Zhang
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Moritz D. Brandt
- Department of Neurology, University Hospital, Technische Universität Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
- University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany
- Biopsychology, Faculty of Psychology, TU Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
- University Neuropsychology Center, Faculty of Medicine, TU Dresden, Germany
- Corresponding author. Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Germany Schubertstrasse 42, D-01309, Dresden, Germany.
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Thalamic GABA may modulate cognitive control in restless legs syndrome. Neurosci Lett 2019; 712:134494. [DOI: 10.1016/j.neulet.2019.134494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022]
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Zhao Y, Zhang Y, Yang Z, Wang J, Xiong Z, Liao J, Hao L, Liu G, Ren Y, Wang Q, Duan L, Zheng Z, Dong J. Sleep Disorders and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Prospective Cohort Study. Kidney Blood Press Res 2019; 44:1115-1127. [PMID: 31537006 DOI: 10.1159/000502355] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease experience a high burden of sleep disorders, and there are associations between sleep disorders and cognitive impairment. OBJECTIVES Based on our previous cross-sectional survey on cognitive impairment in peritoneal dialysis, we further explored the relationship between sleep disorders and cognitive impairment, and predictors for declining cognitive function. METHOD We conducted a multicenter prospective cohort study enrolling 458 clinically stable patients on peritoneal dialysis who were then followed up for 2 years.Demographic data, comorbidities, depression, and biochemistry data were collected at baseline. Sleep disorders including insomnia, restless legs syndrome, sleep apnea syndrome, excessive daytime sleepiness, possible narcolepsy, sleep walking and nightmares, and possible rapid eye movement behavior disorders were assessed using a panel of specific sleep questionnaires at baseline and in a second survey. Global cognitive function was measured at baseline and in a second survey, using the Modified Mini-Mental State Examination. Specific cognitive domains were evaluated using Trail-Making Test Forms A and B for executive function, and subtests of the Battery for the Assessment of Neuropsychological Status were used to asses immediate and delayed memory, visuospatial skills, and language ability. RESULTS Sleep disorders were common among peritoneal dialysis patients. The prevalence of cognitive impairment evaluated by the Modified Mini-Mental State Examination (3MS) increased from 19.8 to 23.9%. Possible narcolepsy was associated with decreased Modified Mini-Mental State Examination scores at baseline. During follow-up, sleepwalking and nightmares were associated with higher risks of declined delayed memory in the longitudinal study. CONCLUSIONS Possible narcolepsy was associated with general cognitive dysfunction, and sleep walking and nightmares were risk factors for impaired delayed memory.
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Affiliation(s)
- Youlu Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Yuhui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zhikai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zuying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jinlan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, the Second Hospital of Anhui Medical University, Anhui, China
| | - Guiling Liu
- Renal Division, the Second Hospital of Anhui Medical University, Anhui, China
| | - Yeping Ren
- Renal Division, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Renal Division, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Liping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | - Zhaoxia Zheng
- Renal Division, Handan Central Hospital, Hebei, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China, .,Institute of Nephrology, Peking University, Beijing, China, .,Key Laboratory of Renal Disease, Ministry of Health, Beijing, China, .,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China,
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Abdoli N, Sadeghi Bahmani D, Farnia V, Alikhani M, Golshani S, Holsboer-Trachsler E, Brand S. Among substance-abusing traffic offenders, poor sleep and poor general health predict lower driving skills but not slower reaction times. Psychol Res Behav Manag 2018; 11:557-566. [PMID: 30519130 PMCID: PMC6233697 DOI: 10.2147/prbm.s173946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Traffic accidents are a significant health issue in Iran. Explanations for such accidents have included single consideration of the role of poor sleep and negative psychological trait and state variables. In this study, we examined whether and to what extent sleep, general health, and aggression can concomitantly predict driving behavior. Methods A total of 360 male traffic offenders (driving under substance use; mean age: 31 years) participated in this study. They completed the questionnaires covering sociodemographic, sleep-related, and behavior-related variables. In addition, their visual and acoustic reaction times were objectively tested. Results Poor sleep, poor general health, and higher aggression scores were associated with self-rated poor driving behavior. Poor sleep was directly associated with poor driving behavior and indirectly via poor general health and aggression. In contrast, visual and acoustic reaction times were unrelated to sleep, general health, aggression, or self-rated driving behavior. Conclusion To our knowledge, this is the first study in Iran to assess concomitantly poor sleep, poor general health, and higher aggression scores as independent predictors of poor driving behavior among a larger sample of substance-abusing traffic offenders. Furthermore, visual and acoustic reaction times were unrelated to sleep, general health, aggression, and driving behavior. Finally, importantly, poor sleep predicted both directly and indirectly poor driving behavior.
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Affiliation(s)
- Nasrin Abdoli
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,
| | - Dena Sadeghi Bahmani
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran, .,Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland.,Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran.,Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,
| | - Mostafa Alikhani
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,
| | - Sanobar Golshani
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,
| | - Edith Holsboer-Trachsler
- Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Serge Brand
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran, .,Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics, University of Basel, Basel, Switzerland.,Kermanshah University of Medical Sciences, Sleep Disorders Research Center, Kermanshah, Iran.,Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.,Division of Sport Science, and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Li G, Tang H, Chen J, Qi X, Chen S, Ma J. Executive and Visuospatial Dysfunction in Patients With Primary Restless Legs Syndrome/Willis-Ekbom Disease: Study of a Chinese Population. J Clin Sleep Med 2018; 14:785-790. [PMID: 29734979 DOI: 10.5664/jcsm.7106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/26/2018] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES The aim of the study was to investigate the cognitive function of patients with primary restless legs syndrome/Willis-Ekbom disease (RLS/ WED) in a Chinese population. METHODS A total of 40 patients with RLS/WED who were drug naïve and 40 controls, matched by age, sex, and educational level, were evaluated by cognitive function assessments, including the Chinese version of the Mini-Mental State Examination (MMSE-C), clock drawing test (CDT), Auditory Verbal Learning Test (AVLT), Rey-Osterrieth Complex Figure Test (CFT), and Stroop Color Word Test (SCWT). RESULTS Patients with RLS/WED showed worse performance on the SCWT (Stroop Card C time: 102.36 ± 17.12 versus 87.08 ± 7.73 seconds, P = .033; Interference Index: 3.39 ± 0.38 versus 2.90 ± 0.15, P < .0001), CFT (24.05 ± 9.28 versus 33.74 ± 1.59, P = .008), and CDT than controls (16-score method: 10.13 ± 3.94 versus 13.98 ± 1.79, P = .0002) after adjusting for Hamilton Anxiety Scale score, Hamilton Depression Scale score, Epworth Sleepiness Scale score, and Pittsburgh Sleep Quality Index total score to eliminate the confounders of concomitant sleep disturbances, anxiety, and depression. CONCLUSIONS Our study suggested that cognitive functions involving executive and visuospatial domains might be disturbed in Chinese patients with primary RLS/WED.
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Affiliation(s)
- Gen Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; *contributed equally
| | - Huidong Tang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; *contributed equally
| | - Jie Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; *contributed equally
| | - Xuemei Qi
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; *contributed equally
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; *contributed equally
| | - Jianfang Ma
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; *contributed equally
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Heim B, Pertl MT, Stefani A, Heidbreder A, Zamarian L, Brandauer E, Averbeck B, Delazer M, Seppi K, Högl B, Poewe W, Djamshidian A. Reflection impulsivity perceptual decision-making in patients with restless legs syndrome. Ann Clin Transl Neurol 2018; 5:315-322. [PMID: 29560376 PMCID: PMC5846451 DOI: 10.1002/acn3.535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives The objective of this study was to investigate perceptual decision‐making and reflection impulsivity in drug naïve patients with restless legs syndrome (RLS) and patients with dopaminergic therapy. Methods A total of 35 RLS patients (20 who were drug naïve regarding dopaminergic medication and 15 patients treated with dopaminergic therapy without augmentation or impulse control disorders) were included in this study. We used the Beads task and the Pixel task which assess reflection impulsivity and perceptual decision‐making, respectively. Results were compared to 20 healthy controls. Results Both RLS patient groups gathered less evidence than healthy controls in the Beads task before making a decision (P < 0.001), but patients with dopaminergic treatment gathered less information than drug naïve patients (P = 0.026). Moreover, both patient groups made more choices against the evidence than healthy controls (both P < 0.01), but there was no difference between the two patient groups. In the Pixel task, we found an effect of task difficulty on reaction times with patients and controls responding faster with reduced task difficulty. There was neither an effect of group on reaction times nor an effect of group on error rates. Conclusions Reflection impulsivity is common in RLS patients, regardless whether they are drug naïve or treated with dopaminergic therapy. Thus, RLS patients tend to gather less information compared to healthy controls which could have a negative effect on decision‐making in daily life and should be investigated further.
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Affiliation(s)
- Beatrice Heim
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Marie-Theres Pertl
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Ambra Stefani
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Anna Heidbreder
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Laura Zamarian
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | | | - Bruno Averbeck
- Laboratory of Neuropsychology National Institute of Mental Health National Institutes of Health Bethesda Maryland 20892-4415
| | - Margarete Delazer
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Klaus Seppi
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Birgit Högl
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Werner Poewe
- Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - Atbin Djamshidian
- Department of Neurology Medical University of Innsbruck Innsbruck Austria.,Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies University of London London United Kingdom
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Brand S, Schilling R, Ludyga S, Colledge F, Sadeghi Bahmani D, Holsboer-Trachsler E, Pühse U, Gerber M. Further Evidence of the Zero-Association Between Symptoms of Insomnia and Facial Emotion Recognition-Results From a Sample of Adults in Their Late 30s. Front Psychiatry 2018; 9:754. [PMID: 30705644 PMCID: PMC6344466 DOI: 10.3389/fpsyt.2018.00754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Restoring sleep is associated with favorable cognitive, emotional, and behavioral adaptations. As regards the association between sleep duration and facial emotion recognition (FER), results are conflicting, and as regards the association between symptoms of insomnia and FER, no study has been performed so far. Accordingly, the aim of the present study was to investigate whether subjective sleep was associated with FER, along with perceived stress and mental toughness. Method: A total of 201 police officers (mean age = 38.5 years, 64.2% males) took part in the present cross-sectional study. They completed questionnaires covering socio-demographic data, subjective symptoms of insomnia, perceived stress, and mental toughness. Further, they underwent a computerized FER test, consisting of facial emotion labeling and facial emotion matching. Results: Performance of FER (accuracy, speed) was unrelated to subjective symptoms of insomnia. Lower FER was associated with higher age, but not to perceived stress or mental toughness. No gender differences were observed. Higher symptoms of insomnia were associated with higher stress scores and lower scores of mental toughness. Conclusions: The pattern of results suggests that FER was not associated with symptoms of insomnia, understood as a proxy of sleep quality, among adults. This observation replicates those studies showing a zero-association between sleep and FER.
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Affiliation(s)
- Serge Brand
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,Center of Affective, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disturbances Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - René Schilling
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Sebastian Ludyga
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Flora Colledge
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Dena Sadeghi Bahmani
- Center of Affective, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disturbances Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Edith Holsboer-Trachsler
- Center of Affective, Stress and Sleep Disorders, Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Zhang R, Schrempf W, Brandt MD, Mückschel M, Beste C, Stock AK. RLS patients show better nocturnal performance in the Simon task due to diminished visuo-motor priming. Clin Neurophysiol 2017; 129:112-121. [PMID: 29172115 DOI: 10.1016/j.clinph.2017.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/03/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The restless legs syndrome (RLS) is characterized by sensory-motor symptoms which usually occur predominantly at rest in the evening and at night. It is assumed that this circadian rhythm is caused by low dopamine levels in the evening. Yet, it has never been investigated whether RLS patients show diurnal variations in cognitive functions modulated by dopamine and what neurophysiological and functional neuroanatomical processes underlie such modulations. METHODS We used a Simon task combined with EEG and source localization to investigate whether top-down response selection and/or automatic visuo-motor priming are subject to diurnal changes in RLS patients, as compared to matched healthy controls. RESULTS We found that RLS patients showed better task performance due to reduced visuo-motor priming in the evening, as reflected by smaller early lateralized readiness potential (e-LRP) amplitudes and decreased activation of the superior parietal cortex and premotor cortex. Top-down response selection and early attentional processing were unaffected by RLS. CONCLUSIONS Counterintuitively, RLS patients show enhanced task performance in the evening, i.e. when experiencing dopaminergic deficiency. Yet, this may be explained by deficits in visuo-motor priming that lead to reduced false response tendencies. SIGNIFICANCE This study reveals a counterintuitive circadian variation of cognitive functions in RLS patients.
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Affiliation(s)
- Rui Zhang
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Schubertstr. 42, 01307 Dresden, Germany.
| | - Wiebke Schrempf
- Department of Neurology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Moritz D Brandt
- Department of Neurology, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; German Center for Neurodegenerative Diseases (DZNE) Dresden, Arnoldstraße 18, 01307 Dresden, Germany
| | - Moritz Mückschel
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Schubertstr. 42, 01307 Dresden, Germany; MS Centre Dresden, Faculty of Medicine of the TU Dresden, Blasewitzer Str. 43, 01307 Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Schubertstr. 42, 01307 Dresden, Germany; Experimental Neurobiology, National Institute of Mental Health, Topolová 748, 25067 Klecany, Czech Republic
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Schubertstr. 42, 01307 Dresden, Germany
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Zhang R, Brandt MD, Schrempf W, Beste C, Stock AK. Neurophysiological mechanisms of circadian cognitive control in RLS patients - an EEG source localization study. NEUROIMAGE-CLINICAL 2017; 15:644-652. [PMID: 28664035 PMCID: PMC5480014 DOI: 10.1016/j.nicl.2017.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/09/2017] [Accepted: 06/10/2017] [Indexed: 01/18/2023]
Abstract
The circadian variation of sensory and motor symptoms with increasing severity in the evening and at night is a key diagnostic feature/symptom of the restless legs syndrome (RLS). Even though many neurological diseases have shown a strong nexus between motor and cognitive symptoms, it has remained unclear whether cognitive performance of RLS patients declines in the evening and which neurophysiological mechanisms are affected by the circadian variation. In the current study, we examined daytime effects (morning vs. evening) on cognitive performance in RLS patients (n = 33) compared to healthy controls (n = 29) by analyzing flanker interference effects in combination with EEG and source localization techniques. RLS patients showed larger flanker interference effects in the evening than in the morning (p = .023), while healthy controls did not display a comparable circadian variation. In line with this, the neurophysiological data showed smaller N1 amplitudes in RLS patients compared to controls in the interfering task condition in the evening (p = .042), but not in the morning. The results demonstrate diurnal cognitive changes in RLS patients with intensified impairments in the evening. It seems that not all dopamine-regulated cognitive processes are altered in RLS and thus show daytime-dependent impairments. Instead, the daytime-related cognitive impairment emerges from attentional selection processes within the extra-striate visual cortex, but not from later cognitive processes such as conflict monitoring and response selection. RLS patients have larger flanker interference effect in the evening. RLS patients have enhanced impairment of attentional selection in the evening. Nocturnal attentional impairment relies on the extra-striate visual cortex. Conflict monitoring and response selection are not affected by RLS.
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Affiliation(s)
- Rui Zhang
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Schubertstr. 42, 01307 Dresden, Germany.
| | - Moritz D Brandt
- Department of Neurology, Carl Gustav Carus University Hospital Dresden, Fetscherstraße 74, 01307 Dresden, Germany; German Center for Neurodegenerative Diseases (DZNE) Dresden, 01307 Dresden, Germany
| | - Wiebke Schrempf
- Department of Neurology, Carl Gustav Carus University Hospital Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Schubertstr. 42, 01307 Dresden, Germany; Experimental Neurobiology, National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden, Schubertstr. 42, 01307 Dresden, Germany
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Athavale Y, Krishnan S, Dopsa DD, Berneshawi AG, Nouraei H, Raissi A, Murray BJ, Boulos MI. Advanced signal analysis for the detection of periodic limb movements from bilateral ankle actigraphy. J Sleep Res 2016; 26:14-20. [PMID: 27457202 DOI: 10.1111/jsr.12438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/22/2016] [Indexed: 11/28/2022]
Abstract
Actigraphy can assist in the detection of periodic limb movements in sleep. Although several actigraphs have been previously reported to accurately detect periodic limb movements, many are no longer available; of the existing actigraphs, most sample too infrequently to accurately detect periodic limb movements. The purpose of this study was to use advanced signal analysis to validate a readily available actigraph that has the capability of sampling at relatively high frequencies. We simultaneously recorded polysomnography and bilateral ankle actigraphy in 96 consecutive patients presenting to our sleep laboratory. After pre-processing and conditioning, the bilateral ankle actigraphy signals were then analysed for 14 simple time, frequency and morphology-based features. These features reduced the signal dimensionality and aided in better representation of the periodic limb movement activity in the actigraph signals. These features were then processed by a Naïve-Bayes binary classifier for distinguishing between normal and abnormal periodic limb movement indices. We trained the Naïve-Bayes classifier using a training set, and subsequently tested its classification accuracy using a testing set. From our experiments, using a periodic limb movement index cut-off of 5, we found that the Naïve-Bayes classifier had a correct classification rate of 78.9%, with a sensitivity of 80.3% and a specificity of 73.7%. The algorithm developed in this study has the potential of facilitating identification of periodic limb movements across a wide spectrum of patient populations via the use of bilateral ankle actigraphy.
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Affiliation(s)
- Yashodhan Athavale
- Department of Electrical & Computer Engineering, Ryerson University, Toronto, Canada
| | - Sridhar Krishnan
- Department of Electrical & Computer Engineering, Ryerson University, Toronto, Canada
| | - Dustin D Dopsa
- Department of Electrical & Computer Engineering, Ryerson University, Toronto, Canada
| | - Andrew G Berneshawi
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hirmand Nouraei
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Afsaneh Raissi
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian J Murray
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark I Boulos
- Department of Medicine (Neurology), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
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Durgin T, Witt EA, Fishman J. The Humanistic and Economic Burden of Restless Legs Syndrome. PLoS One 2015; 10:e0140632. [PMID: 26501875 PMCID: PMC4621026 DOI: 10.1371/journal.pone.0140632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022] Open
Abstract
Objectives To evaluate the humanistic and economic burden of a restless legs syndrome (RLS) diagnosis with regard to health-related quality of life, work productivity loss, healthcare resource use, and direct and indirect costs. Study Design Self-reported data came from the 2012 National Health and Wellness Survey (NHWS), a large, annual, nationally representative cross-sectional general health survey of US adults. Methods RLS patients (n = 2,392) were matched on demographic and health characteristics to Non-RLS respondents via propensity score matching differences between groups were tested with Bivariate and multivariable analyses. Results RLS patients had significantly lower health-related quality of life scores: Mental Component Summary (44.60 vs. 48.92, p<.001), Physical Component Summary (40.57 vs. 46.78, p<.001), Health Utilities (.63 vs. .71, p<.001) and higher levels of work productivity loss in the past seven days including absenteeism (8.1% vs. 9.3%, p<.001), presenteeism (26.5% vs. 15.8%, p<.001), and overall productivity loss (30.1% vs. 18.1%, p<.001) as well as general activity impairment (46.1% vs. 29.7%, p<.001). RLS patients had significantly higher healthcare resource use in the past 6 months than non-RLS patients: healthcare provider visits (7.46 vs. 4.42%, p<.001), ER visits (0.45 vs. 0.24, p<.001), and hospitalizations (0.24 vs. 0.15, p<.001). RLS patients also had higher estimated direct and indirect costs than non-RLS patients. Finally, it was found that across outcomes increasing severity is associated with increased economic and humanistic burden for RLS patients. Conclusions RLS patients suffer a greater humanistic and economic burden than those without RLS. Moreover as severity increases so does the burden of RLS.
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Affiliation(s)
- Tracy Durgin
- UCB Pharma, Smyrna, Georgia, United States of America
| | - Edward A. Witt
- Kantar Health, Princeton, New Jersey, United States of America
- * E-mail:
| | - Jesse Fishman
- UCB Pharma, Smyrna, Georgia, United States of America
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15
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Galbiati A, Marelli S, Giora E, Zucconi M, Oldani A, Ferini-Strambi L. Neurocognitive function in patients with idiopathic Restless Legs Syndrome before and after treatment with dopamine-agonist. Int J Psychophysiol 2015; 95:304-9. [DOI: 10.1016/j.ijpsycho.2014.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/05/2014] [Accepted: 12/07/2014] [Indexed: 11/13/2022]
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Sonni A, Kurdziel LBF, Baran B, Spencer RMC. The effects of sleep dysfunction on cognition, affect, and quality of life in individuals with cerebellar ataxia. J Clin Sleep Med 2015; 10:535-43. [PMID: 24812539 DOI: 10.5664/jcsm.3706] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVE Cerebellar ataxia comprises a group of debilitating diseases that are the result of progressive cerebellar degeneration. Recent studies suggest that, like other neurodegenerative diseases, sleep impairments are common in cerebellar ataxia. In light of the role of sleep in mood regulation and cognition, we sought to assess interactions between sleep, cognition, and affect in individuals with cerebellar ataxia. METHODS A survey of 176 individuals with cerebellar ataxia was conducted. The battery of instruments included a modified International Cooperative Ataxia Rating Scale, Pittsburgh Sleep Quality Index, Restless Leg Syndrome Questionnaire, REM Behavior Disorder Questionnaire, Beck Depression Inventory, Epworth Sleepiness Scale, and a Composite Cognitive Questionnaire. RESULTS Fifty-one percent of individuals indicated significant sleep disturbances on the Pittsburgh Sleep Quality Index, 73% of participants had two or more symptoms of restless leg syndrome, and 88% had two or more symptoms of REM behavior disorder. Ataxia severity, based on the modified International Cooperative Ataxia Rating Scale, predicted scores on the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and REM Behavior Disorder Questionnaire. Median split analyses revealed that cognitive function appeared to be reduced and depressive symptoms were greater for those individuals with poor subjective sleep quality and severe RLS. Importantly, sleep appears to play a mediatory role between disease severity and depressive symptoms. CONCLUSIONS These results suggest that disturbed sleep may have detrimental effects on cognition and affect in individuals with cerebellar ataxia. While objective measures are needed, such results suggest that treating sleep deficits in these individuals may improve cognitive and mental health as well as overall quality of life.
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Affiliation(s)
- Akshata Sonni
- Neuroscience and Behavior, University of Massachusetts, Amherst MA
| | | | - Bengi Baran
- Department of Psychology, University of Massachusetts, Amherst MA
| | - Rebecca M C Spencer
- Neuroscience and Behavior, University of Massachusetts, Amherst MA ; Department of Psychology, University of Massachusetts, Amherst MA
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Working memory deficit in patients with restless legs syndrome: an event-related potential study. Sleep Med 2014; 15:808-15. [DOI: 10.1016/j.sleep.2014.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 03/05/2014] [Accepted: 03/09/2014] [Indexed: 01/18/2023]
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Moon YJ, Song JY, Lee BU, Koo YS, Lee SK, Jung KY. Comparison of Cognitive Function between Patients with Restless Legs Syndrome and Healthy Controls. SLEEP MEDICINE RESEARCH 2014. [DOI: 10.17241/smr.2014.5.1.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kim M, Song JY, Kim SM, Moon YJ, Koo YS, Jung KY. Effect of Pramipexole on Cognitive Functions in Restless Legs Syndrome. ACTA ACUST UNITED AC 2014. [DOI: 10.13078/jksrs.14004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mestre TA, Strafella AP, Thomsen T, Voon V, Miyasaki J. Diagnosis and treatment of impulse control disorders in patients with movement disorders. Ther Adv Neurol Disord 2013; 6:175-88. [PMID: 23634190 PMCID: PMC3625015 DOI: 10.1177/1756285613476127] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Impulse control disorders are a psychiatric condition characterized by the failure to resist an impulsive act or behavior that may be harmful to self or others. In movement disorders, impulse control disorders are associated with dopaminergic treatment, notably dopamine agonists (DAs). Impulse control disorders have been studied extensively in Parkinson's disease, but are also recognized in restless leg syndrome and atypical Parkinsonian syndromes. Epidemiological studies suggest younger age, male sex, greater novelty seeking, impulsivity, depression and premorbid impulse control disorders as the most consistent risk factors. Such patients may warrant special monitoring after starting treatment with a DA. Various individual screening tools are available for people without Parkinson's disease. The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease has been developed specifically for Parkinson's disease. The best treatment for impulse control disorders is prevention. However, after the development of impulse control disorders, the mainstay intervention is to reduce or discontinue the offending anti-Parkinsonian medication. In refractory cases, other pharmacological interventions are available, including neuroleptics, antiepileptics, amantadine, antiandrogens, lithium and opioid antagonists. Unfortunately, their use is only supported by case reports, small case series or open-label clinical studies. Prospective, controlled studies are warranted. Ongoing investigations include naltrexone and nicotine.
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Affiliation(s)
- Tiago A Mestre
- Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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