1
|
Yılmaz E. Can restless legs be a sign of something else? A case report of spondyloarthritis presenting with restless legs syndrome and a review of the literature. Reumatismo 2023; 75. [PMID: 38115781 DOI: 10.4081/reumatismo.2023.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/30/2023] [Indexed: 12/21/2023] Open
Abstract
Restless legs syndrome (RLS) is a chronic movement disorder characterized by an urge or need to move the limbs, usually associated with uncomfortable sensations in the legs and sleep disorders. In general, two clinical forms of RLS are described: primary and secondary. Although primary RLS has a familial component, the underlying mechanism is still not fully understood but seems to be related to abnormalities in the dopaminergic and glutamatergic pathways of the central nervous system. The secondary forms of the syndrome are associated with iron deficiency, renal failure, pregnancy, diabetes mellitus, peripheral neuropathy, and several rheumatologic disorders such as rheumatoid arthritis and Sjögren's syndrome. In a few clinical trials, an increased frequency of RLS has been reported in patients with spondyloarthritis. In this report, a case of coexistence of spondyloarthritis and RLS is presented, showing satisfactory improvement with conservative treatment and additionally adding naproxen. Anemia of chronic disease occurring in rheumatic diseases, and associated iron deficiency may contribute to the development of RLS.
Collapse
Affiliation(s)
- E Yılmaz
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakıf University, Istanbul.
| |
Collapse
|
2
|
van der Veen S, Caviness JN, Dreissen YE, Ganos C, Ibrahim A, Koelman JH, Stefani A, Tijssen MA. Myoclonus and other jerky movement disorders. Clin Neurophysiol Pract 2022; 7:285-316. [PMID: 36324989 PMCID: PMC9619152 DOI: 10.1016/j.cnp.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Myoclonus and other jerky movements form a large heterogeneous group of disorders. Clinical neurophysiology studies can have an important contribution to support diagnosis but also to gain insight in the pathophysiology of different kind of jerks. This review focuses on myoclonus, tics, startle disorders, restless legs syndrome, and periodic leg movements during sleep. Myoclonus is defined as brief, shock-like movements, and subtypes can be classified based the anatomical origin. Both the clinical phenotype and the neurophysiological tests support this classification: cortical, cortical-subcortical, subcortical/non-segmental, segmental, peripheral, and functional jerks. The most important techniques used are polymyography and the combination of electromyography-electroencephalography focused on jerk-locked back-averaging, cortico-muscular coherence, and the Bereitschaftspotential. Clinically, the differential diagnosis of myoclonus includes tics, and this diagnosis is mainly based on the history with premonitory urges and the ability to suppress the tic. Electrophysiological tests are mainly applied in a research setting and include the Bereitschaftspotential, local field potentials, transcranial magnetic stimulation, and pre-pulse inhibition. Jerks due to a startling stimulus form the group of startle syndromes. This group includes disorders with an exaggerated startle reflex, such as hyperekplexia and stiff person syndrome, but also neuropsychiatric and stimulus-induced disorders. For these disorders polymyography combined with a startling stimulus can be useful to determine the pattern of muscle activation and thus the diagnosis. Assessment of symptoms in restless legs syndrome and periodic leg movements during sleep can be performed with different validated scoring criteria with the help of electromyography.
Collapse
Affiliation(s)
- Sterre van der Veen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - John N. Caviness
- Department of Neurology, Mayo Clinic Arizona, Movement Neurophysiology Laboratory, Scottsdale, AZ, USA
| | - Yasmine E.M. Dreissen
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christos Ganos
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes H.T.M. Koelman
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Corresponding author at: Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands.
| |
Collapse
|
3
|
Gemignani F. Irritable bowel syndrome, restless legs syndrome, small fiber neuropathy, and fibromyalgia. Sleep Med 2021; 83:4. [PMID: 33984655 DOI: 10.1016/j.sleep.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
|
4
|
Jiménez-Jiménez FJ, Alonso-Navarro H, García-Martín E, Agúndez JAG. Association between restless legs syndrome and peripheral neuropathy: A systematic review and meta-analysis. Eur J Neurol 2021; 28:2423-2442. [PMID: 33772991 DOI: 10.1111/ene.14840] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/27/2021] [Accepted: 03/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The coexistence of peripheral neuropathy (PN) and restless legs syndrome (RLS) or Willis-Ekbom disease is relatively frequent, but its prevalence has shown a high variability across studies. In addition, several reports have shown data suggesting the presence of PN in patients with idiopathic RLS. METHODS A search was undertaken using the PubMed, Embase and Web of Science Databases, from 1966 to 6 December 2020, crossing the search term 'restless legs syndrome' with 'neuropathy', 'polyneuropathy' (PNP) and 'peripheral neuropathy', and the references of interest for this topic were identified; a meta-analysis was performed, according to PRISMA guidelines, and a calculation of pooled prevalences, where appropriate, was made using standard methods. RESULTS Restless legs syndrome has been reported in 5.2%-53.7% of patients with PN (average 21.5%; 95% confidence interval 18.6%-24.5%), and PN has been reported in 0%-87.5% of patients with RLS (average 41.8%; 95% confidence interval 39.9%-43.6%), both being significantly more frequent than in controls. The heterogeneity across studies could be due to differences in the diagnostic criteria used for both RLS and PN. RLS is a frequent clinical complaint in patients with PN of different aetiologies, mainly diabetic PN, uraemic PNP, familial amyloid PNP, Charcot-Marie-Tooth disease and chronic dysimmune inflammatory PNP. Recent neurophysiological findings suggest the presence of small sensory fibre loss in patients diagnosed with idiopathic RLS, but it remains to be determined whether RLS associated with small sensory fibre loss and idiopathic RLS are different clinical entities. CONCLUSIONS Future studies including clinical and neurophysiological assessment and skin biopsy involving a large series of patients with PN and RLS are needed for a better understanding of the association between these two entities.
Collapse
Affiliation(s)
| | | | - Elena García-Martín
- UNEx, ARADyAL Instituto de Salud Carlos III, University Institute of Molecular Pathology Biomarkers, Cáceres, Spain
| | - José A G Agúndez
- UNEx, ARADyAL Instituto de Salud Carlos III, University Institute of Molecular Pathology Biomarkers, Cáceres, Spain
| |
Collapse
|
5
|
Mirghani H. Restless Legs Syndrome Among Sudanese Patients With Type 2 Diabetes Mellitus: A Case-Control Study. Cureus 2020; 12:e9635. [PMID: 32923236 PMCID: PMC7480782 DOI: 10.7759/cureus.9635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background There is increasing awareness about the association of restless legs syndrome (RLS) with type 2 diabetes. This study assessed RLS and its associations among patients with diabetes. Material and methods This case-control study was conducted among 160 subjects (82 patients with diabetes and 78 controls) attending a diabetic clinic in Omdurman, Sudan, during the period from June 2018 to September 2019. A structured questionnaire was used to collect demographic factors, diabetic neuropathy, nephropathy, retinopathy, and macrovascular complications. The neck circumference was measured to assess adiposity, and a blood sample was taken for the glycated hemoglobin (HbA1c) estimation. The local ethical committee approved the research, and the Statistical Package for Social Sciences (SPSS; IBM Corp., Armonk, NY) was used for data analysis. A P-value of <0.05 was considered significant. Results There were 82 patients with type 2 diabetes and 78 controls matched for age and sex. Restless legs syndrome was higher among patients with diabetes (31.7% vs. 10.3%%) with a significant statistical difference, P-<0.05. A direct positive relationship was found between restless legs syndrome and diabetic neuropathy (Wald=5.48, P-value=0.019, 95%CI 1.70-410.76), no relationship was found between RLS, diabetic retinopathy, glycated hemoglobin, sex, and neck circumference, P-values (0.757, 0.804, 0.317, and 0.361 respectively). Conclusion Restless legs syndrome was prevalent among patients with type 2 diabetes and was more common among patients with diabetic neuropathy, no relationship was found between restless legs syndrome, age, sex, neck circumference, HbA1c, and retinopathy.
Collapse
|
6
|
Byrne DA, Sobey CM, Trahan J, Bagai K, Walters A. Spinal Cord Stimulation in Patients With Chronic Pain and Restless Legs Syndrome: A Case Report. A A Pract 2019; 13:110-113. [PMID: 30933049 DOI: 10.1213/xaa.0000000000001007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Restless legs syndrome can be a debilitating condition that affects a patient's ability to function and their quality of life. Neuromodulation may represent a potential option for nonpharmacological management of restless legs syndrome. We present 3 patients who have a chronic pain diagnosis and medically refractory restless legs syndrome that warranted neuromodulation. After neuromodulation, all 3 patients had improvement in their restless legs syndrome symptoms and were taking less pain medication, and 2 out of 3 had significantly improved functionality at short-term follow-up. This case series suggests that spinal cord stimulation may be a viable nonpharmacological treatment option for medically refractory restless legs syndrome.
Collapse
Affiliation(s)
| | | | | | - Kanika Bagai
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arthur Walters
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
7
|
Karroum EG. Painful Willis-Ekbom disease: unbearable and distinct form of restless legs? Scand J Pain 2019; 19:429-431. [DOI: 10.1515/sjpain-2019-2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Elias Georges Karroum
- Department of Neurology , The George Washington University School of Medicine and Health Sciences , 2150 Pennsylvania Ave, NW 9th Floor , Washington, DC 20037 , USA
| |
Collapse
|
8
|
Gemignani F. Restless legs syndrome from the spinal cord perspective: A flexor reflex circuitopathy? J Sleep Res 2018; 27:e12704. [DOI: 10.1111/jsr.12704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Franco Gemignani
- Former Associate Professor of Neurology at the University of Parma; Parma Italy
| |
Collapse
|
9
|
Fila M, Stasiołek M, Markiewicz A, Bogucki A. Functional Evaluation of Small Fiber Pathways in Primary Restless Legs Syndrome: Aδ Pathway Study. J Clin Sleep Med 2017; 13:1455-1462. [PMID: 29117885 DOI: 10.5664/jcsm.6848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/04/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to provide a neurophysiological evaluation of the function of large and small fibers, particularly the peripheral part of the thermonociceptive Aδ pathway in patients with primary restless legs syndrome (RLS). METHODS The main evaluation was based on an analysis of the parameters of laser-evoked potentials (LEPs), N2 and P2 components, and an assessment of thermonociceptive thresholds (pain thresholds; PThs). Routine nerve conduction studies (NCS) were also performed. RESULTS No essential or important differences of clinical significance were observed in the parameters of large fiber conduction between the study and the control groups. Prolonged latencies of N2 and P2 potentials were obtained during foot stimulation in patients with primary RLS when compared to controls (N2, P2-lower right limb, and N2-lower left limb). We also observed higher amplitudes of LEPs evaluated as P2 and N2-P2 potentials in patients with primary RLS in comparison with the control group. Significantly higher (normal distribution P < .05) thermonociceptive thresholds in both lower and upper limbs were found in the RLS group. CONCLUSIONS On the basis of the analysis of LEPs and their comparison with the respective results from the control group, the presence of functional disability of the thermonociceptive Aδ pathway was confirmed in patients with primary RLS. The results indicated the presence of changes in the conduction of small fiber pathways in the pathomechanism of idiopathic RLS.
Collapse
Affiliation(s)
- Michał Fila
- Clinical Neurophysiology Unit, Neurology Department, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Mariusz Stasiołek
- Neurology Department, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Adam Markiewicz
- Neurology Department, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Andrzej Bogucki
- Department of Extrapyramidal Diseases, Central University Hospital, Medical University of Lodz, Poland
| |
Collapse
|
10
|
Anderson JC, Fritz ML, Benson JM, Tracy BL. Nerve Decompression and Restless Legs Syndrome: A Retrospective Analysis. Front Neurol 2017; 8:287. [PMID: 28729849 PMCID: PMC5498562 DOI: 10.3389/fneur.2017.00287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 06/02/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction Restless legs syndrome (RLS) is a prevalent sleep disorder affecting quality of life and is often comorbid with other neurological diseases, including peripheral neuropathy. The mechanisms related to RLS symptoms remain unclear, and treatment options are often aimed at symptom relief rather than etiology. RLS may present in distinct phenotypes often described as “primary” vs. “secondary” RLS. Secondary RLS is often associated with peripheral neuropathy. Nerve decompression surgery of the common and superficial fibular nerves is used to treat peripheral neuropathy. Anecdotally, surgeons sometimes report improved RLS symptoms following nerve decompression for peripheral neuropathy. The purpose of this retrospective analysis was to quantify the change in symptoms commonly associated with RLS using visual analog scales (VAS). Methods Forty-two patients completed VAS scales (0–10) for pain, burning, numbness, tingling, weakness, balance, tightness, aching, pulling, cramping, twitchy/jumpy, uneasy, creepy/crawly, and throbbing, both before and 15 weeks after surgical decompression. Results Subjects reported significant improvement among all VAS categories, except for “pulling” (P = 0.14). The change in VAS following surgery was negatively correlated with the pre-surgery VAS for both the summed VAS (r = −0.58, P < 0.001) and the individual VAS scores (all P < 0.01), such that patients who reported the worst symptoms before surgery exhibited relatively greater reductions in symptoms after surgery. Conclusion This is the first study to suggest improvement in RLS symptoms following surgical decompression of the common and superficial fibular nerves. Further investigation is needed to quantify improvement using RLS-specific metrics and sleep quality assessments.
Collapse
Affiliation(s)
- James C Anderson
- Anderson Podiatry Center for Nerve Pain, Fort Collins, CO, United States
| | - Megan L Fritz
- Anderson Podiatry Center for Nerve Pain, Fort Collins, CO, United States.,Neuromuscular Function Lab, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | | | - Brian L Tracy
- Neuromuscular Function Lab, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| |
Collapse
|
11
|
Lanza G, Bachmann CG, Ghorayeb I, Wang Y, Ferri R, Paulus W. Central and peripheral nervous system excitability in restless legs syndrome. Sleep Med 2017; 31:49-60. [PMID: 27745789 DOI: 10.1016/j.sleep.2016.05.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 02/07/2023]
Abstract
Neurophysiological techniques have been applied in restless legs syndrome (RLS) to obtain direct and indirect measures of central and peripheral nervous system excitability, as well as to probe different neurotransmission pathways. Data converge on the hypothesis that, from a pure electrophysiological perspective, RLS should be regarded as a complex sensorimotor disorder in which cortical, subcortical, spinal cord, and peripheral nerve generators are all involved in a network disorder, resulting in an enhanced excitability and/or decreased inhibition. Although the spinal component may have dominated in neurophysiological assessment, possibly because of better accessibility compared to the brainstem or cerebral components of a hypothetical dysfunction of the diencephalic A11 area, multiple mechanisms, such as reduced central inhibition and abnormal peripheral nerve function, contribute to the pathogenesis of RLS similarly to some chronic pain conditions. Dopamine transmission dysfunction, either primary or triggered by low iron and ferritin concentrations, may also bridge the gap between RLS and chronic pain entities. Further support of disturbed central and peripheral excitability in RLS is provided by the effectiveness of nonpharmacological tools, such as repetitive transcranial magnetic stimulation and transcutaneous spinal direct current stimulation, in transiently modulating neural excitability, thereby extending the therapeutic repertoire. Understanding the complex interaction of central and peripheral neuronal circuits in generating the symptoms of RLS is mandatory for a better refinement of its therapeutic support.
Collapse
Affiliation(s)
- Giuseppe Lanza
- Sleep Research Center, I.R.C.C.S. "Oasi Maria SS.", Troina, Italy.
| | | | - Imad Ghorayeb
- Department of Clinical Neurophysiology, CHU de Bordeaux, Bordeaux, France; CNRS, INCIA, CNRS UMR 5287, Université de Bordeaux, Bordeaux, France
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Raffale Ferri
- Sleep Research Center, I.R.C.C.S. "Oasi Maria SS.", Troina, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg August University Göttingen, Göttingen, Germany
| |
Collapse
|
12
|
Fawale MB, Ismail IA, Mustapha AF, Komolafe MA, Adedeji TA. Restless Legs Syndrome in a Nigerian Elderly Population. J Clin Sleep Med 2016; 12:965-72. [PMID: 27070251 DOI: 10.5664/jcsm.5926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/03/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The prevalence of restless legs syndrome (RLS) is highest in the elderly in Caucasian populations; the prevalence of RLS in elderly Africans is not known. This study aimed at determining the frequency and associations of RLS in a Nigerian elderly population. METHODS The study population comprised of 633 consecutive elderly individuals aged 65-105 years attending the general outpatient clinic of the State Hospital, Ilesa, for minor complaints and routine check-up. The diagnosis of RLS was made using the 2003 minimal criteria of the International Restless Legs Syndrome Study Group. Relevant sociodemographic and clinical data, including sleep duration, were also obtained. RESULTS Restless legs syndrome was found in 3.5% of the study population with a male-female ratio of 2:1. There was no significant age (p = 0.427) or gender (p = 0.178) influence on the prevalence of RLS except in the 75- to 84-year age group where there was significant male preponderance (p = 0.044). A strong independent association between RLS and sleep duration (OR, 3.229; 95% CI, 1.283-8.486; p = 0.013) and past history of head injury (OR, 4.691; 95% CI, 1.750-12.577; p = 0.002) was found. CONCLUSIONS Our finding support previous reports of a possible lower prevalence of RLS in Africans. Restless legs syndrome independently increases the odds of habitual sleep curtailment in elderly individuals. Head injury may be a risk factor for future RLS; this requires further investigation as indirect evidence for a possible link between RLS and traumatic brain injury exists.
Collapse
Affiliation(s)
- Michael B Fawale
- Neurology Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Adekunle F Mustapha
- Neurology Unit, Department of Medicine, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria
| | - Morenikeji A Komolafe
- Neurology Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Tewogbade A Adedeji
- Department of Chemical Pathology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| |
Collapse
|
13
|
Ahmed M, Hays R, Steven Poceta J, Jaros MJ, Kim R, Shang G. Effect of Gabapentin Enacarbil on Individual Items of the International Restless Legs Study Group Rating Scale and Post-sleep Questionnaire in Adults with Moderate-to-Severe Primary Restless Legs Syndrome: Pooled Analysis of 3 Randomized Trials. Clin Ther 2016; 38:1726-1737.e1. [DOI: 10.1016/j.clinthera.2016.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 12/23/2022]
|
14
|
Gemignani F, Parrino L. Characterization of the painful restless legs syndrome. Sleep Med 2015; 16:1449. [DOI: 10.1016/j.sleep.2015.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/31/2015] [Indexed: 11/16/2022]
|
15
|
Chokroverty S. Differential Diagnoses of Restless Legs Syndrome/Willis-Ekbom Disease. Sleep Med Clin 2015; 10:249-62, xii. [DOI: 10.1016/j.jsmc.2015.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
16
|
Bastia JK, Bhoi SK, Kalita J, Misra UK. Neuropathy in a cohort of restless leg syndrome patients. J Clin Neurosci 2015; 22:1314-8. [DOI: 10.1016/j.jocn.2015.01.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/12/2015] [Accepted: 01/17/2015] [Indexed: 11/28/2022]
|
17
|
|
18
|
Kallianpur AR, Jia P, Ellis RJ, Zhao Z, Bloss C, Wen W, Marra CM, Hulgan T, Simpson DM, Morgello S, McArthur JC, Clifford DB, Collier AC, Gelman BB, McCutchan JA, Franklin D, Samuels DC, Rosario D, Holzinger E, Murdock DG, Letendre S, Grant I. Genetic variation in iron metabolism is associated with neuropathic pain and pain severity in HIV-infected patients on antiretroviral therapy. PLoS One 2014; 9:e103123. [PMID: 25144566 PMCID: PMC4140681 DOI: 10.1371/journal.pone.0103123] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/27/2014] [Indexed: 02/06/2023] Open
Abstract
HIV sensory neuropathy and distal neuropathic pain (DNP) are common, disabling complications associated with combination antiretroviral therapy (cART). We previously associated iron-regulatory genetic polymorphisms with a reduced risk of HIV sensory neuropathy during more neurotoxic types of cART. We here evaluated the impact of polymorphisms in 19 iron-regulatory genes on DNP in 560 HIV-infected subjects from a prospective, observational study, who underwent neurological examinations to ascertain peripheral neuropathy and structured interviews to ascertain DNP. Genotype-DNP associations were explored by logistic regression and permutation-based analytical methods. Among 559 evaluable subjects, 331 (59%) developed HIV-SN, and 168 (30%) reported DNP. Fifteen polymorphisms in 8 genes (p<0.05) and 5 variants in 4 genes (p<0.01) were nominally associated with DNP: polymorphisms in TF, TFRC, BMP6, ACO1, SLC11A2, and FXN conferred reduced risk (adjusted odds ratios [ORs] ranging from 0.2 to 0.7, all p<0.05); other variants in TF, CP, ACO1, BMP6, and B2M conferred increased risk (ORs ranging from 1.3 to 3.1, all p<0.05). Risks associated with some variants were statistically significant either in black or white subgroups but were consistent in direction. ACO1 rs2026739 remained significantly associated with DNP in whites (permutation p<0.0001) after correction for multiple tests. Several of the same iron-regulatory-gene polymorphisms, including ACO1 rs2026739, were also associated with severity of DNP (all p<0.05). Common polymorphisms in iron-management genes are associated with DNP and with DNP severity in HIV-infected persons receiving cART. Consistent risk estimates across population subgroups and persistence of the ACO1 rs2026739 association after adjustment for multiple testing suggest that genetic variation in iron-regulation and transport modulates susceptibility to DNP.
Collapse
Affiliation(s)
- Asha R. Kallianpur
- Department of Genomic Medicine, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Peilin Jia
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Ronald J. Ellis
- Department of Neurology, University of California San Diego, San Diego, California, United States of America
| | - Zhongming Zhao
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Cinnamon Bloss
- Scripps Genomic Medicine, Scripps Translational Science Institute, and Scripps Health, La Jolla, California, United States of America
| | - Wanqing Wen
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Christina M. Marra
- Department of Neurology, University of Washington, Seattle, Washington, United States of America
| | - Todd Hulgan
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - David M. Simpson
- Department of Neurology, Icahn School of Medicine of Mt. Sinai, New York, New York, United States of America
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine of Mt. Sinai, New York, New York, United States of America
| | - Justin C. McArthur
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - David B. Clifford
- Department of Neurology, Washington University, St. Louis, Missouri, United States of America
| | - Ann C. Collier
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Benjamin B. Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - J. Allen McCutchan
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Donald Franklin
- HIV Neurobehavioral Research Center & CHARTER Center, University of California San Diego, San Diego, California, United States of America
| | - David C. Samuels
- Department of Molecular Physiology and Biophysics and Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Debralee Rosario
- HIV Neurobehavioral Research Center & CHARTER Center, University of California San Diego, San Diego, California, United States of America
| | - Emily Holzinger
- Department of Molecular Physiology and Biophysics and Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Deborah G. Murdock
- Department of Molecular Physiology and Biophysics and Center for Human Genetics Research, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Scott Letendre
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Igor Grant
- Department of Psychiatry, University of California San Diego, San Diego, California, United States of America
| | | |
Collapse
|
19
|
Abstract
OBJECTIVE This narrative review describes the differential diagnosis of restless legs syndrome, and provides an overview of the evidence for the associations between RLS and potential comorbidities. Secondary causes of RLS and the characteristics of pediatric RLS are also discussed. Finally, management strategies for RLS are summarized. METHODS The review began with a comprehensive PubMed search for 'restless legs syndrome/Willis-Ekbom disease' in combination with the following: anxiety, arthritis, attention-deficit hyperactivity disorder, cardiac, cardiovascular disease, comorbidities, depression, end-stage renal disease, erectile dysfunction, fibromyalgia, insomnia, kidney disease, liver disease, migraine, mood disorder, multiple sclerosis, narcolepsy, neuropathy, obesity, pain, Parkinson's disease, polyneuropathy, pregnancy, psychiatric disorder, sleep disorder, somatoform pain disorder, and uremia. Additional papers were identified by reviewing the reference lists of retrieved publications. RESULTS AND CONCLUSIONS Although clinical diagnosis of RLS can be straightforward, diagnostic challenges may arise when patients present with comorbid conditions. Comorbidities of RLS include insomnia, depressive and anxiety disorders, and pain disorders. Differential diagnosis is particularly important, as some of the medications used to treat insomnia and depression may exacerbate RLS symptoms. Appropriate diagnosis and management of RLS symptoms may benefit patient well-being and, in some cases, may lessen comorbid disease burden. Therefore, it is important that physicians are aware of the presence of RLS when treating patients with conditions that commonly co-occur with the disorder.
Collapse
|
20
|
Luigetti M, Del Grande A, Testani E, Bisogni G, Losurdo A, Giannantoni NM, Mazza S, Sabatelli M, Della Marca G. Restless leg syndrome in different types of demyelinating neuropathies: a single-center pilot study. J Clin Sleep Med 2014; 9:945-9. [PMID: 23997707 DOI: 10.5664/jcsm.3000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE to determine the prevalence of restless legs syndrome (RLS) in a cohort of patients with demyelinating neuropathies. METHODS Patients were retrospectively recruited from our cohort of different forms of demyelinating neuropathies, including chronic inflammatory demyelinating neuropathy (CIDP), Charcot-Marie-Tooth 1A (CMT1A), and hereditary neuropathy with liability to pressure palsies (HNPP) referred to our Department of Neurology in a 10-year period. The validated 4-item RLS questionnaire was used for diagnosis of RLS. All patients with RLS who fulfilled criteria underwent a suggested immobilization test to confirm the diagnosis. A group of outpatients referred to the sleep disorders unit and data from published literature were used as controls. RESULTS Prevalence of RLS in demyelinating neuropathy group was higher than prevalence observed in control population (p = 0.0142) or in the literature data (p = 0.0007). In particular, in comparison with both control population and literature data, prevalence of RLS was higher in CIDP group (p = 0.0266 and p = 0.0063, respectively) and in CMT1A group (p = 0.0312 and p = 0.0105, respectively), but not in HNPP (p = 1.000 and p = 0.9320, respectively). CONCLUSIONS our study confirms a high prevalence of RLS in inflammatory neuropathies as CIDP and, among inherited neuropathies, in CMT1A but not in HNPP. Considering that this is only a small cohort from a single-center retrospective experience, the link between RLS and neuropathy remains uncertain, and larger multicenter studies are probably needed to clarify the real meaning of the association between RLS and neuropathy.
Collapse
Affiliation(s)
- Marco Luigetti
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Tekatas A, Pamuk ON. Increased frequency of restless leg syndrome in patients with ankylosing spondylitis. Int J Rheum Dis 2014; 18:58-62. [DOI: 10.1111/1756-185x.12323] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Aslan Tekatas
- Department of Neurology; Trakya University Medical Faculty; Edirne Turkey
| | - Omer N. Pamuk
- Department of Internal Medicine; Division of Rheumatology; Trakya University Medical Faculty; Edirne Turkey
| |
Collapse
|
22
|
Abstract
Movement disorders, which include disorders such as Parkinson's disease, dystonia, Tourette's syndrome, restless legs syndrome, and akathisia, have traditionally been considered to be disorders of impaired motor control resulting predominantly from dysfunction of the basal ganglia. This notion has been revised largely because of increasing recognition of associated behavioural, psychiatric, autonomic, and other non-motor symptoms. The sensory aspects of movement disorders include intrinsic sensory abnormalities and the effects of external sensory input on the underlying motor abnormality. The basal ganglia, cerebellum, thalamus, and their connections, coupled with altered sensory input, seem to play a key part in abnormal sensorimotor integration. However, more investigation into the phenomenology and physiological basis of sensory abnormalities, and about the role of the basal ganglia, cerebellum, and related structures in somatosensory processing, and its effect on motor control, is needed.
Collapse
Affiliation(s)
- Neepa Patel
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
| | - Mark Hallett
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
23
|
Gemignani F. Letter to the Editor. Pain 2014; 155:198-200. [DOI: 10.1016/j.pain.2013.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 11/27/2022]
|
24
|
Response to Letter to the Editor. Pain 2014; 155:200-201. [DOI: 10.1016/j.pain.2013.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 09/29/2013] [Indexed: 11/22/2022]
|
25
|
Prevalence of restless legs syndrome in patients with chronic pain in Maputo, Mozambique. Sleep Med 2013; 14:1417-8. [PMID: 24211034 DOI: 10.1016/j.sleep.2013.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/02/2013] [Accepted: 06/07/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Because there is only one study to our knowledge on the prevalence of restless legs syndrome (RLS) in sub-Saharan Africa and RLS is more common in patients with some pain syndromes, we aimed to determine the prevalence of RLS in a population with chronic pain in Maputo, Mozambique. METHODS Our study was conducted in the Pain Unit of the Central Hospital of Maputo, Mozambique. Patients were individually interviewed by a neurologist, and only those fulfilling the criteria were included. After collection of demographic data and pain features, the patients answered the screening questions regarding RLS. RESULTS A total of 123 patients with pain were interviewed. Five individuals were excluded. RLS was found in eight (6.77%) of 118 patients. The mean age of the eight patients with RLS was 54.6years. Five patients (62.5%) were women and six (75%) were black individuals. Seven (87.5%) patients were diagnosed with neuropathic pain; one of them had AIDS and another one (12.5%) had orthopedic pain. The presence of hypertension and neuropathies was more frequent in the RLS group. CONCLUSION Despite the secondary causes involved, we believe that it is relevant to report the RLS prevalence detected in our study.
Collapse
|
26
|
Winkelman JW, Gagnon A, Clair AG. Sensory symptoms in restless legs syndrome: the enigma of pain. Sleep Med 2013; 14:934-42. [DOI: 10.1016/j.sleep.2013.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 04/12/2013] [Accepted: 05/18/2013] [Indexed: 01/18/2023]
|