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Zorgor G, Kabeloglu V, Soysal A. Restless legs syndrome after acute ıschemic stroke and ıts relation to lesion location. Sleep Biol Rhythms 2022; 20:551-560. [PMID: 38468622 PMCID: PMC10899909 DOI: 10.1007/s41105-022-00401-9] [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: 04/22/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
Purpose We aimed to investigate the prevalence, clinical profiles and lesion location of Restless Legs Syndrome (RLS) developed after ischemic stroke. Methods This study prospectively included 244 patients with acute cerebral infarction. All patients were evaluated for RLS, and those who met all of the essential diagnostic criteria of the International RLS Study Group were diagnosed with RLS. The evaluation of lesion location was performed by magnetic resonance imaging. International Restless Legs Syndrome Rating Scale was performed 1 week, 1 month, and 3 months after the index stroke to determine the symptom severity of the patients and to observe the exacerbation or regression in follow-up. Results A total of 14 patients (5.7%) had post-stroke RLS (psRLS). The psRLS group consisted mostly of males (9 males, 5 females). Among the patients with psRLS, 12 had a subcortical stroke (9.2%, 130 patients) whereas only 2 had a cortical stroke (1.8%, 114 patients) (p = 0.01). The subcortical lesion locations in the psRLS group were the pons, basal ganglia and/or corona radiata, thalamus, and cerebellum in order of decreasing frequency. Five patients had symptoms in both legs, and 9 patients had symptoms in unilateral legs (7 contralateral, 2 ipsilateral to the lesion). At follow-up, the symptoms of 6 patients resolved completely without medication, 5 patients responded well to pramipexole and 1 patient responded poorly. Only 2 patients who refused to take medication had worsened symptoms. Conclusion The subcortical ischemic lesions are associated with psRLS. Pons, basal ganglia and corona radiata are the structures more likely to cause RLS.
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Affiliation(s)
- Gulsah Zorgor
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
- Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Vasfiye Kabeloglu
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
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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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3
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Buratti L, Rocchi C, Totaro V, Silvestrini M. Polygraphy: a useful tool to discover undetected atrial fibrillation. Minerva Med 2022; 112:818. [PMID: 35168308 DOI: 10.23736/s0026-4806.20.06572-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Laura Buratti
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy -
| | - Chiara Rocchi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Viviana Totaro
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
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Ruppert E, Hacquard A, Tatu L, Namer IJ, Wolff V, Kremer S, Lagha-Boukbiza O, Bataillard M, Bourgin P. Stroke-related restless legs syndrome: Clinical and anatomo-functional characterization of an emerging entity. Eur J Neurol 2021; 29:1011-1016. [PMID: 34889000 DOI: 10.1111/ene.15207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Stroke-related restless legs syndrome (sRLS) secondary to ischemic lesions is an emerging entity and an interesting condition, but there are limited available data to help us further understand its underlying pathways. In this study, we characterized sRLS clinically, neuroanatomically and functionally. METHODS Consecutive patients hospitalized in the Stroke Unit of the University Hospital of Strasbourg were assessed clinically and electrophysiologically for sRLS characteristics. They underwent brain magnetic resonance imaging for the neuroanatomical study of involved structures, and received functional evaluations with 18 F-FDG (2-deoxy-2-[fluorine-18]fluoro-D-glucose) positron emission tomography (PET) for glucose consumption, 123 I-FP-CIT ([123]I-2beta-carbometoxy-3beta-[4-iodophenyl]-N-[3-fluoropropyl]nortropane) single-photon emission computed tomography for dopamine reuptake and PET with 18 F-FDOPA ((3,4-dihydroxy-6-[18]F-fluoro-l-phenylalanine) for presynaptic dopaminergic synthesis. RESULTS Sixteen patients with sRLS, eight women and eight men, aged 41-81 years, were included. The clinical characteristics of sRLS and idiopathic RLS were similar. Most patients presented with bilateral and symmetric de novo RLS. Eight patients had infarction in the lenticulostriate area (middle cerebral artery and internal carotid arteria). The body of the caudate nucleus was most commonly affected. Seven patients had sRLS secondary to ventral brainstem infarction (perforating branches of the basilar arteria) affecting the pons in six patients and the medulla oblongata in one patient. Both the corticospinal tract and the cortico-pontocerebellar fibres were lesioned in all patients with brainstem stroke. One patient had infarction in the left posterior cerebellar vermis and occipital area (posterior cerebral artery and superior cerebellar artery). Isotopic explorations showed a significantly increased dopaminergic tone in the striatum ipsilateral to lenticulostriate infarction. Dopamine fixation was normal in patients with stroke outside of the lenticulostriate area. CONCLUSIONS Clinicians should be aware of the characteristics of sRLS for the appropriate diagnosis and treatment of this condition.
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Affiliation(s)
- Elisabeth Ruppert
- Department of Neurology, Sleep and Electrophysiology Clinic - CIRCSom, University Hospital of Strasbourg, Strasbourg, France.,Faculty of Medicine, University of Strasbourg, Strasbourg, France.,Institute for Cellular and Integrative Neurosciences, CNRS - UPR 3212, Strasbourg, France
| | - Aurélien Hacquard
- Department of Neurology, Sleep and Electrophysiology Clinic - CIRCSom, University Hospital of Strasbourg, Strasbourg, France
| | - Laurent Tatu
- Department of Anatomy, UFR Sciences Médicales et Pharmaceutiques, University of Franche-Comté, Besançon, France.,Department of Neuromuscular Diseases, CHU Besançon, Besançon, France
| | - Izzie Jacques Namer
- Faculty of Medicine, University of Strasbourg, Strasbourg, France.,Department of Biophysics and Nuclear Medicine, University Hospital of Strasbourg, Strasbourg, France.,ICube, University of Strasbourg/CNRS, UMR 7357, Strasbourg, France
| | - Valérie Wolff
- Faculty of Medicine, University of Strasbourg, Strasbourg, France.,Stroke Unit, University Hospital of Strasbourg, Strasbourg, France.,EA3072, Federation of Translational Medicine of Strasbourg, University of Strasbourg, Strasbourg, France
| | - Stéphane Kremer
- ICube, University of Strasbourg/CNRS, UMR 7357, Strasbourg, France.,Department of Imaging 2, University Hospital of Strasbourg, Strasbourg, France
| | - Ouhaïd Lagha-Boukbiza
- Department of Neurology, Movement Disorders Clinic, University Hospital of Strasbourg, Strasbourg, France
| | - Marc Bataillard
- Department of Neurology, Sleep and Electrophysiology Clinic - CIRCSom, University Hospital of Strasbourg, Strasbourg, France.,Faculty of Medicine, University of Strasbourg, Strasbourg, France.,Institute for Cellular and Integrative Neurosciences, CNRS - UPR 3212, Strasbourg, France
| | - Patrice Bourgin
- Department of Neurology, Sleep and Electrophysiology Clinic - CIRCSom, University Hospital of Strasbourg, Strasbourg, France.,Faculty of Medicine, University of Strasbourg, Strasbourg, France.,Institute for Cellular and Integrative Neurosciences, CNRS - UPR 3212, Strasbourg, France
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Buratti L, Cruciani C, Pulcini A, Rocchi C, Totaro V, Lattanzi S, Viticchi G, Falsetti L, Silvestrini M. Lacunar stroke and heart rate variability during sleep. Sleep Med 2020; 73:23-28. [PMID: 32769029 DOI: 10.1016/j.sleep.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Autonomic instability during sleep can influence the risk of cerebrovascular diseases. In this study, we performed a polygraphy to evaluate, heart rate variability (HRV) in a group of patients with lacunar stroke that is a condition at high risk of recurrence. METHODS Twenty-one lacunar stroke patients were enrolled one month after stroke occurrence. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). The presence of common sleep disorders and autonomic changes during the night was investigated by a polygraphy monitoring. Results were compared with those obtained in a group of 21 healthy subjects. RESULTS Patients and controls were similar for age, sex distribution and main cardiovascular risk factors with the exception of the body mass index. Significant differences were detected for all polysomnographic (PSG) parameters and for the PSQI score. By considering HRV values, patients with pathologic values (12 patients, HRV>2) showed significantly higher values in BMI (31 ± 2.9 vs. 26.6 ± 3.6, p = 0.006) and PSQI scores (7.9 ± 2.6 vs. 4.2 ± 1.9) with respect to patients with normal HRV values (nine patients, HRV≤2). CONCLUSIONS The results of this study suggest that the prevalence of nocturnal autonomic dysfunction is high in lacunar stroke patients even in the absence of the commonest sleep-related disorders. An abnormal HRV may contribute to increase the risk of stroke recurrence. Based on our results, the indication to polygraphy in patients with lacunar stroke should be carefully considered.
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Affiliation(s)
- Laura Buratti
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy.
| | - Crizia Cruciani
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Alessandra Pulcini
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Chiara Rocchi
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Viviana Totaro
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Simona Lattanzi
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Giovanna Viticchi
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine, Ospedali Riuniti, Via Conca 71, 60020, Ancona, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
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Shiina T, Suzuki K, Okamura M, Matsubara T, Hirata K. Restless legs syndrome and its variants in acute ischemic stroke. Acta Neurol Scand 2019; 139:260-268. [PMID: 30449044 DOI: 10.1111/ane.13055] [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: 09/23/2018] [Revised: 11/07/2018] [Accepted: 11/13/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The clinical-radiological correlation between restless legs syndrome (RLS) or its variants and acute ischemic stroke remains unclear. METHODS This study prospectively included 104 consecutive patients with acute ischemic stroke, confirmed by diffusion-weighted imaging. The frequency and clinical characteristics of RLS or RLS variants were evaluated according to the International RLS Study Group criteria, as was the topography of the associated lesions. RESULTS Among 104 patients with acute ischemic stroke, 6 (5.8%) and 2 patients (1.9%) had RLS and RLS variants, respectively, for a total of 8 patients (7.7%). Three (3.3%) had poststroke RLS/RLS variants: 2 (66.7%) had bilateral symptoms and 1 (33.3%) had unilateral symptoms contralateral to the lesion. RLS symptoms developed within 2 days after the onset of stroke. Forty percent of prestroke RLS/RLS variant patients experienced exacerbation of their symptoms after stroke onset, and two-thirds of poststroke RLS/RLS variant patients required treatment for their RLS/RLS variants. Patients positive for RLS/RLS variants tended to have difficulty falling asleep, but there was no difference in daytime sleepiness, sleep quality, depressive symptoms, stroke subtypes, comorbid diseases, laboratory data, or modified Rankin Scale scores at admission or discharge between patients with and without RLS/RLS variants. RLS/RLS variants were most frequently observed to accompany lesions in the medulla (25%), followed by the pons (15.4%), the corona radiata (14.8%), the basal ganglia (3.8%), and the cortex (3.8%). CONCLUSION RLS/RLS variants were found in 8% of acute ischemic stroke patients. Adequate screening and management are needed to improve patients' quality of life.
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Affiliation(s)
- Tomohiko Shiina
- Department of Neurology; Dokkyo Medical University; Tochigi Japan
| | - Keisuke Suzuki
- Department of Neurology; Dokkyo Medical University; Tochigi Japan
| | - Madoka Okamura
- Department of Neurology; Dokkyo Medical University; Tochigi Japan
| | - Takeo Matsubara
- Department of Neurology; Dokkyo Medical University; Tochigi Japan
| | - Koichi Hirata
- Department of Neurology; Dokkyo Medical University; Tochigi Japan
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Clinical and radiological characteristics of restless legs syndrome following acute lacunar infarction. Sleep Med 2018; 53:81-87. [PMID: 30458382 DOI: 10.1016/j.sleep.2018.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/31/2018] [Accepted: 06/15/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent studies have suggested that cerebral ischemic infarction may contribute to the development of restless legs syndrome (RLS). This study analyzed the clinical and radiological profiles of RLS with onset after acute lacunar infarction. METHODS In this retrospective study we enrolled 244 consecutive patients with acute lacunar infarction between January 2012 and June 2014. RLS was identified and evaluated based on the International RLS Rating Scale (IRLS-RS). Individual sleep quality was assessed using the Epworth Sleepiness Scale (ESS). Psychological state was also assessed using the Hamilton Depression Scale (HDS) and the Hamilton Anxiety Scale (HAS). RESULTS The incidence of RLS in patients with lacunar infarction was 5.33%. Our participant group consisted of nine males and four females. Three patients had symptoms in bilateral limbs, and 10 patients had symptoms only contralateral to the cerebral infarction. The infarctions were localized to the pons, centrum semiovale, thalamus, putamen, medulla, and occipital lobe. Contralateral paralysis was found in 13 patients, and contralateral sensory deficit in seven patients. The average IRLS-RS, ESS, HDS, HAS scores were 19.07 ± 8.70, 4.69 ± 5.82, 4.38 ± 4.68, and 3.85 ± 4.76, respectively. Nine patients had diabetes mellitus. After administration of dopaminergic drugs, patients' RLS significantly improved. CONCLUSIONS The incidence of RLS after acute lacunar infarction was 5.33%. Pons, centrum semiovale, and basal ganglia were the common locations of responsible lesions. Compared to idiopathic RLS, symptoms of RLS after acute lacunar infarction appeared more unilateral and more likely involved the arm. Moreover, diabetes mellitus may be a risk factor for RLS in stroke patients.
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Robbins R, Seixas A, Jean-Louis G, Parthasarathy S, Rapoport DM, Ogedegbe G, Ladapo JA. National patterns of physician management of sleep apnea and treatment among patients with hypertension. PLoS One 2018; 13:e0196981. [PMID: 29791455 PMCID: PMC5965818 DOI: 10.1371/journal.pone.0196981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/24/2018] [Indexed: 12/12/2022] Open
Abstract
STUDY OBJECTIVES Sleep apnea is associated with hypertension, and treatment may improve outcomes. We examine national burden of sleep apnea, rates of sleep apnea treatment, and whether racial/ethnic disparities exist among patients with hypertension. METHODS Data from the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), 2005-2012, were analyzed (N = 417,950). We identified hypertension patient visits where sleep apnea diagnosis or complaint was recorded. Primary outcome measures were sleep study, medication, or behavioral therapy (diet, weight loss, or exercise counseling). We used multivariate logistic regression to examine treatment by demographic/clinical factors. RESULTS Among patients with hypertension, sleep apnea was identified in 11.2-per-1,000 visits. Overall, patients with hypertension and a sleep disorder were referred for sleep study in 14.4% of visits, prescribed sleep medication in 11.2% of visits, and offered behavioral therapy in 34.8% of visits. Adjusted analyses show behavioral therapy more likely to be provided to obese patients than normal/overweight (OR = 4.96, 95%CI[2.93-8.38]), but less likely to be provided to smokers than nonsmokers (OR = 0.54, 95%CI[0.32-0.93]). Non-Hispanic blacks were less likely to receive medications than non-Hispanic whites (OR = 0.19, 95% CI[0.06-0.65]). CONCLUSIONS In the U.S., sleep apnea were observed in a small proportion of hypertension visits, a population at high-risk for the disorder. One explanation for the low prevalence of sleep apnea observed in this patient population at high risk for the disorder is under-diagnosis of sleep related breathing disorders. Behavioral therapy was underutilized, and non-Hispanic Blacks were less likely to receive medications than non-Hispanic Whites.
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Affiliation(s)
- Rebecca Robbins
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Azizi Seixas
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Girardin Jean-Louis
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Sairam Parthasarathy
- Department of Medicine, University of Arizona, Tuscon, Arizona, United States of America
| | - David M. Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Gbenga Ogedegbe
- Department of Population Health, NYU School of Medicine, New York, New York, United States of America
| | - Joseph A. Ladapo
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
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Chandan S, Shukla G, Gupta A, Srivastava A, Vibha D, Prasad K. Acute-onset Restless legs syndrome in acute neurological conditions-a prospective study on patients with the Guillain-Barre syndrome and acute stroke. Acta Neurol Scand 2018; 137:488-499. [PMID: 29359321 DOI: 10.1111/ane.12890] [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] [Accepted: 12/08/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES While the Restless legs syndrome (RLS) is usually recognized as a chronic condition, it has often been diagnosed among patients with acute neurological illnesses, in which limb discomfort is reported. This study was conducted to determine how many among these, actually have acute-onset RLS, and also to evaluate characteristics of this subgroup of patients with Guillain-Barre syndrome (GBS) and stroke developing acute-onset RLS. METHODS Consecutive patients diagnosed with GBS and eligible stroke patients, admitted to our Neurology services over a 1-year period, were enrolled. They were evaluated for symptoms of RLS based on IRLSSG consensus criteria and the AIIMS RLS Questionnaire for Indian patients (ARQIP). RESULTS Forty adults with GBS and 58 with stroke were included. A total of 10 of the 40 (25%) patients with GBS developed definite acute RLS, which was mostly monophasic. Seven (70%) of these had demyelinating type of GBS, a significant association with acute RLS (P = .024). Six of the 58 stroke patients (10%) developed definite acute-onset, often persistent RLS. Subcortical location showed significant association with increased risk of developing acute RLS (P < .001). All patients diagnosed with acute-onset RLS had an immediate and good response to dopamine agonists. CONCLUSION This is the first study showing that acute-onset RLS is common, affecting nearly 25% of patients with GBS and 10% patients with acute stroke. Recognizing and treating it can majorly contribute toward symptom relief and early improvement in the quality of life for this population.
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Affiliation(s)
- S. Chandan
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - G. Shukla
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - A. Gupta
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - A. Srivastava
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - D. Vibha
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - K. Prasad
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
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Effect of continuous positive airway pressure on carotid intima-media thickness in patients with obstructive sleep apnea: A meta-analysis. PLoS One 2017; 12:e0184293. [PMID: 28863162 PMCID: PMC5580911 DOI: 10.1371/journal.pone.0184293] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/20/2017] [Indexed: 11/19/2022] Open
Abstract
Objective Obstructive sleep apnea (OSA) is associated with increased carotid intima-media thickness (IMT), an early marker of atherosclerosis. Continuous positive airway pressure (CPAP) is the first-line treatment for OSA. A meta-analysis was performed to determine whether CPAP therapy could decrease carotid IMT. Methods The PubMed, Embase, Web of Science, and Cochrane library were searched before March, 2017. Weighted mean difference (WMD) was calculated to estimate the treatment effects of pre and post-CPAP therapy. Seven studies were examined and the meta-analysis was performed using STATA 12.0. Results There was no change of carotid IMT before and after CPAP treatment in OSA patients (WMD = 0.052, 95% confidence interval (CI) = −0.002 to 0.105, z = 1.90, p = 0.057). Meanwhile, meta-analysis of the two RCTs showed that carotid IMT was not changed in CPAP group when compared with control group (WMD = 0.002 95% CI = −0.125 to 0.129, z = 0.03, p = 0.976). Subgroup analyses indicated that carotid IMT was significantly decreased after CPAP use in more severe OSA patients (AHI≥50) (WMD = 0.073, 95% CI = 0.022 to 0.124, z = 2.80, p = 0.005) and patients with therapeutic duration ≥6 months (WMD = 0.121, 95% CI = 0.019 to 0.223, z = 2.32, p = 0.021). Conclusions CPAP had no impact on carotid IMT in OSA patients. However, carotid IMT was significantly decreased after CPAP treatment in more severe OSA patients and patients with longer CPAP usage.
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Kawada T. Restless leg syndrome and periodic limb movements in sleep: risk for cardiovascular disease. Sleep Med 2017; 36:180. [DOI: 10.1016/j.sleep.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/05/2017] [Indexed: 11/24/2022]
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