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Tu X, Wu N, Wan Y, Gan J, Liu Z, Song L. Association of dietary selenium intake and all-cause mortality of Parkinson's disease and its interaction with blood cadmium level: a retrospective cohort study. BMC Geriatr 2024; 24:415. [PMID: 38730347 PMCID: PMC11088170 DOI: 10.1186/s12877-024-05000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a slowly progressive neurodegenerating disease that may eventually lead to disabling condition and pose a threat to the health of aging populations. This study aimed to explore the association of two potential risk factors, selenium and cadmium, with the prognosis of Parkinson's disease as well as their interaction effect. METHODS Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 to 2015-2016 and National Death Index (NDI). Participants were classified as Parkinson's patients by self-reported anti-Parkinson medications usage. Cox regression models and restricted cubic spline models were applied to evaluate the association between PD mortality and selenium intake level as well as blood cadmium level. Subgroup analysis was also conducted to explore the interaction between them. RESULTS A total of 184 individuals were included. In full adjusted cox regression model (adjusted for age, gender, race, hypertension, pesticide exposure, smoking status and caffeine intake), compared with participants with low selenium intake, those with normal selenium intake level were significantly associated with less risk of death (95%CI: 0.18-0.76, P = 0.005) while no significant association was found between low selenium intake group and high selenium group (95%CI: 0.16-1.20, P = 0.112). Restricted cubic spline model indicated a nonlinear relationship between selenium intake and PD mortality (P for nonlinearity = 0.050). The association between PD mortality and blood cadmium level was not significant (95%CI: 0.19-5.57, P = 0.112). However, the interaction term of selenium intake and blood cadmium showed significance in the cox model (P for interaction = 0.048). Subgroup analysis showed that the significant protective effect of selenium intake existed in populations with high blood cadmium but not in populations with low blood cadmium. CONCLUSION Moderate increase of selenium intake had a protective effect on PD mortality especially in high blood cadmium populations.
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Affiliation(s)
- Xinyu Tu
- School of Medicine, Shanghai Jiao Tong University, No.227 Chongqing Rd (S), Shanghai, China
| | - Na Wu
- Department of neurology, Xinhua Hospital, Shanghai Jiao tong University School of Medicine, No.1665 Kongjiang Rd, Shanghai, China
| | - Ying Wan
- Department of neurology, Xinhua Hospital, Shanghai Jiao tong University School of Medicine, No.1665 Kongjiang Rd, Shanghai, China
| | - Jing Gan
- Department of neurology, Xinhua Hospital, Shanghai Jiao tong University School of Medicine, No.1665 Kongjiang Rd, Shanghai, China
| | - Zhenguo Liu
- Department of neurology, Xinhua Hospital, Shanghai Jiao tong University School of Medicine, No.1665 Kongjiang Rd, Shanghai, China.
| | - Lu Song
- Department of neurology, Xinhua Hospital, Shanghai Jiao tong University School of Medicine, No.1665 Kongjiang Rd, Shanghai, China.
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Pellitteri G, Versace S, Merlino G, Nilo A, Gigli GL, Valente M. A comprehensive update on the ADMET considerations for α2δ calcium channel ligand medications for treating restless legs syndrome. Expert Opin Drug Metab Toxicol 2024; 20:133-142. [PMID: 38482850 DOI: 10.1080/17425255.2024.2329738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is a sleep-related sensory-motor disorder associated with poor sleep quality and impaired daily functioning. In patients affected by chronic RLS/WED, a pharmacological therapy is recommended. International guidelines suggest to start the treatment with a α2δ calcium channel ligand in most cases, unless contraindicated. AREAS COVERED The present review is based on an extensive Internet and PubMed search from 1986 to 2024. Our purpose is to describe the absorption, distribution, metabolism, and toxicology (ADMET) of the α2δ ligands, with common consideration for the therapeutic class, specificities of different compounds, efficacy, and safety in relation to other treatment options. EXPERT OPINION α2δ ligands are quite similar in their ADMET profiles, sharing most of the pharmacokinetics and potential adverse effects. However, we highlight the linear kinetic of gabapentin enacarbil and pregabalin, differently from gabapentin. α2δ ligands are safe and effective for the treatment of RLS/WED. Additional benefits can be obtained in comorbid insomnia, chronic pain syndromes, history of impulse control disorder, and comorbid anxiety. The use of α2δ ligands is associated with poor risk of augmentation. We still need new long-term safe and effective treatments, which could be developed along with our knowledge of RLS/WED pathophysiology.
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Affiliation(s)
- Gaia Pellitteri
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
| | - Salvatore Versace
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
- Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Giovanni Merlino
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
- Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Gian Luigi Gigli
- Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
- Department of Medicine (DMED), University of Udine, Udine, Italy
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Morais MA, Franco B, Holanda ASS, Simino LADP, Manconi M, Torsoni A, Esteves AM. Effectiveness of exercise and pramipexole in the treatment of restless leg syndrome: Implications on the dopaminergic system and PTPRD. Sleep Med 2023; 110:201-211. [PMID: 37633178 DOI: 10.1016/j.sleep.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Dopaminergic dysfunction, iron reduction and variations in the PTPRD gene (protein tyrosine phosphatase receptor type delta) may be associated with restless leg syndrome (RLS). Here, we evaluate the effect of pramipexole (PPX) and exercise on genes and proteins associated with RLS and on sleep patterns in spontaneously hypertensive rats (SHR). METHODS Animals were distributed into 4 groups: 1) Control (CTRL); 2) Exercise (EX); 3) Exercise and pramipexole (EX + PPX); and 4) Pramipexole (PPX). PPX treatment was performed daily (0.125 mg/kg), while exercise was conducted over 5 sessions per week, both for 4 weeks. RESULTS EX + PPX increased the protein levels of PTPRD, reduced the protein levels of the enzyme tyrosine hydroxylase (TH) and improved sleep parameters in both cycles; on the other hand, the use of PPX reduced mRNA and protein levels of PTPRD and TH but improved the sleep pattern in the light cycle. However, in the dark cycle, pramipexole caused the worsening of symptoms. CONCLUSIONS We suggest that the improvement in sleep pattern by EX + PPX may be associated with the increased protein levels of PTPRD and that EX + PPX can reverse the negative effects of PPX.
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Affiliation(s)
- Milca A Morais
- Faculdade de Ciências Aplicadas - Universidade Estadual de Campinas, Street Pedro Zaccaria, 1300, 13484-350, Limeira, Brazil.
| | - Beatriz Franco
- Faculdade de Educação Física - Universidade Estadual de Campinas, Érico Veríssimo Avenue, 701 - Cidade Universitária Zeferino Vaz, Campinas, Brazil.
| | - Alessandro S S Holanda
- Faculdade de Ciências Aplicadas - Universidade Estadual de Campinas, Street Pedro Zaccaria, 1300, 13484-350, Limeira, Brazil.
| | - Laís Angélica de Paula Simino
- Faculdade de Ciências Aplicadas - Universidade Estadual de Campinas, Street Pedro Zaccaria, 1300, 13484-350, Limeira, Brazil.
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Via Tesserete 46, Lugano CH-6903, Switzerland.
| | - Adriana Torsoni
- Faculdade de Ciências Aplicadas - Universidade Estadual de Campinas, Street Pedro Zaccaria, 1300, 13484-350, Limeira, Brazil.
| | - Andrea M Esteves
- Faculdade de Ciências Aplicadas - Universidade Estadual de Campinas, Street Pedro Zaccaria, 1300, 13484-350, Limeira, Brazil.
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Woods S, Basco J, Clemens S. Effects of iron-deficient diet on sleep onset and spinal reflexes in a rodent model of Restless Legs Syndrome. Front Neurol 2023; 14:1160028. [PMID: 37273717 PMCID: PMC10234126 DOI: 10.3389/fneur.2023.1160028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Restless Legs Syndrome (RLS) is a common sensorimotor and a sleep disorder that affects 2.5-10% of the European and North American populations. RLS is also often associated with periodic leg movements during sleep (PLMS). Despite ample evidence of genetic contributions, the underlying mechanisms that elicit the sensory and motor symptoms remain unidentified. Clinically, RLS has been correlated with an altered central iron metabolism, particularly in the brain. While several animal models have been developed to determine the outcome of an altered iron homeostasis on brain function, the potential role of an altered iron homeostasis on sleep and sensorimotor circuits has not yet been investigated. Here, we utilize a mouse model to assess the effects of an iron-deficient (ID) but non-anemic state on sleep time and episodes, and sensorimotor reflexes in male and female mice. We found that animals on the ID diet displayed an increased expression of the transferrin receptor in the spinal cord, confirming the results of previous studies that focused only on the impact of ID in the brain. We also demonstrate that the ID diet reduced hematocrit levels compared to controls but not into the anemic range, and that animals on the ID diet exhibited RLS-like symptoms with regard to sleep onset and spinal cord reflex excitability. Interestingly, the effects on the spinal cord were stronger in females than in males, and the ID diet-induced behaviors were rescued by the return of the animals to the control diet. Taken together, these results demonstrate that diet-induced ID changes to CNS function are both inducible and reversible, and that they mimic the sleep and sensorimotor RLS symptoms experienced in the clinic. We therefore propose replacing the commonly used phrase "brain iron deficiency" (BID) hypothesis in the RLS research field with the term "iron deficiency in the central nervous system" (ID-CNS), to include possible effects of altered iron levels on spinal cord function.
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Schütz L, Sixel-Döring F, Hermann W. Management of Sleep Disturbances in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2029-2058. [PMID: 35938257 PMCID: PMC9661340 DOI: 10.3233/jpd-212749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 06/07/2023]
Abstract
Parkinson's disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.
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Affiliation(s)
- Lukas Schütz
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
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Abstract
Restless Legs Syndrome (RLS) is a sensorimotor disorder that severely affects sleep. It is characterized by an urge to move the legs that is often accompanied by periodic limb movements during sleep (PLMS). RLS has a high prevalence in the population and is usually a life-long condition. While its origins remain unclear, RLS is initially highly responsive to treatment with dopaminergics that target the D3 receptor. However, over time patients often develop a gradual tolerance that can lead to the emergence of adverse effects and the augmentation of the symptoms. While the basal ganglia and the striatum control leg movements, the lumbar spinal cord is the gateway for the sensory processing of the symptoms and critical for the associated leg movements. D3 receptors are highly expressed in nucleus accumbens (NAc) of the striatum and the sensory-processing areas of the spinal dorsal horn. In contrast, D1 receptors are strongly expressed throughout the entire striatum and in the ventral horn of the spinal cord. Long-term treatment with D3 receptor full agonists is associated with an upregulation of the D1 receptor subtype, and D3 and D1 receptors can form functional heteromers, in which the D3R controls the D1R function. It is conceivable that the switch from beneficial treatment to augmentation observed in RLS patients after prolonged D3R agonist exposure may be the result of unmasked D1-like receptor actions.
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Affiliation(s)
- Stefan Clemens
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
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Vlasie A, Trifu S, Lupuleac C, Kohn B, Cristea M. Restless legs syndrome: An overview of pathophysiology, comorbidities and therapeutic approaches (Review). Exp Ther Med 2021; 23:185. [PMID: 35069866 PMCID: PMC8764906 DOI: 10.3892/etm.2021.11108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Andrei Vlasie
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | - Simona Trifu
- Department of Clinical Neurosciences, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Cristiana Lupuleac
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | - Bianca Kohn
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | - Mihai Cristea
- Department of Morphological Sciences, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
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Innes KE, Selfe TK, Montgomery C, Hollingshead N, Huysmans Z, Srinivasan R, Wen S, Hausmann MJ, Sherman K, Klatt M. Effects of a 12-week yoga versus a 12-week educational film intervention on symptoms of restless legs syndrome and related outcomes: an exploratory randomized controlled trial. J Clin Sleep Med 2021; 16:107-119. [PMID: 31957638 DOI: 10.5664/jcsm.8134] [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] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES To assess the effects of a yoga versus educational film (EF) program on restless legs syndrome (RLS) symptoms and related outcomes in adults with RLS. METHODS Forty-one community-dwelling, ambulatory nonpregnant adults with moderate to severe RLS were randomized to a 12-week yoga (n = 19) or EF program (n = 22). In addition to attending classes, all participants completed practice/treatment logs. Yoga group participants were asked to practice at home 30 minutes per day on nonclass days; EF participants were instructed to record any RLS treatments used on their daily logs. Core outcomes assessed pretreatment and posttreatment were RLS symptoms and symptom severity (International RLS Study Group Scale (IRLS) and RLS ordinal scale), sleep quality, mood, perceived stress, and quality of life (QOL). RESULTS Thirty adults (13 yoga, 17 EF), aged 24 to 73 (mean = 50.4 ± 2.4 years), completed the 12-week study (78% female, 80.5% white). Post-intervention, both groups showed significant improvement in RLS symptoms and severity, perceived stress, mood, and QOL-mental health (P ≤ .04). Relative to the EF group, yoga participants demonstrated significantly greater reductions in RLS symptoms and symptom severity (P ≤ .01), and greater improvements in perceived stress and mood (P ≤ .04), as well as sleep quality (P = .09); RLS symptoms decreased to minimal/mild in 77% of yoga group participants, with none scoring in the severe range by week 12, versus 24% and 12%, respectively, in EF participants. In the yoga group, IRLS and RLS severity scores declined with increasing minutes of homework practice (r = .7, P = .009 and r = .6, P = .03, respectively), suggesting a possible dose-response relationship. CONCLUSIONS Findings of this exploratory RCT suggest that yoga may be effective in reducing RLS symptoms and symptom severity, decreasing perceived stress, and improving mood and sleep in adults with RLS. CLINICAL TRIAL REGISTRATION Registry: Clinicaltrials.gov; Title: Yoga vs. Education for Restless Legs: a Feasibility Study; Identifier: NCT03570515; URL: https://clinicaltrials.gov/ct2/show/NCT03570515.
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Affiliation(s)
- Kim E Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia
| | - Terry Kit Selfe
- Health Science Center Libraries, University of Florida, Gainesville, Florida
| | - Caitlin Montgomery
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia
| | - Nicole Hollingshead
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Zenzi Huysmans
- West Virginia University College of Physical Activity and Sport Sciences, Morgantown, West Virginia
| | - Roshini Srinivasan
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sijin Wen
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia
| | - Madeleine J Hausmann
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Karen Sherman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Maryanna Klatt
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio
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Lv Q, Wang X, Asakawa T, Wang XP. Pharmacologic Treatment of Restless Legs Syndrome. Curr Neuropharmacol 2021; 19:372-382. [PMID: 33380302 PMCID: PMC8033969 DOI: 10.2174/1570159x19666201230150127] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/24/2020] [Accepted: 12/19/2020] [Indexed: 01/14/2023] Open
Abstract
Restless legs syndrome (RLS)/Willis-Ekbom disease is a neurologic disorder characterized by a strong desire to move when at rest (usually in the evening) and paraesthesia in their lower legs. The most widely used therapies for first-line treatment of RLS are dopaminergic drugs; however, their long-term use can lead to augmentation. α2δ Ligands, opioids, iron, glutamatergic drugs, adenosine, and sleep aids have been investigated as alternatives. The pathogenesis of RLS is not well understood. Despite the efficacy of dopaminergic drugs in the treatment of this disorder, unlike in Parkinson's disease dopaminergic cell loss in the substantia nigra has not been observed in RLS. The etiology of RLS is likely complex, involving multiple neural pathways. RLS-related genes identified in genome-wide association studies can provide insight into the mechanistic basis and pathophysiology of RLS. Here we review the current treatments and knowledge of the mechanisms underlying RLS.
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Affiliation(s)
| | | | - Tetsuya Asakawa
- Address correspondence to these authors at the Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, No.1111 Xianxia Road, 200336, Shanghai, China; Tel: +86-021-52039999-72223; Fax: +86-021-52039999-72223; E-mail: and Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, 1-20-1, Higashi-ku, Hamamatsu-city, Shizuoka 431-3192, Japan; Tel: + 81-53-435-2283; Fax: + 81-53-435-2282;, E-mail:
| | - Xiao Ping Wang
- Address correspondence to these authors at the Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, No.1111 Xianxia Road, 200336, Shanghai, China; Tel: +86-021-52039999-72223; Fax: +86-021-52039999-72223; E-mail: and Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, 1-20-1, Higashi-ku, Hamamatsu-city, Shizuoka 431-3192, Japan; Tel: + 81-53-435-2283; Fax: + 81-53-435-2282;, E-mail:
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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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Abstract
Restless legs syndrome (RLS), with a lifetime prevalence of up to 10%, is a frequent neurological disease and the most common movement disorder in sleep. A compulsive urge to move the legs with sensory symptoms and sleep disturbances can significantly impair the quality of life. Furthermore, RLS frequently occurs as a comorbidity to various internal and neurological diseases. It is diagnosed clinically based on the five essential diagnostic criteria. For treatment, an iron deficiency should first be excluded. Drugs approved for the treatment of RLS include dopaminergics (L-DOPA/benserazide) and dopamine agonists as well as oxycodone/naloxone, as a second-line treatment in severe cases. Augmentation as a deterioration of symptoms is a clinically defined complication of high-dose dopaminergic treatment, requiring special management strategies. Due to its high prevalence of up to 25%, RLS plays also an important role in the care of pregnant women.
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Restless-legs-Syndrom: ein Update. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Park KT, Sim I, Ko HS, Lim YH. Gamma Aminobutyric Acid Increases Absorption of Glycine-Bound Iron in Mice with Iron Deficiency Anemia. Biol Trace Elem Res 2020; 197:628-638. [PMID: 31927755 DOI: 10.1007/s12011-020-02027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022]
Abstract
Iron deficiency is a leading cause of anemia. Amino acids are known to promote the absorption of both soluble and insoluble iron. The bioavailability of organic iron is higher than that of inorganic iron. Therefore, the aim of this study was to evaluate the iron absorption of glycine-bound iron (an organic iron) and a combination of glycine-bound iron and gamma aminobutyric acid (GABA) in mice with iron deficiency anemia (IDA). Mice were fed an iron-deficient diet for 3 weeks, followed by oral administration of GABA, inorganic iron, glycine-bound iron, or GABA plus glycine-bound iron for 5 weeks. Ferritin storage in the spleen was measure by immunohistochemistry (IHC). Iron deposition in the liver and spleen tissues was analyzed using atomic absorption spectrometry. Expression levels of iron absorption-related genes were measured by quantitative real-time polymerase chain reaction (qPCR). Iron absorption was enhanced in the glycine-bound iron-treated group compared with the inorganic iron-treated group. Hemoglobin, serum Fe, ferritin, and liver iron levels did not increase in mice treated with GABA alone. However, mice administered GABA in combination with glycine-bound iron showed higher iron absorption than those administered organic iron alone. Our results indicate that glycine-bound iron in combination with GABA might exert a synergistic effect on iron absorption and bioavailability, suggesting that the addition of GABA to existing iron supplements might increase their effectiveness for treating IDA.
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Affiliation(s)
- Keun-Tae Park
- Research and Development Center, Milae Bioresources Co. Ltd., Seoul, 05542, Republic of South Korea
- Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul, 02841, Republic of South Korea
| | - Insuk Sim
- Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul, 02841, Republic of South Korea
| | - Hyun-Soo Ko
- Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul, 02841, Republic of South Korea
| | - Young-Hee Lim
- Department of Integrated Biomedical and Life Sciences, College of Health Science, Korea University, Seoul, 02841, Republic of South Korea.
- Department of Public Health Science (Brain Korea 21 PLUS program), Graduate School, Korea University, Seoul, 02841, Republic of South Korea.
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, 08308, Republic of South Korea.
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Zuzuárregui JRP, During EH. Sleep Issues in Parkinson's Disease and Their Management. Neurotherapeutics 2020; 17:1480-1494. [PMID: 33029723 PMCID: PMC7851262 DOI: 10.1007/s13311-020-00938-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Parkinson's disease (PD) is an alpha-synucleinopathy that leads to prominent motor symptoms including tremor, bradykinesia, and postural instability. Nonmotor symptoms including autonomic, neurocognitive, psychiatric symptoms, and sleep disturbances are also seen frequently in PD. The impact of PD on sleep is related to motor and nonmotor symptoms, in addition to the disruption of the pathways regulating sleep by central nervous system pathology. Rapid eye movement sleep behavior disorder is a parasomnia that can lead to self-injury and/or injury to partners at night. Restless legs syndrome is a subjective sensation of discomfort and urge to move the legs prior to falling asleep and can lead to insomnia and reduced sleep quality. Excessive daytime sleepiness is common in PD and exerts a negative impact on quality of life in addition to increasing the risk of falls. Obstructive sleep apnea is a breathing disorder during sleep that can cause frequent awakenings and excessive daytime sleepiness. Circadian rhythm dysfunction can lead to an advanced or delayed onset of sleep in patients and create disruption of normal sleep and wake times. All of these disorders are common in PD and can significantly reduce sleep quantity, sleep quality, or quality of life for patients and caretakers. Treatment approaches for each of these disorders are distinct and should be individualized to the patient. We review the literature regarding these common sleep issues encountered in PD and their treatment options.
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Affiliation(s)
| | - Emmanuel H During
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, CA, USA
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15
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Rémi J. [Not Available]. MMW Fortschr Med 2020; 162:54-59. [PMID: 32895836 DOI: 10.1007/s15006-020-1214-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Jan Rémi
- Klinikum Großhadern d. LMU München, Marchioninistr. 15, 81377, München, Germany.
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16
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Kocar TD, Müller HP, Kassubek J. Differential functional connectivity in thalamic and dopaminergic pathways in restless legs syndrome: a meta-analysis. Ther Adv Neurol Disord 2020; 13:1756286420941670. [PMID: 32821291 PMCID: PMC7412904 DOI: 10.1177/1756286420941670] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: Restless legs syndrome (RLS) is a sensorimotor disorder with alterations in somatosensory processing in association with a dysfunctional cerebral network, involving the basal ganglia, limbic network, and sensorimotor pathways. Resting state functional magnetic resonance imaging (MRI) is a powerful tool to provide in vivo insight into functional processing and as such is of special interest in RLS considering the widespread pattern of networks involved in this disorder. In this meta-analysis of resting state functional MRI studies, we analyzed the preponderance of functional connectivity changes associated with RLS and discussed possible links to sensorimotor dysfunction and somatosensory processing. Methods: A systematic research using the online library PubMed was conducted and a total of seven studies passed the inclusion criteria of the meta-analysis. The results of these studies were merged and a statistical probability map was generated that indicated the likelihood of functional connectivity changes within the combined cohort, both for increased and decreased connectivity. Results: The meta-analysis demonstrated decreased functional connectivity within the dopaminergic network in participants with RLS compared with healthy controls, including the nigrostriatal, mesolimbic, and mesocortical pathways. Increased functional connectivity was observed bilaterally in the thalamus, including its ventral lateral, ventral anterior, and ventral posterior lateral nuclei, and the pulvinar. Discussion: Sensorimotor dysfunction in RLS seems to be reflected by decreased functional connectivity within the dopaminergic pathways. Network extension in the thalamus can be regarded as an adaptation to somatosensory dysfunction in RLS. This differential functional connectivity pattern extends prior findings on cerebral somatosensory processing in RLS and offers an explanation for the efficacy of dopaminergic treatment.
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Affiliation(s)
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, Ulm, 89081, Germany
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17
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Auvinen P, Koponen H, Kautiainen H, Korniloff K, Ahonen T, Vanhala M, Mäntyselkä P. The influence of restless legs symptoms on musculoskeletal pain in depression. Scand J Pain 2020; 20:603-610. [PMID: 32106087 DOI: 10.1515/sjpain-2019-0128] [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: 09/20/2019] [Accepted: 01/17/2020] [Indexed: 11/15/2022]
Abstract
Background and aims Restless legs syndrome is a sensorimotor disorder associated with mental health conditions notably depression. Restless legs symptoms and depression are commonly associated with pain. The study investigated the influence of restless legs symptoms on musculoskeletal pain in patients with depression or with increased depressive symptoms. Methods A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in patients with depressive symptoms (n = 695) and controls without a psychiatric diagnosis (n = 410) by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory and the psychiatric diagnosis was confirmed by means of a diagnostic interview (MINI). The prevalence and intensity of musculoskeletal pain was captured with form-based questions. A single-question screen for restless legs symptoms was applied. Results There was a significant difference in the prevalence of continuous widespread musculoskeletal pain between the three study groups: the controls 4.6% (95% CI: 2.8-7.1), the patients with symptoms of depression without a diagnosis 16.0% (11.7-21.1), and the patients with diagnosed depression 22.1% (18.3-23.3) (p = 0.006 after being adjusted for age, sex, smoking, use of alcohol, education years, body mass index, use of antidepressants, and physical activity, after multiple corrections, all groups were significantly different from each other). Compared with those not having restless legs symptoms, subjects with restless legs symptoms had more often continuous widespread musculoskeletal pain in the control subjects (p = 0.001; 2.3% vs. 10.5%) and in the patients with depressive symptoms without a depression diagnosis (p = 0.024; 9.1 vs. 18.7%) but not in those with diagnosed depression (p = 0.98; 19.5 vs. 19.4%). The restless legs symptoms were associated with the intensity of pain in all groups (p < 0.001). Conclusions Restless legs symptoms were related to continuous widespread musculoskeletal pain in subjects without depressive symptoms and in patients with depressive symptoms without a depression diagnosis. Pain intensity was higher in the subjects with restless legs symptoms regardless of depressive symtoms or depression. Implications Clinical management of pain in patients with restless legs symptoms should include an increased focus on the prevention and treatment of either conditions.
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Affiliation(s)
- Piritta Auvinen
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Primary Health Care Unit, Kuopio, Finland, Phone: +358407063831
| | - Hannu Koponen
- University of Helsinki and Helsinki University Hospital; Psychiatry, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Katariina Korniloff
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Tiina Ahonen
- Primary Health Care Unit, Central Finland Central Hospital, Jyväskylä, Finland
| | - Mauno Vanhala
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
| | - Pekka Mäntyselkä
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
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18
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Çam M, Kutluana U. Evaluation of upper endoscopic findings in patients with restless legs syndrome and gastric complaints. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:217-223. [PMID: 32294750 DOI: 10.1590/0004-282x20190192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 11/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effect of gastrointestinal system disorders on Restless Legs Syndrome/Willis-Ekbom disease (RLS/WED) has been previously demonstrated by using serological tests. However, this association has not been supported by histopathological studies so far. OBJECTIVE To investigate the relationship between RLS/WED, upper endoscopic imaging and histopathological results in patients diagnosed with RLS who underwent endoscopy because of gastrointestinal system (GIS) complaints. METHODS Case-control study, including 100 patients diagnosed with RLS who presented dyspeptic complaints and underwent upper GIS endoscopy and 106 age- and sex-matched controls. RLS diagnosis was evaluated according to the four main diagnostic criteria determined by the International RLS Study Group. All patients underwent upper GIS endoscopic intervention and at least one gastric and/or antral biopsy. RESULTS There was no significant difference between patients and controls in relation to endoscopically seen gastric ulcer, duodenal ulcer, gastroesophageal reflux disease (GERD) findings and Helicobacter pylori (HP) positivity (p>0.05). Intestinal metaplasia and mucosal atrophy were more common in RLS/WED patients compared to controls (p=0.026 and p=0.017, respectively). Additionally, ferritin levels were found to be lower than the reference value. CONCLUSIONS The detection of increased severity of intestinal metaplasia, mucosal atrophy, and gastric inflammation in RLS/WED patients with dyspeptic complaints may entail the close gastrointestinal system evaluation of these patients. However, larger randomized and controlled trials are required on this subject where patients are evaluated by upper GIS endoscopic biopsy.
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Affiliation(s)
- Mustafa Çam
- Canakkale Onsekiz Mart University, School of Medicine, Department of Neurology, Canakkale, Turkey
| | - Ufuk Kutluana
- Uşak Univerrity School of Medicine, Department of Internal Medicine, Uşak, Turkey
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19
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Md S, Karim S, Saker SR, Gie OA, Hooi LC, Yee PH, Kang AWC, Zhe CK, Ian N, Aldawsari HM, Hosny KM, Alhakamy NA. Current Status and Challenges in Rotigotine Delivery. Curr Pharm Des 2020; 26:2222-2232. [PMID: 32175832 DOI: 10.2174/1381612826666200316154300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/09/2020] [Indexed: 12/11/2022]
Abstract
Rotigotine is a non-ergoline, high lipophilic dopamine agonist. It is indicated as the first-line therapy for Parkinson's disease (PD) and Restless Leg Syndrome (RLS). However, the precise mechanism of rotigotine is yet to be known. Rotigotine has similar safety and tolerability to the other oral non-ergolinic dopamine antagonists in clinical trials, which include nausea, dizziness and somnolence. Neupro® was the first marketed transdermal patch formulation having rotigotine. The transdermal delivery system is advantageous as it enables continuous administration of the drug, thus providing steady-state plasma drug concentration for 24-hours. Intranasal administration of rotigotine allows the drug to bypass the blood-brain barrier enabling it to reach the central nervous system within minutes. Rotigotine can also be formulated as an extended-release microsphere for injection. Some challenges remain in other routes of rotigotine administration such as oral, parenteral and pulmonary, whereby resolving these challenges will be beneficial to patients as they are less invasive and comfortable in terms of administration. This review compiles recent work on rotigotine delivery, challenges and its future perspective.
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Affiliation(s)
- Shadab Md
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.,Center of Excellence for Drug Research & Pharmaceutical Industries, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shahid Karim
- Department of Pharmacology, College of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Sanggetha R Saker
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Ooi A Gie
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Lim C Hooi
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Phua H Yee
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Alvin W C Kang
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Chen K Zhe
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Ng Ian
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Hibah M Aldawsari
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.,Center of Excellence for Drug Research & Pharmaceutical Industries, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khaled M Hosny
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.,Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni- Suef University, Beni-Suef, Egypt
| | - Nabil A Alhakamy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.,Center of Excellence for Drug Research & Pharmaceutical Industries, King Abdulaziz University, Jeddah, Saudi Arabia
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Abstract
Movement disorders in women during pregnancy are uncommon. Therefore, high quality studies are limited, and guidelines are lacking for the treatment of movement disorders in pregnancy, thus posing a significant therapeutic challenge for the treating physicians. In this chapter, we discuss movement disorders that arise during pregnancy and the preexisting movement disorders during pregnancy. Common conditions encountered in pregnancy include but are not limited to restless legs syndrome, chorea gravidarum, Parkinson disease, essential tremor, and Huntington disease as well as more rare movement disorders (Wilson's disease, dystonia, etc.). This chapter summarizes the published literature on movement disorders and pharmacologic and surgical considerations for neurologists and physicians in other specialties caring for patients who are pregnant or considering pregnancy.
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Affiliation(s)
- Fang Ba
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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21
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Trenkwalder C, Paulus W. Pharmacological treatments of augmentation in restless legs syndrome patients. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2019; 84:255-265. [PMID: 31229175 DOI: 10.1016/bs.apha.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Augmentation, a treatment-induced paradoxical worsening of the symptoms of restless legs syndrome (RLS) that is caused by long-term dopaminergic therapy, in particular with higher doses, remains the major challenge of RLS treatment. The mainstay of treatment continues to be preventing augmentation, either by starting RLS therapy with alternative drugs or by sensitizing physicians about the absolute necessity of respecting approved dosages of dopaminergic drugs when treating RLS and never exceeding the maximum recommended dosages. In the case of a positive diagnosis of augmentation, treatment consists of reducing or eliminating dopaminergic therapy, ensuring that serum ferritin is clearly higher than the level assumed to be necessary from a hematological point of view and/or switching treatment to alternative drugs such as α2δ ligands, opiates, or to combination therapy.
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Affiliation(s)
- Claudia Trenkwalder
- Department of Neurosurgery, University Medical Center, Göttingen, Germany; Paracelsus-Elena Hospital, Center of Parkinsonism and Movement Disorders, Kassel, Germany.
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
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22
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Rosen IM, Aurora RN, Kirsch DB, Carden KA, Malhotra RK, Ramar K, Abbasi-Feinberg F, Kristo DA, Martin JL, Olson EJ, Rosen CL, Rowley JA, Shelgikar AV. Chronic Opioid Therapy and Sleep: An American Academy of Sleep Medicine Position Statement. J Clin Sleep Med 2019; 15:1671-1673. [PMID: 31739858 PMCID: PMC6853382 DOI: 10.5664/jcsm.8062] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 01/23/2023]
Abstract
None There is a complex relationship among opioids, sleep and daytime function. Patients and medical providers should be aware that chronic opioid therapy can alter sleep architecture and sleep quality as well as contribute to daytime sleepiness. It is also important for medical providers to be cognizant of other adverse effects of chronic opioid use including the impact on respiratory function during sleep. Opioids are associated with several types of sleep-disordered breathing, including sleep-related hypoventilation, central sleep apnea (CSA), and obstructive sleep apnea (OSA). Appropriate screening, diagnostic testing, and treatment of opioid-associated sleep-disordered breathing can improve patients' health and quality of life. Collaboration among medical providers is encouraged to provide high quality, patient-centered care for people who are treated with chronic opioid therapy.
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Affiliation(s)
- Ilene M. Rosen
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - R. Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Kelly A. Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | - Raman K. Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Jennifer L. Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California
- David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Eric J. Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
| | | | - Anita V. Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - American Academy of Sleep Medicine Board of Directors
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Sleep Medicine, Atrium Health, Charlotte, North Carolina
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Millennium Physician Group, Fort Myers, Florida
- University of Pittsburgh, Pittsburgh, Pennsylvania
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California
- David Geffen School of Medicine at the University of California, Los Angeles, California
- Department of Pediatrics, Case Western Reserve University, University Hospitals - Cleveland Medical Center, Cleveland, Ohio
- Wayne State University, Detroit, Michigan
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
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23
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Harrison EG, Keating JL, Morgan PE. The experience of living with restless legs syndrome: A qualitative study. J Health Psychol 2019; 26:1154-1167. [DOI: 10.1177/1359105319871632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Restless legs syndrome is a sensorimotor disorder that significantly affects quality of life. This study explored the experience of people living with restless legs syndrome. Focus groups were analysed thematically resulting in five themes. Participants described disempowerment in managing symptoms, difficulty coping and poor understanding of the condition. Participants tried many therapies with little relief and were unable to monitor treatment effects. Concerns with healthcare services were common. Feeling understood provided validation and empowerment. Healthcare providers can help people with restless legs syndrome by improving restless legs syndrome awareness, providing psychosocial support and education, and assisting people to monitor treatment effects.
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24
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Huang CW, Lee MJ, Wang LJ, Lee PT, Tu YK, Hsu CW, Lin PY. Comparative efficacy and acceptability of treatments for restless legs syndrome in end-stage renal disease: a systematic review and network meta-analysis. Nephrol Dial Transplant 2019; 35:1609-1618. [DOI: 10.1093/ndt/gfz097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Restless legs syndrome (RLS) is common in end-stage renal disease (ESRD) patients and impairs health and quality of life significantly. However, the optimal treatment of RLS in ESRD patients is uncertain and less studied compared with idiopathic RLS patients.
Methods
We conducted a systematic review and network meta-analysis to compare the efficacy and acceptability of treatments for RLS in ESRD patients. Randomized controlled trials (RCTs) by February 2019 in the PubMed, Cochrane Library, Embase and ClinicalTrials.gov were reviewed. RLS severity reduction was treated as treatment efficacy, and adverse events were treated as acceptable. Both outcomes were appraised using a random effects model expressed as standardized mean differences and odds ratios with 95% confidence intervals (CIs), respectively, and were ranked using surface under the cumulative ranking curve (SUCRA) probabilities to obtain a hierarchy of interventions.
Results
A total of 12 RCTs were included, comprising 9 interventions and 498 participants. All the interventions significantly improved RLS severity without critical side effects compared with placebo. Gabapentin achieved the greatest decrease of RLS severity [standardized mean difference (SMD) = 1.95, 95% CI 0.81–3.09 (SUCRA: 79.3%)], despite its frequent adverse events [SMD = 0.18, 95% CI 0.02–1.50 (19.9%)]. The combination therapy of exercise plus dopamine agonist had better efficacy [SMD = 1.60, 95% CI 0.08–3.12 (59.8%)] and acceptability [SMD = 1.41, 95% CI 0.01–142.53 (63.9%)] compared with that of vitamin C plus vitamin E [SMD = 1.50, 95% CI 0.47–2.54 (56.6%); SMD = 0.32, 95% CI 0.04–2.86 (32.5%)].
Conclusions
This network meta-analysis supports that gabapentin is the most effective treatment for RLS in ESRD patients. Exercise plus dopamine agonist is a favorable combination therapy concerning side effects. Future large RCTs with long-term treatment outcomes are necessary.
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Affiliation(s)
- Chien-Wei Huang
- Department of Medicine, Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Min-Jing Lee
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Tsang Lee
- Department of Medicine, Division of Nephrology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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25
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Chen P, Ijomone OM, Lee KH, Aschner M. Caenorhabditis elegans and its applicability to studies on restless legs syndrome. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2019; 84:147-174. [PMID: 31229169 DOI: 10.1016/bs.apha.2018.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Restless legs syndrome (RLS) is a common neurological disorder in the United States. This disorder is characterized by an irresistible urge to move the legs, although the symptoms vary in a wide range. The pathobiology of RLS has been linked to iron (Fe) deficiency and dopaminergic (DAergic) dysfunction. Several genetic factors have been reported to increase the risk of RLS. Caenorhabditis elegans (C. elegans) is a well-established animal model with a fully sequenced genome, which is highly conserved with mammals. Given the detailed knowledge of its genomic architecture, ease of genetic manipulation and conserved biosynthetic and metabolic pathways, as well as its small size, ease of maintenance, speedy generation time and large brood size, C. elegans provides numerous advantages in studying RLS-associated gene-environment interactions. Here we will review current knowledge about RLS symptoms, pathology and treatments, and discuss the application of C. elegans in RLS study, including the worm homologous genes and methods that could be performed to advance the pathophysiology RLS.
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Affiliation(s)
- Pan Chen
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Omamuyovwi Meashack Ijomone
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States; Department of Human Anatomy, Federal University of Technology, Akure, Nigeria
| | - Kun He Lee
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, United States.
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De Vloo P, Reddy GD, Rowland N, Sammartino F, Llinas M, Paul D, Murray BJ, Lang AE, Fasano A, Munhoz RP, Kalia SK. Successful spinal cord stimulation for severe medication-refractory restless legs syndrome. Mov Disord 2019; 34:585-586. [PMID: 30768799 DOI: 10.1002/mds.27644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/17/2018] [Accepted: 01/23/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Philippe De Vloo
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gaddum Duemani Reddy
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Rowland
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Francesco Sammartino
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Darcia Paul
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
| | - Brian J Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Krembil Research Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Krembil Research Institute, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto, Ontario, Canada
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Cortés A, Casadó-Anguera V, Moreno E, Casadó V. The heterotetrameric structure of the adenosine A 1-dopamine D 1 receptor complex: Pharmacological implication for restless legs syndrome. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2019; 84:37-78. [PMID: 31229177 DOI: 10.1016/bs.apha.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Dopaminergic and purinergic signaling play a pivotal role in neurological diseases associated with motor symptoms, including Parkinson's disease (PD), multiple sclerosis, amyotrophic lateral sclerosis, Huntington disease, Restless Legs Syndrome (RLS), spinal cord injury (SCI), and ataxias. Extracellular dopamine and adenosine exert their functions interacting with specific dopamine (DR) or adenosine (AR) receptors, respectively, expressed on the surface of target cells. These receptors are members of the family A of G protein-coupled receptors (GPCRs), which is the largest protein superfamily in mammalian genomes. GPCRs are target of about 40% of all current marketed drugs, highlighting their importance in clinical medicine. The striatum receives the densest dopamine innervations and contains the highest density of dopamine receptors. The modulatory role of adenosine on dopaminergic transmission depends largely on the existence of antagonistic interactions mediated by specific subtypes of DRs and ARs, the so-called A2AR-D2R and A1R-D1R interactions. Due to the dopamine/adenosine antagonism in the CNS, it was proposed that ARs and DRs could form heteromers in the neuronal cell surface. Therefore, adenosine can affect dopaminergic signaling through receptor-receptor interactions and by modulations in their shared intracellular pathways in the striatum and spinal cord. In this work we describe the allosteric modulations between GPCR protomers, focusing in those of adenosine and dopamine within the A1R-D1R heteromeric complex, which is involved in RLS. We also propose that the knowledge about the intricate allosteric interactions within the A1R-D1R heterotetramer, may facilitate the treatment of motor alterations, not only when the dopamine pathway is hyperactivated (RLS, chorea, etc.) but also when motor function is decreased (SCI, aging, PD, etc.).
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Affiliation(s)
- Antoni Cortés
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Verònica Casadó-Anguera
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Estefanía Moreno
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Vicent Casadó
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain; Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain.
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Czesnik D, Howells J, Bartl M, Veiz E, Ketzler R, Kemmet O, Walters AS, Trenkwalder C, Burke D, Paulus W. I h contributes to increased motoneuron excitability in restless legs syndrome. J Physiol 2018; 597:599-609. [PMID: 30430565 DOI: 10.1113/jp275341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022] Open
Abstract
KEY POINTS Restless legs patients complain about sensory and motor symptoms leading to sleep disturbances. Symptoms include painful sensations, an urge to move and involuntary leg movements. The responsible mechanisms of restless legs syndrome are still not known, although current studies indicate an increased neuronal network excitability. Reflex studies indicate the involvement of spinal structures. Peripheral mechanisms have not been investigated so far. In the present study, we provide evidence of increased hyperpolarization-activated cyclic nucleotide-gated (HCN) channel-mediated inward rectification in motor axons. The excitability of sensory axons was not changed. We conclude that, in restless legs syndrome, an increased HCN current in motoneurons may play a pathophysiological role, such that these channels could represent a valuable target for pharmaceutical intervention. ABSTRACT Restless legs syndrome is a sensorimotor network disorder. So far, the responsible pathophysiological mechanisms are poorly understood. In the present study, we provide evidence that the excitability of peripheral motoneurons contributes to the pathophysiology of restless legs syndrome. In vivo excitability studies on motor and sensory axons of the median nerve were performed on patients with idiopathic restless legs syndrome (iRLS) who were not currently on treatment. The iRLS patients had greater accommodation in motor but not sensory axons to long-lasting hyperpolarization compared to age-matched healthy subjects, indicating greater inward rectification in iRLS. The most reasonable explanation is that hyperpolarization-activated cyclic nucleotide-gated (HCN) channels open at less hyperpolarized membrane potentials, a view supported by mathematical modelling. The half-activation potential for HCN channels (Bq) was the single best parameter that accounted for the difference between normal controls and iRLS data. A 6 mV depolarization of Bq reduced the discrepancy between the normal control model and the iRLS data by 92.1%. Taken together, our results suggest an increase in the excitability of motor units in iRLS that could enhance the likelihood of leg movements. The abnormal axonal properties are consistent with other findings indicating that the peripheral system is part of the network involved in iRLS.
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Affiliation(s)
- Dirk Czesnik
- Department of Clinical Neurophysiology, Medical School Göttingen, University of Göttingen, Göttingen, Germany
| | - James Howells
- Brain & Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Michael Bartl
- Department of Clinical Neurophysiology, Medical School Göttingen, University of Göttingen, Göttingen, Germany
| | - Elisabeth Veiz
- Department of Clinical Neurophysiology, Medical School Göttingen, University of Göttingen, Göttingen, Germany
| | - Rebecca Ketzler
- Department of Clinical Neurophysiology, Medical School Göttingen, University of Göttingen, Göttingen, Germany
| | - Olga Kemmet
- Department of Clinical Neurophysiology, Medical School Göttingen, University of Göttingen, Göttingen, Germany
| | - Arthur S Walters
- Division of Sleep Medicine, School of Medicine, Medical Center North, Vanderbilt University, Nashville, TN, USA
| | - Claudia Trenkwalder
- Clinic of Neurosurgery, University Medical Center, Paracelsus Klinik Kassel, Göttingen, Germany
| | - David Burke
- Royal Prince Alfred Hospital and The University of Sydney, Sydney, NSW, Australia
| | - Walter Paulus
- Department of Clinical Neurophysiology, Medical School Göttingen, University of Göttingen, Göttingen, Germany
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Liu S, Huang Y, Tai H, Zhang K, Wang Z, Shen D, Fu H, Su N, Shi J, Ding Q, Liu M, Guan Y, Gao J, Cui L. Excessive daytime sleepiness in Chinese patients with sporadic amyotrophic lateral sclerosis and its association with cognitive and behavioural impairments. J Neurol Neurosurg Psychiatry 2018; 89:1038-1043. [PMID: 30045943 DOI: 10.1136/jnnp-2018-318810] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the frequency and clinical features of excessive daytime sleepiness (EDS) and its association with cognitive and behavioural impairments in patients with amyotrophic lateral sclerosis (ALS). METHODS We conducted a cross-sectional investigation to explore the frequency and clinical features of EDS in a group of 121 Chinese patients with ALS compared with 121 age-matched and sex-matched healthy subjects. EDS was diagnosed using the Epworth Sleepiness Scale (ESS). Other characteristics of patients with ALS including sleep quality, REM sleep behaviour disorder (RBD), restless legs syndrome (RLS), cognition, behaviour, depression and anxiety were also evaluated. RESULTS EDS was significantly more frequent in patients with ALS than in controls (26.4% vs 8.3%; p<0.05). Patients with ALS with EDS scored lower scores on the revised ALS Functional Rating Scale (ALSFRS-R), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and MMSE and MoCA delayed memory subitems and higher on the Frontal Behavioural Inventory (FBI) than patients with ALS without EDS. ESS scores correlated with global ALSFRS-R, FBI, MMSE and MoCA scores and MMSE and MoCA delayed memory scores. RLS and global ALSFRS-R scores were independently associated with EDS in patients with ALS. CONCLUSIONS We identified a high frequency of EDS symptoms in Chinese patients with ALS, and these patients might have more serious physical, cognitive and frontal behaviour impairment. Patients with ALS might improve quality of life from the timely recognition and optimised management of EDS symptoms. Our results further suggest that ALS is a heterogeneous disease that might exhibit abnormal sleep-wake patterns.
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Affiliation(s)
- Shuangwu Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Hongfei Tai
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Kang Zhang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Zhili Wang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Hanhui Fu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Ning Su
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Jiayu Shi
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Jing Gao
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China .,Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China
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Comorbidities, treatment, and pathophysiology in restless legs syndrome. Lancet Neurol 2018; 17:994-1005. [PMID: 30244828 DOI: 10.1016/s1474-4422(18)30311-9] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/05/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022]
Abstract
Restless legs syndrome, also known as Willis-Ekbom disease, is a common neurological condition whose manifestation is affected by complex environmental and genetic interactions. Restless legs syndrome can occur on its own, mostly at a young age, or with comorbidities such as cardiovascular disease, diabetes, and arterial hypertension, making it a difficult condition to properly diagnose. However, the concept of restless legs syndrome as being two entities, primary or secondary to another condition, has been challenged with genetic data providing further insight into the pathophysiology of the condition. Although dopaminergic treatment was formerly the first-line therapy, prolonged use can result in a serious worsening of symptoms known as augmentation. Clinical studies on pregabalin, gabapentin enacarbil, oxycodone-naloxone, and iron preparations have provided new treatment options, but most patients still report inadequate long-term management of symptoms. Studies of the hypoxic pathway activation and iron deficiency have provided valuable information about the pathophysiology of restless legs syndrome that should now be translated into new, more effective treatments for restless legs syndrome.
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Liu S, Shen D, Tai H, Su N, Ding Q, Fu H, Zhang K, Wang Z, Liu M, Huang Y, Cui L. Restless Legs Syndrome in Chinese Patients With Sporadic Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:735. [PMID: 30214425 PMCID: PMC6125374 DOI: 10.3389/fneur.2018.00735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: To evaluate the frequency and clinical features of restless legs syndrome (RLS) in a group of Chinese patients with amyotrophic lateral sclerosis (ALS). Methods: 109 Patients included in this study fulfilled the revised El Escorial diagnostic criteria for clinically definite, probable and lab-supported probable ALS, and a group of 109 control subjects was matched for age and sex to the ALS group. Disease severity was assessed by the revised ALS functional rating scale (ALSFRS-R). The diagnosis of RLS was made according to the criteria of the International RLS Study Group. Other characteristics including sleep quality, excessive daytime sleepiness (EDS), REM sleep behavior disorder (RBD), depression and anxiety were also evaluated in ALS patients. Results: RLS was significantly more frequent in ALS patients than in control subjects (14.6 vs. 0.9%; P < 0.05). Compared to those without RLS, ALS patients with RLS reported a higher frequency of anxiety and EDS. ALS patients with RLS showed more severe legs dysfunction. EDS and legs function scores of the ALSFRS-R were independent factors significantly associated with RLS in ALS patients. Conclusions: Our findings suggest that Chinese ALS patients exhibit a high frequency of RLS symptoms and that these patients may benefit from recognition of the condition and optimized management of its symptoms. Moreover, ALS patients might cause circadian rhythms disturbance and our study further supports that ALS is a heterogeneous disorder involving multiple systems; further studies are needed to confirm these preliminary findings.
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Affiliation(s)
- Shuangwu Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Hongfei Tai
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Ning Su
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Hanhui Fu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Kang Zhang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Zhili Wang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Yan Huang
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China.,Neuroscience Center, Chinese Academy of Medical Sciences, Beijing, China
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Meneely S, Dinkins ML, Kassai M, Lyu S, Liu Y, Lin CT, Brewer K, Li Y, Clemens S. Differential Dopamine D1 and D3 Receptor Modulation and Expression in the Spinal Cord of Two Mouse Models of Restless Legs Syndrome. Front Behav Neurosci 2018; 12:199. [PMID: 30233336 PMCID: PMC6131574 DOI: 10.3389/fnbeh.2018.00199] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 08/13/2018] [Indexed: 12/22/2022] Open
Abstract
Restless Legs Syndrome (RLS) is often and successfully treated with dopamine receptor agonists that target the inhibitory D3 receptor subtype, however there is no clinical evidence of a D3 receptor dysfunction in RLS patients. In contrast, genome-wide association studies in RLS patients have established that a mutation of the MEIS1 gene is associated with an increased risk in developing RLS, but the effect of MEIS1 dysfunction on sensorimotor function remain unknown. Mouse models for a dysfunctional D3 receptor (D3KO) and Meis1 (Meis1KO) were developed independently, and each animal expresses some features associated with RLS in the clinic, but they have not been compared in their responsiveness to treatment options used in the clinic. We here confirm that D3KO and Meis1KO animals show increased locomotor activities, but that only D3KO show an increased sensory excitability to thermal stimuli. Next we compared the effects of dopaminergics and opioids in both animal models, and we assessed D1 and D3 dopamine receptor expression in the spinal cord, the gateway for sensorimotor processing. We found that Meis1KO share most of the tested behavioral properties with their wild type (WT) controls, including the modulation of the thermal pain withdrawal reflex by morphine, L-DOPA and D3 receptor (D3R) agonists and antagonists. However, Meis1KO and D3KO were behaviorally more similar to each other than to WT when tested with D1 receptor (D1R) agonists and antagonists. Subsequent Western blot analyses of D1R and D3R protein expression in the spinal cord revealed a significant increase in D1R but not D3R expression in Meis1KO and D3KO over WT controls. As the D3R is mostly present in the dorsal spinal cord where it has been shown to modulate sensory pathways, while activation of the D1Rs can activate motoneurons in the ventral spinal cord, we speculate that D3KO and Meis1KO represent two complementary animal models for RLS, in which the mechanisms of sensory (D3R-mediated) and motor (D1R-mediated) dysfunctions can be differentially explored.
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Affiliation(s)
- Samantha Meneely
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Mai-Lynne Dinkins
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Miki Kassai
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Shangru Lyu
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yuning Liu
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Chien-Te Lin
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
- East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Kori Brewer
- Department of Emergency Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Yuqing Li
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
- Wuxi Medical School, Jiangnan University, Wuxi, China
| | - Stefan Clemens
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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Rezvani F, Sayadnasiri M, Rezaei O. Restless legs syndrome in patients infected withHelicobacter pylori. Neurol Res 2018; 40:581-585. [DOI: 10.1080/01616412.2018.1454704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Farzaneh Rezvani
- Department of Clinical Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammad Sayadnasiri
- Neurology, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Omid Rezaei
- Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Harrison EG, Keating JL, Morgan PE. Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials. Disabil Rehabil 2018; 41:2006-2014. [PMID: 29561180 DOI: 10.1080/09638288.2018.1453875] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Introduction: Restless legs syndrome (RLS) is a sensorimotor disorder characterised by an uncomfortable urge to move the legs. Management is primarily pharmacological. Effects for non-pharmacological, non-surgical options are published but lack systematic examination. Objectives: To synthesise results of non-pharmacological/non-surgical treatment compared to no-treatment controls or alternative treatment for RLS on any relevant outcome. Methods: Databases and reference lists of reviews were searched for randomised controlled trials (RCTs) comparing non-pharmacological treatment to alternative or no treatment controls for idiopathic RLS. Search results were independently screened for inclusion by two researchers; disagreements regarding eligibility were resolved with discussion. Outcomes were summarised, and pooled where possible in meta-analysis. Results: The search yielded 442 articles. Eleven trials met inclusion criteria. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture were significantly more effective for RLS severity than control conditions. Vibration pads, cryotherapy, and transcranial direct current stimulation were ineffective in reducing RLS severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture significantly improved some sleep-related outcomes. Conclusions: Few studies were identified and quality of evidence was not high. Some non-pharmacological interventions may be beneficial for reducing RLS severity and enhancing sleep. Implications for Rehabilitation The current management of restless leg syndrome is primarily pharmacological, and medications can have unwanted side effects. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture may reduce restless leg syndrome severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture may improve some sleep-related outcomes in restless leg syndrome. Non-pharmacological interventions for RLS may cause placebo effects and rehabilitation professionals should control for this possibility in future investigations.
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Affiliation(s)
- Eloise G Harrison
- a Department of Physiotherapy , Monash University , Frankston , Australia
| | - Jennifer L Keating
- a Department of Physiotherapy , Monash University , Frankston , Australia
| | - Prue E Morgan
- a Department of Physiotherapy , Monash University , Frankston , Australia
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35
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Ratneswaran C, Sagoo MK, Steier J. Preface for the 3rd Clinical Update Sleep, 23rd February 2018, Royal College of Physicians, London, UK: year in review. J Thorac Dis 2018; 10:S1-S23. [PMID: 29445524 PMCID: PMC5803052 DOI: 10.21037/jtd.2017.10.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Culadeeban Ratneswaran
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Manpreet K Sagoo
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Unit/Sleep Disorders Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Trenkwalder C, Winkelmann J, Oertel W, Virgin G, Roubert B, Mezzacasa A. Ferric carboxymaltose in patients with restless legs syndrome and nonanemic iron deficiency: A randomized trial. Mov Disord 2017. [PMID: 28643901 PMCID: PMC5655783 DOI: 10.1002/mds.27040] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Compromised iron status is important in restless legs syndrome pathophysiology. We compared the efficacy and tolerability of ferric carboxymaltose (single intravenous dose) versus placebo for restless legs syndrome treatment in iron-deficient nonanemic patients. METHODS Patients with moderate to severe restless legs syndrome and serum ferritin < 75 μg/L (or serum ferritin 75-300 μg/L and transferrin saturation < 20%) were randomized to ferric carboxymaltose (1000 mg iron) or placebo. Mean change difference between ferric carboxymaltose and placebo in International Restless Legs Syndrome Severity Scale score from baseline to week 4 was the primary end point; week 12 was a secondary end point. RESULTS Ferric carboxymaltose treatment (n = 59) led to nonsignificant improvement over placebo (n = 51) in International Restless Legs Syndrome Severity Scale score at week 4 (difference [95% confidence interval], -2.5 [-5.93 to 1.02], P = 0.163), reaching significance by week 12 (-4.66 [-8.59 to -0.73], P = 0.021). CONCLUSIONS In patients who responded to treatment, ferric carboxymaltose may require more time to stabilize restless legs syndrome than previously assumed. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Claudia Trenkwalder
- Department of Neurosurgery, University Medical Center, Göttingen, Germany.,Paracelsus-Elena Klinik, Kassel, Germany
| | - Juliane Winkelmann
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Institut für Neurogenomik, Helmholtz Zentrum München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Wolfgang Oertel
- Institut für Neurogenomik, Helmholtz Zentrum München, Munich, Germany.,Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Abstract
Gabapentin enacarbil is an extended-release prodrug of gabapentin that is approved in the USA (Horizant(®)) and Japan (Regnite(®)) for the treatment of moderate to severe primary restless legs syndrome (RLS) in adults [featured indication]. This article summarizes pharmacological, efficacy and tolerability data relevant to the use of oral gabapentin enacarbil in this indication. In double-blind, multicentre trials, treatment with gabapentin enacarbil 600 mg/day for 12 weeks significantly improved the symptoms of moderate to severe primary RLS in adults. Gabapentin enacarbil also significantly improved RLS pain scores and generally improved sleep and mood outcomes. These data are supported by retrospective pooled analyses of three of these trials (XP081, PIVOT RLS I and PIVOT RLS II), with gabapentin enacarbil generally improving symptoms irrespective of disease severity, associated sleep disturbance or prior dopamine agonist use. Responses to gabapentin enacarbil were sustained in longer-term trials, with lower relapse rates in gabapentin enacarbil than placebo recipients in a longer-term maintenance study. Overall, in short and longer-term trials, relatively few patients discontinued treatment, adverse events were mostly mild to moderate in severity, and somnolence/sedation and dizziness were the most commonly reported adverse events. Notably, there were no reports of augmentation or QT-interval prolongation. Gabapentin enacarbil is an important agent for the treatment of adults with moderate to severe primary RLS.
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Affiliation(s)
- Esther S Kim
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand.
| | - Emma D Deeks
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand
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Hardy De Buisseret FX, Mairesse O, Newell J, Verbanck P, Neu D. While Isolated Periodic Limb Movement Disorder Significantly Impacts Sleep Depth and Efficiency, Co-Morbid Restless Leg Syndrome Mainly Exacerbates Perceived Sleep Quality. Eur Neurol 2017; 77:272-280. [DOI: 10.1159/000471920] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
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Takahashi M, Nishida S, Nakamura M, Kobayashi M, Matsui K, Ito E, Usui A, Inoue Y. Restless legs syndrome augmentation among Japanese patients receiving pramipexole therapy: Rate and risk factors in a retrospective study. PLoS One 2017; 12:e0173535. [PMID: 28264052 PMCID: PMC5338826 DOI: 10.1371/journal.pone.0173535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/21/2017] [Indexed: 12/14/2022] Open
Abstract
To investigate the rate of and risk factors for restless legs syndrome (RLS) augmentation in Japanese patients receiving pramipexole (PPX) treatment. Records of 231 consecutive patients with idiopathic RLS who received PPX therapy for more than one month in a single sleep disorder center were analyzed retrospectively. Augmentation was diagnosed based on the Max Planck Institute criteria; associated factors were identified by logistic regression analysis. Mean age at PPX initiation was 60.6 ± 14.9 years and mean treatment duration was 48.5 ± 26.4 months. Augmentation was diagnosed in 21 patients (9.1%). Daily PPX dose and treatment duration were significantly associated with augmentation. By analyzing the receiver operating characteristic curve, a PPX dose of 0.375 mg/day was found to be the optimal cut-off value for predicting augmentation. After stratifying patients according to PPX treatment duration, at median treatment duration of 46 months, optimal cut-off values for daily doses were 0.375 and 0.500 mg/day for <46 months and ≥46 months of treatment, respectively. The RLS augmentation with PPX treatment in Japanese patients was occurred at rate of 9.1%, being quite compatible with previously reported rates in Caucasian patients. The symptom could appear within a relatively short period after starting the treatment in possibly vulnerable cases even with a smaller drug dose. Our results support the importance of keeping doses of PPX low throughout the RLS treatment course to prevent augmentation.
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Affiliation(s)
| | - Shingo Nishida
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Maezawa Hospital, Tochigi, Japan
| | - Masaki Nakamura
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Mina Kobayashi
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Kentaro Matsui
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Eiki Ito
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Akira Usui
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- * E-mail:
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Pain, opioids, and sleep: implications for restless legs syndrome treatment. Sleep Med 2017; 31:78-85. [DOI: 10.1016/j.sleep.2016.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 12/31/2022]
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Khan FH, Ahlberg CD, Chow CA, Shah DR, Koo BB. Iron, dopamine, genetics, and hormones in the pathophysiology of restless legs syndrome. J Neurol 2017; 264:1634-1641. [PMID: 28236139 DOI: 10.1007/s00415-017-8431-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 12/16/2022]
Abstract
Restless legs syndrome (RLS) is a common, chronic neurologic condition, which causes a persistent urge to move the legs in the evening that interferes with sleep. Human and animal studies have been used to study the pathophysiologic state of RLS and much has been learned about the iron and dopamine systems in relation to RLS. Human neuropathologic and imaging studies have consistently shown decreased iron in different brain regions including substantia nigra and thalamus. These same areas also demonstrate a state of relative dopamine excess. While it is not known how these changes in dopamine or iron produce the symptoms of RLS, genetic and hormone studies of RLS have identified other biologic systems or genes, such as the endogenous opioid and melanocortin systems and BTBD9 and MEIS1, that may explain some of the iron or dopamine changes in relation to RLS. This manuscript will review what is known about the pathophysiology of RLS, especially as it relates to changes in iron, dopamine, genetics, and hormonal systems.
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Affiliation(s)
- Farhan H Khan
- Lippard Laboratory of Clinical Investigation, Division of Movement Disorders, Department of Neurology, Yale University School of Medicine, Room 710, West Haven VAMC, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Caitlyn D Ahlberg
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Christopher A Chow
- Lippard Laboratory of Clinical Investigation, Division of Movement Disorders, Department of Neurology, Yale University School of Medicine, Room 710, West Haven VAMC, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Divya R Shah
- Lippard Laboratory of Clinical Investigation, Division of Movement Disorders, Department of Neurology, Yale University School of Medicine, Room 710, West Haven VAMC, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Brian B Koo
- Lippard Laboratory of Clinical Investigation, Division of Movement Disorders, Department of Neurology, Yale University School of Medicine, Room 710, West Haven VAMC, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Connecticut Veterans Affairs Medical Center, 950 Campbell Avenue, West Haven, CT, 06516, USA.
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Trenkwalder C, Canelo M, Lang M, Schroeder H, Kelling D, Berkels R, Schollmayer E, Heidbrede T, Benes H. Management of augmentation of restless legs syndrome with rotigotine: a 1-year observational study. Sleep Med 2017; 30:257-265. [DOI: 10.1016/j.sleep.2015.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 11/26/2022]
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Piovezan RD, Kase C, Moizinho R, Tufik S, Poyares D. Gabapentin acutely increases the apnea-hypopnea index in older men: data from a randomized, double-blind, placebo-controlled study. J Sleep Res 2017; 26:166-170. [DOI: 10.1111/jsr.12495] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/10/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ronaldo D. Piovezan
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
| | - Camila Kase
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
| | - Renato Moizinho
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
| | - Sergio Tufik
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
| | - Dalva Poyares
- Sleep Medicine Division; Universidade Federal de São Paulo; São Paulo Brazil
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Kumar V, Venkatasubramanian G. Gabapentin treatment in clozapine-induced restless legs syndrome: two cases and a review of the literature. Ther Adv Psychopharmacol 2017; 7:42-47. [PMID: 28101323 PMCID: PMC5228712 DOI: 10.1177/2045125316672133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Restless legs syndrome (RLS) is a neuro-sensorimotor disorder affecting 2-4% of adults. It is characterized by intense urges to move the legs, associated with unpleasant sensory disturbances in the legs occurring at rest and manifests mostly in the evening and night, relieved by movement. Diagnosis is primarily based on clinical presentation and the consensus criteria for the diagnosis have been established. Antipsychotics, the dopamine antagonists, have been reported to induce RLS. Dopamine agonists, the effective first-line treatment of RLS, carry the risk of inducing or worsening psychosis. Many nondopaminergic agents including antiepileptic medications have also been used in the treatment of primary RLS. In this report we describe clozapine-induced RLS in two patients with schizophrenia and its successful treatment with gabapentin, a nondopaminergic agent. In addition, we have reviewed the available literature on clozapine-induced RLS and its management.
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Affiliation(s)
- Vijaya Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, New Kabini Hostel Complex, Hosur road, Bangalore, Karnataka 560029, India
| | - Ganesan Venkatasubramanian
- The Schizophrenia Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Diagnosestellung und Therapie des Restless-Legs-Syndroms. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Antidepressant-like effect of pramipexole in an inflammatory model of depression. Behav Brain Res 2016; 320:365-373. [PMID: 27825895 DOI: 10.1016/j.bbr.2016.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 12/13/2022]
Abstract
Pramipexole (PPX), a dopamine D2/3 receptor preferring agonist, is currently in use for the treatment of Parkinson's disease symptoms and restless legs syndrome. Recently, anti-inflammatory properties of PPX have been shown in an autoimmune model of multiple sclerosis, and case reports indicate PPX ameliorates depressive symptoms. Since peripheral inflammation is known to induce depression-like behavior in rodents, we assessed the potential antidepressant effect of PPX in an inflammatory model of depression induced by LPS. Repeated (daily for 7days, 1mg/kg, i.p.), but not acute (1h before LPS) treatment with PPX abolished the depression-like behavior induced by LPS (0.1mg/kg, i.p.) in the forced swim test, and the anhedonic behavior in the splash test. Interestingly, PPX per se decreased interleukin 1β levels and reversed LPS-induced increase in its content in mice hippocampus⋅ Repeated PPX treatment also prevented the increase in hippocampal levels of the 3-nitrotyrosine protein adducts induced by LPS. Haloperidol (0.2mg/kg, i.p.) and sulpiride (50mg/kg, i.p.) were unable to prevent the antidepressant-like effect of PPX in LPS-treated mice. Altogether, these results suggest that the observed antidepressant-like effect of PPX in LPS-treated mice may be dependent on its anti-inflammatory properties and may not be related to dopamine D2 receptor activation.
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Ferini-Strambi L, Marelli S, Galbiati A. Clinical pharmacology and efficacy of rotigotine (Neupro® patch) in the treatment of restless leg syndrome. Expert Opin Drug Metab Toxicol 2016; 12:967-75. [DOI: 10.1080/17425255.2016.1194393] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Luigi Ferini-Strambi
- Division of Neuroscience, Sleep Disorders Center, Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Sara Marelli
- Division of Neuroscience, Sleep Disorders Center, Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Galbiati
- Division of Neuroscience, Sleep Disorders Center, Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
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Cortés A, Moreno E, Rodríguez-Ruiz M, Canela EI, Casadó V. Targeting the dopamine D3 receptor: an overview of drug design strategies. Expert Opin Drug Discov 2016; 11:641-64. [PMID: 27135354 DOI: 10.1080/17460441.2016.1185413] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Dopamine is a neurotransmitter widely distributed in both the periphery and the central nervous system (CNS). Its physiological effects are mediated by five closely related G protein-coupled receptors (GPCRs) that are divided into two major subclasses: the D1-like (D1, D5) and the D2-like (D2, D3, D4) receptors. D3 receptors (D3Rs) have the highest density in the limbic areas of the brain, which are associated with cognitive and emotional functions. These receptors are therefore attractive targets for therapeutic management. AREAS COVERED This review summarizes the functional and pharmacological characteristics of D3Rs, including the design and clinical relevance of full agonists, partial agonists and antagonists, as well as the capacity of these receptors to form active homodimers, heterodimers or higher order receptor complexes as pharmacological targets in several neurological and neurodegenerative disorders. EXPERT OPINION The high sequence homology between D3R and the D2-type challenges the development of D3R-selective compounds. The design of new D3R-preferential ligands with improved physicochemical properties should provide a better pharmacokinetic/bioavailability profile and lesser toxicity than is found with existing D3R ligands. It is also essential to optimize D3R affinity and, especially, D3R vs. D2-type binding and functional selectivity ratios. Developing allosteric and bitopic ligands should help to improve the D3R selectivity of these drugs. As most evidence points to the ability of GPCRs to form homomers and heteromers, the most promising therapeutic strategy in the future is likely to involve the application of heteromer-selective drugs. These selective ligands would display different affinities for a given receptor depending on the receptor partners within the heteromer. Therefore, designing novel compounds that specifically target and modulate D1R-D3R heteromers would be an interesting approach for the treatment of levodopa (L-DOPA)-induced dyskinesias.
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Affiliation(s)
- Antoni Cortés
- a Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) , Spain.,b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona (IBUB) , University of Barcelona , Barcelona , Spain
| | - Estefanía Moreno
- a Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) , Spain.,b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona (IBUB) , University of Barcelona , Barcelona , Spain
| | - Mar Rodríguez-Ruiz
- a Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) , Spain.,b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona (IBUB) , University of Barcelona , Barcelona , Spain
| | - Enric I Canela
- a Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) , Spain.,b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona (IBUB) , University of Barcelona , Barcelona , Spain
| | - Vicent Casadó
- a Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) , Spain.,b Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, Institute of Biomedicine of the University of Barcelona (IBUB) , University of Barcelona , Barcelona , Spain
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Gulyani S, Salas R, Mari Z, Choi S, Mahajan A, Gamaldo C. Evaluating and Managing Sleep Disorders in the Parkinson's Disease Clinic. ACTA ACUST UNITED AC 2016; 6:165-172. [PMID: 27818912 DOI: 10.1016/j.baga.2016.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Parkinson's disease is a multi-systems neurodegenerative disorder that is characterized by a combination of motor and non-motor symptoms. Non-motor symptoms of Parkinson's disease comprise a variety of cognitive, neuropsychiatric, autonomic, sensory, and sleep complaints. Although sleep disruption represents one of the most common non-motor symptom complaints among Parkinson's disease patients, recommendations regarding effective evaluation and management strategies for this specific population remain limited. This review gives an evidence based summary of the available treatment options and management strategies for the sleep complaints commonly encountered by patients with Parkinson's disease.
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Affiliation(s)
- S Gulyani
- Human Neurosciences Unit/National Institutes on Aging/NIH. Baltimore, MD
| | - R Salas
- Johns Hopkins University, School of Medicine, Department of Neurology
| | - Z Mari
- Johns Hopkins University, School of Medicine, Department of Neurology
| | - S Choi
- Johns Hopkins University, School of Medicine, Department of Neurology
| | | | - C Gamaldo
- Johns Hopkins University, School of Medicine, Department of Neurology
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