Restless mouth syndrome

Restless legs syndrome variants: A systematic review

Introduction

Restless Legs Syndrome (RLS) is a clinical syndrome that may manifest itself in non-leg parts of the body as well, called RLS variant, which is considered a distinct entity by some researchers. In this systematic review, we tried to evaluate various clinical features and effective treatments of RLS variants and compare them with that of typical RLS.

Methods

This study was conducted following the PRISMA guideline. The primary search was performed in the data resources of Medline (PubMed), Web of Science, and Scopus, as well as the Google Scholar search engine. The required data were extracted from the studies.

Results

In this review, 1565 studies were initially identified and finally 39 studies were selected. The most common RLS variants were observed to involve hands, head, abdomen, and genitalia. These patients mostly complained of sleep disturbance and feelings of itching, tingling and twitching. Supportive diagnostic criteria of RLS including familial history of RLS, periodic limb movements during sleep (PLMS) and response to treatment with dopaminergic agents were assessed.

Conclusion

It seems that patients with RLS variant can undergo the same diagnostic and therapeutic work-up as patients with conventional RLS. It is suggested that these two disorders fall into the same syndromic spectrum.

Dopamine agonist responsive burning mouth syndrome: Report of eight cases

BACKGROUND

Burning mouth syndrome (BMS) is characterized by burning sensation of the oral mucosa. There is a lack of effective treatment. In recent years, a special subtype of BMS has been reported, in which oral burning sensation is alleviated after chewing, speaking, or dopaminergic drug delivery. Currently, there are few reports about the subtype of BMS in China. This study was a retrospective analysis of the clinical data of BMS patients sensitive to dopamine agonist at our hospital, aiming to improve the recognition on this disease.

CASE SUMMARY

Eight patients diagnosed with dopamine agonist responsive BMS at the Liaocheng People's Hospital from January 1, 2017 to June 30, 2020 were recruited. The clinical manifestations, treatment, and prognosis were retrospectively analyzed. There were three male and five females in the eight patients. The median age was 56 years (range, 46-65 years). All the eight patients showed burning pain in the mouth. The symptoms were mild in the morning and severe in the evening, and alleviated after chewing, talking, and other oral activities. Four patients were accompanied by restless legs syndrome (RLS). Family history of RLS was positive in two patients. All patients were treated with pramipexol, and symptoms were basically relieved after 2-8 wk.

CONCLUSION

Dopamine agonist responsive BMS is a special subtype of BMS, which is alleviated after oral activities. Dopamine receptor agonist is an effective treatment.

Measurement of Motivation States for Physical Activity and Sedentary Behavior: Development and Validation of the CRAVE Scale

Physical activity, and likely the motivation for it, varies throughout the day. The aim of this investigation was to create a short assessment (CRAVE: Cravings for Rest and Volitional Energy Expenditure) to measure motivation states (wants, desires, urges) for physical activity and sedentary behaviors. Five studies were conducted to develop and evaluate the construct validity and reliability of the scale, with 1,035 participants completing the scale a total of 1,697 times. In Study 1, 402 university students completed a questionnaire inquiring about the want or desire to perform behaviors "at the present moment (right now)." Items related to physical activity (e.g., "move my body") and sedentary behaviors (e.g., "do nothing active"). An exploratory structural equation model (ESEM) revealed that 10 items should be retained, loading onto two factors (5 each for Move and Rest). In Study 2, an independent sample (n = 444) confirmed these results and found that Move and Rest desires were associated with stage-of-change for exercise behavior. In Study 3, 127 community-residing participants completed the CRAVE at 6-month intervals over two years- two times each session. Across-session interclass correlations (ICC) for Move (ICC = 0.72-0.95) and Rest (ICC = 0.69-0.88) were higher than when they were measured across 24-months (Move: ICC = 0.53; Rest: ICC = 0.49), indicating wants/desires have state-like qualities. In Study 4, a maximal treadmill test was completed by 21 university students. The CRAVE was completed immediately pre and post. Move desires decreased 26% and Rest increased 74%. Changes in Move and Rest desires were moderately associated with changes in perceived physical fatigue and energy. In Study 5, 41 university students sat quietly during a 50-min lecture. They completed the CRAVE at 3 time points. Move increased 19.6% and Rest decreased 16.7%. Small correlations were detected between move and both perceived energy and tiredness, but not calmness or tension. In conclusion, the CRAVE scale has good psychometric properties. These data also support tenets of the WANT model of motivation states for movement and rest (Stults-Kolehmainen et al., 2020a). Future studies need to explore how desires to move/rest relate to dynamic changes in physical activity and sedentarism.

Restless Legs Syndrome: Contemporary Diagnosis and Treatment

Restless legs syndrome (RLS) is characterized by an uncomfortable urge to move the legs while at rest, relief upon movement or getting up to walk, and worsened symptom severity at night. RLS may be primary (idiopathic) or secondary to pregnancy or a variety of systemic disorders, especially iron deficiency, and chronic renal insufficiency. Genetic predisposition with a family history is common. The pathogenesis of RLS remains unclear but is likely to involve central nervous system dopaminergic dysfunction, as well as other, undefined contributing mechanisms. Evaluation begins with a thorough history and examination, and iron measures, including ferritin and transferrin saturation, should be checked at presentation and with worsened symptoms, especially when augmentation develops. Augmentation is characterized by more intense symptom severity, earlier symptom occurrence, and often, symptom spread from the legs to the arms or other body regions. Some people with RLS have adequate symptom control with non-pharmacological measures such as massage or temperate baths. First-line management options include iron-replacement therapy in those with evidence for reduced body-iron stores or, alternatively, with prescribed gabapentin or pregabalin, and dopamine agonists such as pramipexole, ropinirole, and rotigotine. Second-line therapies include intravenous iron infusion in those who are intolerant of oral iron and/or those having augmentation with intense, severe RLS symptoms, and opioids including tramadol, oxycodone, and methadone. RLS significantly impacts patients' quality of life and remains a therapeutic area sorely in need of innovation and a further pipeline of new, biologically informed therapies.

Motivation States for Physical Activity and Sedentary Behavior: Desire, Urge, Wanting, and Craving

To better explain daily fluctuations in physical activity and sedentary behavior, investigations of motivation are turning from social cognitive frameworks to those centered on affect, emotion and automaticity, such as the Affect and Health Behavior Framework (AHBF), Integrated Framework and Affective-Reflective Theory (ART). This shift has necessitated: (a) re-examination of older theories and their constructs, such as drives, needs and tensions and (b) an inspection of competing theories from other fields that also attempt to explain dynamic changes in health behaviors. The Dynamical Model of Desire, Elaborated Intrusion Theory and others commonly share with AHBF the idea that human behavior is driven strongly by desires and/or the similar concepts of wants, urges, and cravings. These affectively-charged motivation states (ACMS) change quickly and may better explain physical activity behavior from one moment to the next. Desires for movement predominantly derive from negative but also positive reinforcement. Data from clinical populations with movement dysfunction or psychiatric disorders provides further evidence of these drivers of movement. Those with Restless Legs Syndrome, akathisia, tic disorders and exercise dependence all report strong urges to move and relief when it is accomplished. Motor control research has identified centers of the brain responsible for wants and urges for muscular movement. Models elaborated herein differentiate between wants, desires, urges and cravings. The WANT model (Wants and Aversions for Neuromuscular Tasks) conceptualizes desires for movement and rest as varying by magnitude, approach or avoidance-orientation (wants versus aversions) and as occupying independent dimensions instead of opposite ends of the same axis. For instance, one hypothetically might be in a state of both high desire for movement and rest simultaneously. Variations in motivation states to move and rest may also be associated with various stress states, like freezing or fight and flight. The first validated instrument to measure feelings of desire/want for movement and rest, the CRAVE Scale (Cravings for Rest and Volitional Energy Expenditure) is already shedding light on the nature of these states. With these advances in theory, conceptual modeling and instrumentation, future investigations may explore the effects of desires and urges for movement and sedentary behavior in earnest.