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Studer B, Roukens R, Happe S, Schmidt SB, Knecht S. COVID-19 Reveals Opportunities for Better Care of Stroke Patients. Dtsch Arztebl Int 2021; 118:346-347. [PMID: 34180797 DOI: 10.3238/arztebl.m2021.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/28/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
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Rose O, Happe S, Huchtemann T, Mönig C, Ohms M, Schwalbe O, Warnecke T, Erzkamp S. Enhancing medication therapy in Parkinson's disease by establishing an interprofessional network including pharmacists. Int J Clin Pharm 2021; 43:441-448. [PMID: 33893597 DOI: 10.1007/s11096-021-01263-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/26/2021] [Indexed: 01/28/2023]
Abstract
Background Optimizing therapy regimens through collaboration and combination of available resources is a promising approach to improve quality of life for patients with Parkinson's disease (PD). Aim The aim of this project was to enhance patient-oriented therapy and interprofessional collaboration by establishing a regional PD network. Setting The network is located in a rural area in Germany. It covers primary, secondary and tertiary care facilities across professional boundaries. Development Recruitment of PD specialists and patient support groups was done by the local newspaper to spread the word. The network was initially open to all healthcare professionals, who stated a focus or special interest in PD. A working group for medication was founded within the network by asking for interested participants. Problems in the medication process were discussed within the group. As a consequence, therapy recommendations (quickcards) and a specific medication plan were developed and a certified education curriculum for pharmacists was developed. Implementation The network grew to > 150 participants across all disciplines and sectors. Quickcards were adjusted, approved and implemented by the network during interquartile meetings. Certified education was implemented and became a requirement for participating pharmacists. Evaluation The quickcards on medication plan and drug-drug-interactions were approved to be useful and feasible by the network by unanimous assent. Overall satisfaction with certified education was high (mean of 1.4 on a scale between 1 = high and 6 = low). Conclusion A regional interprofessional PD network with pharmacists was established and new standards were established. Future research needs to measure the effects on patient outcomes.
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Affiliation(s)
- Olaf Rose
- Impac2t Research, Maximilianstr. 31-33, Münster, Germany.
| | | | - Tessa Huchtemann
- Department of Neurology, University of Münster, Münster, Germany
| | - Constanze Mönig
- Department of Neurology, University of Münster, Münster, Germany
| | - Michael Ohms
- Klinik für Neurologie mit Klinischer Neurophysiologie, Herz-Jesu-Krankenhaus Hiltrup, Westfalenstr. 109, Münster, Germany
| | | | - Tobias Warnecke
- Department of Neurology, University of Münster, Münster, Germany
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Mayer G, Happe S, Evers S, Hermann W, Jansen S, Kallweit U, Muntean ML, Pöhlau D, Riemann D, Saletu M, Schichl M, Schmitt WJ, Sixel-Döring F, Young P. Insomnia in neurological diseases. Neurol Res Pract 2021; 3:15. [PMID: 33691803 PMCID: PMC7944611 DOI: 10.1186/s42466-021-00106-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Insomnia is defined as difficulties of initiating and maintaining sleep, early awakening and poor subjective sleep quality despite adequate opportunity and circumstances for sleep with impairment of daytime performance. These components of insomnia - namely persistent sleep difficulties despite of adequate sleep opportunity resulting in daytime dysfunction - appear secondary or co-morbid to neurological diseases. Comorbid insomnia originates from neurodegenerative, inflammatory, traumatic or ischemic changes in sleep regulating brainstem and hypothalamic nuclei with consecutive changes of neurotransmitters. Symptoms of neurological disorders (i.e motor deficits), co-morbidities (i.e. pain, depression, anxiety) and some disease-specific pharmaceuticals may cause insomnia and/or other sleep problems.This guideline focuses on insomnias in headaches, neurodegenerative movement disorders, multiple sclerosis, traumatic brain injury, epilepsies, stroke, neuromuscular disease and dementia.The most important new recommendations are: Cognitive behavioral therapy (CBTi) is recommended to treat acute and chronic insomnia in headache patients. Insomnia is one of the most frequent sleep complaints in neurodegenerative movement disorders. Patients may benefit from CBTi, antidepressants (trazodone, doxepin), melatonin and gaba-agonists. Insomnia is a frequent precursor of MS symptoms by up to 10 years. CBTi is recommended in patients with MS, traumatic brain injury and. Melatonin may improve insomnia symptoms in children with epilepsies. Patients with insomnia after stroke can be treated with benzodiazepine receptor agonists and sedating antidepressants. For patients with dementia suffering from insomnia trazodone, light therapy and physical exercise are recommended.
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Affiliation(s)
- Geert Mayer
- Neurologische Abteilung der Hephata-Klinik, Schimmelpfengstrasse 6, 34613, Schwalmstadt-Treysa, Germany.
- Neurologische Abteilung der Philipps-Universität Marburg, Mamburg, Germany.
| | - Svenja Happe
- Klinik Maria Frieden, Klinik für Neurologie, Am Krankenhaus 1, 48291, Telgte, Germany
| | - Stefan Evers
- Krankenhaus Lindenbrunn, Abteilung Neurologie, Lindenbrunn 1, 31863, Coppenbrügge, Germany
| | - Wiebke Hermann
- Klinik und Poliklinik für Neurologie und Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Sabine Jansen
- Deutsche Alzheimer Gesellschaft e.V. Selbsthilfe Demenz, Friedrichstr. 236, 10969, Berlin, Germany
| | - Ulf Kallweit
- Klin. Schlaf- und Neuroimmunologie, Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Maria-Lucia Muntean
- Paracelsus Elena Klinik, Schanzenstr. 85 Dr. med Dieter Pöhlau, 34130, Kassel, Germany
- DRK Kamillus Klinik, Hospitalstr. 6, 53567, Asbach, Germany
| | - Dieter Pöhlau
- DRK Kamillus Klinik, Hospitalstr. 6, 53567, Asbach, Germany
| | - Dieter Riemann
- Psychiatrische Universitätsklinik Freiburg, Hauptstraße 5, 79104, Freiburg, Germany
| | - Michael Saletu
- LKH - Graz II, Standort Süd, Wagner Jauregg Platz 1, A-8053, Graz, Austria
| | | | - Wolfgang J Schmitt
- Universitätsklinik für Psychiatrie und Psychotherapie, Murtenstrasse 21, 3008, Bern, Switzerland
| | | | - Peter Young
- Neurologische Klinik Reithofpark, Reithof 1, 83075, Bad Feilnbach, Germany
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Kerkemeyer L, Achtert K, Claus I, Happe S, Overbeck J, Kleen N, Palesch A, Schmuck C, Krouß S, Perick J, Depenbrock L, Nagel M, Siebecker F, Rose O, Warnecke T. Quickcard-Based Approach to Guiding Specific Nonpharmacological Treatments in a German Parkinson's Network. J Clin Med 2020; 9:E2272. [PMID: 32708918 PMCID: PMC7408751 DOI: 10.3390/jcm9072272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 12/18/2022] Open
Abstract
Interdisciplinary care has been shown to be effective at optimizing the treatment of patients with Parkinson's disease. An optimized collaboration between the various healthcare providers involved in the treatment process facilitates successful care. One of the main shortcomings in the German healthcare system is the limited and unstandardized communication between practitioners. The Parkinson's network Münsterland+ (PNM+) is an interdisciplinary network of medical and non-medical experts involved in the treatment of Parkinson's patients: neurologists, physiotherapists, occupational therapists, speech therapists, psychologists, Parkinson's nurses, pharmacists, patients, and relatives. The PNM+ elaborates guideline-based therapy recommendations, provided as so-called "Quickcards". Thereby, the communication of the treating neurologist and therapists is based on a coordinated feedback system and suggestions to adequately select and, if necessary, adjust the therapy. In the German healthcare system, with its fragmented structures, the PNM+ and its activities have been shown to enhance integration of the healthcare providers and thereby optimize the care of Parkinson's disease patients. Future research should evaluate the effects and cost-effectiveness.
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Affiliation(s)
- Linda Kerkemeyer
- Institute for Applied Health Services Research (inav), 10117 Berlin, Germany; (L.K.); (K.A.)
| | - Katharina Achtert
- Institute for Applied Health Services Research (inav), 10117 Berlin, Germany; (L.K.); (K.A.)
| | - Inga Claus
- Department of Neurology, University of Münster, 48149 Münster, Germany;
| | - Svenja Happe
- Klinik Maria Frieden Telgte, 48291 Telgte, Germany;
| | - Jeannette Overbeck
- Neurologische Klinik, Christophorus-Kliniken Dülmen GmbH, 48249 Dülmen, Germany; (J.O.); (N.K.)
| | - Nadine Kleen
- Neurologische Klinik, Christophorus-Kliniken Dülmen GmbH, 48249 Dülmen, Germany; (J.O.); (N.K.)
| | - Anja Palesch
- Fachkräftesicherung im Gesundheitswesen, 46342 Velen, Germany;
| | - Clara Schmuck
- Ergotherapiepraxis Fleischer, 48153 Münster, Germany;
| | | | - Jürgen Perick
- Reha Team Perick GmbH—Ihr Sanitätshaus, 48565 Steinfurt, Germany;
| | - Luisa Depenbrock
- Zentrum für Ambulante Rehabilitation GmbH (ZaR), 48159 Münster, Germany;
| | | | | | - Olaf Rose
- Impac2t Research, 48147 Muenster, Germany;
| | - Tobias Warnecke
- Department of Neurology, University of Münster, 48149 Münster, Germany;
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Steinig J, Bazan A, Happe S, Antonetti S, Shevrin H. Processing of a Subliminal Rebus during Sleep: Idiosyncratic Primary versus Secondary Process Associations upon Awakening from REM- versus Non-REM-Sleep. Front Psychol 2017; 8:1955. [PMID: 29209244 PMCID: PMC5701931 DOI: 10.3389/fpsyg.2017.01955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022] Open
Abstract
Primary and secondary processes are the foundational axes of the Freudian mental apparatus: one horizontally as a tendency to associate, the primary process, and one vertically as the ability for perspective taking, the secondary process. Primary process mentation is not only supposed to be dominant in the unconscious but also, for example, in dreams. The present study tests the hypothesis that the mental activity during REM-sleep has more characteristics of the primary process, while during non-REM-sleep more secondary process operations take place. Because the solving of a rebus requires the ability to non-contexually condensate the literal reading of single stimuli into a new one, rebus solving is a primary process operation by excellence. In a replication of the dream-rebus study of Shevrin and Fisher (1967), a rebus, which consisted of an image of a comb (German: “Kamm”) and an image of a raft (German: “Floß”), resulting in the German rebus word “kampflos” (Engl.: without a struggle), was flashed subliminally (at 1 ms) to 20 participants before going to sleep. Upon consecutive awakenings participants were asked for a dream report, free associations and an image description. Based on objective association norms, there were significantly more conceptual associations referring to Kamm and Floß indexing secondary process mentation when subjects were awakened from non-REM sleep as compared to REM-awakenings. There were not significantly more rebus associations referring to kampflos indexing primary process mentation when awakened from REM-sleep as compared to non-REM awakenings. However, when the associations were scored on the basis of each subject’s individual norms, there was a rebus effect with more idiosyncratic rebus associations in awakenings after REM than after non-REM-sleep. Our results support the general idea that REM-sleep is characterized by primary process thinking, while non-REM-sleep mentation follows the rules of the secondary process.
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Affiliation(s)
- Jana Steinig
- Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany.,Institute of Psychology and Cognition Research, University of Bremen, Bremen, Germany.,Department of Clinical Neurophysiology, Klinikum Bremen-Ost, University of Göttingen, Göttingen, Germany
| | - Ariane Bazan
- Faculté des Sciences Psychologiques et de l'Education, Service de Psychologie Clinique et Différentielle, Université Libre de Bruxelles, Brussels, Belgium
| | - Svenja Happe
- Department of Clinical Neurophysiology, Klinikum Bremen-Ost, University of Göttingen, Göttingen, Germany.,Department of Neurology, Klinik Maria Frieden, Telgte, Germany
| | - Sarah Antonetti
- Faculté des Sciences Psychologiques et de l'Education, Service de Psychologie Clinique et Différentielle, Université Libre de Bruxelles, Brussels, Belgium
| | - Howard Shevrin
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, United States
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Abstract
In order to evaluate a possible association between migraine and restless legs syndrome (RLS), we performed a case-control study on the comorbidity of RLS and migraine. Patients with migraine ( n = 411) and 411 sex- and age-matched control subjects were included. Migraine was diagnosed according to International Headache Society criteria, RLS according to the criteria of the International Restless Legs Syndrome Study Group. Furthermore, all patients had to fill out a self-assessment test performance on depression [Beck's Depression Inventory (BDI)]. RLS frequency was significantly higher in migraine patients than in control subjects (17.3% vs. 5.6%, P < 0.001; odds ratio 3.5, confidence interval 2.2, 5.8). In our sample, there was no significant association between migraine and depression as defined by the BDI score (9.6% in migraine vs. 4.0% in control subjects, P = 0.190). Depression was, however, not significantly more frequent in migraine patients with RLS (13.6%) than in migraine patients without RLS (8.7%). In addition, migraine patients with RLS had a significantly higher BDI score. RLS features did not differ significantly between migraine patients with RLS and control subjects with RLS. There is an association between RLS and migraine and, in addition, a co-association with depression. The underlying mechanism, however, remains undetermined and might be related to a dysfunction of dopaminergic metabolism in migraine.
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Affiliation(s)
- A M Rhode
- Department of Neurology, Klinikum Bremen-Ost and University of Göttingen, Göttingen, Germany
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Happe S, Peikert A, Siegert R, Evers S. The efficacy of lymphatic drainage and traditional massage in the prophylaxis of migraine: a randomized, controlled parallel group study. Neurol Sci 2016; 37:1627-32. [PMID: 27338942 DOI: 10.1007/s10072-016-2645-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/21/2016] [Indexed: 11/25/2022]
Abstract
This study aimed at examining the efficacy of lymphatic drainage (LD) and traditional massage (TM) in the prophylactic treatment of migraine using controlled prospective randomized clinical trial of 64 patients (57 women, 45 ± 10 years) with migraine with and without aura. Patients were randomized into three groups: LD (n = 21); TM (n = 21); waiting group (WG, n = 22). After a 4-week-baseline, a treatment period of 8 weeks was applied followed by a 4-week observation period. The patients filled in a headache diary continuously; every 4 weeks they filled in the German version of the CES-D and the German version of the Headache Disability Inventory. The main outcome measure was migraine frequency per month. At the end of the observation period, the number of migraine attacks and days decreased in the LD group by 1.8 and 3.1, respectively, in the TM group by 1.3 and 2.4, and in the WG by 0.4 and 0.2, respectively. The differences between LD and WG were significant (p = 0.006 and p = 0.015, respectively) as well as the differences between TM und WG (p = 0.042 and p = 0.016, respectively). There was a significant decrease in the amount of analgesic intake in the LD group compared to the two other groups (p = 0.004). TM and LD resulted in a reduction of migraine attack frequency. The analgesic intake only decreased significantly during LD intervention. Useful effects were identified for LD and TM as compared to WG for the prophylaxis of migraine. LD was more efficacious in some parameters than TM.
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Affiliation(s)
- Svenja Happe
- Department of Clinical Neurophysiology, Klinikum Bremen-Ost/University of Göttingen, Bremen, Germany
- Department of Neurology, Krankenhaus Maria Frieden, Telgte, Germany
| | | | - Rudolf Siegert
- Institute of Physical Medicine and Rehabilitation, Klinikum Bremen-Ost/University of Göttingen, Bremen, Germany
| | - Stefan Evers
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany.
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8
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Heidbreder A, Frauscher B, Mitterling T, Boentert M, Schirmacher A, Hörtnagl P, Schennach H, Massoth C, Happe S, Mayer G, Young P, Högl B. Not Only Sleepwalking But NREM Parasomnia Irrespective of the Type Is Associated with HLA DQB1*05:01. J Clin Sleep Med 2016; 12:565-70. [PMID: 26951409 DOI: 10.5664/jcsm.5692] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 12/29/2015] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVES Despite the high prevalence and clinical relevance of NREM parasomnias, data on supportive genetic markers are scarce, and mainly refer to sleepwalking only. METHODS We retrospectively analyzed clinical, polysomnographic, and HLA findings of 74 adults (37 men) with NREM parasomnia gathered from four neurological sleep centers. Parasomniac events were classified according to ICSD-2 criteria. HLA DQB1 genotyping was compared to regional-matched reference allele-frequencies. RESULTS Fifty-six patients had more than 2 different parasomnia type: 11 sleepwalking, 4 sleep terrors, 3 confusional arousals only. Parasomniac events were documented during video-polysomnography (V-PSG) in 70% (49/70) of subjects (71.4% confusional arousals, 8.2% sleep terrors, 4.1% sleepwalking, 16.3% ≥ 2 NREM parasomnia types). Violent behavior during V-PSG occurred in 8.5% (6/71). NREM parasomnia onset was reported after the age of 30 years in 6.8% (5/74). The HLA DQB1*05:01 allele was present in 41% (29/71) compared to 24.2% in the regional-matched reference allele group (p < 0.05). This haplotype prevalence did not differ within the NREM parasomnia type. Epworth Sleepiness Score was 10 or higher in 28.6%. CONCLUSIONS This is a large polysomnography-based case series of patients with NREM parasomnia. In patients with suspected sleepwalking or sleep terrors, polysomnography is highly useful in detecting arousals from NREM sleep as a marker of NREM parasomnia. We confirmed previous findings by demonstrating a high prevalence of the HLA DQB1*05:01 genotype for different types of NREM parasomnias. Our findings therefore support a common genetic background, and corroborate the importance of video-polysomnography in the work-up of parasomnia.
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Affiliation(s)
- Anna Heidbreder
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany.,Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Frauscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Mitterling
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Boentert
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Anja Schirmacher
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Paul Hörtnagl
- Central Institute for Blood-Transfusion and Immunology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Schennach
- Central Institute for Blood-Transfusion and Immunology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Massoth
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Svenja Happe
- Department of Neurology, Clinic Maria Frieden Telgte, Telgte, Germany and University of Göttingen, Göttingen, Germany
| | - Geert Mayer
- Hephata-Klinik Schwalmstadt-Treysa, Schwalmstadt- Treysa, Germany and Philipps University Marburg, Department of Neurology, Marburg, Germany
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Noachtar S, Bast T, Happe S, Lerche H, Pogarell O, Steinhoff B, Tergau F. EEG zum Irreversibilitätsnachweis der klinischen Ausfallssymptome des Gehirns. KLIN NEUROPHYSIOL 2016. [DOI: 10.1055/s-0041-111359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Noachtar
- Klinikum der Universität München – Großhadern, Neurologische Klinik, München
| | - T. Bast
- Epilepsiezentrum Kork, Klinik für Kinder und Jugendliche, Kehl
| | - S. Happe
- Klinik Maria Frieden, Klinik für Neurologie, Telgte
| | - H. Lerche
- Uniklinik Tübingen, Neurologische Klinik, Tübingen
| | - O. Pogarell
- Klinikum der Universität München – Innenstadt, Psychiatrische Klinik, München
| | - B. Steinhoff
- Epilepsiezentrum Kork, Klinik für Erwachsene, Kehl
| | - F. Tergau
- St. Bernward Krankenhaus, Neurologie, Hildesheim
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Lang N, Esser W, Evers S, Kellinghaus C, Nguento A, Schlegel U, Gaida B, Gburek-Augustat J, Altenmüller DM, Burghaus L, Hoffmann F, Fiedler B, Bast T, Rehfeld T, Happe S, Seitz RJ, Boor R, Stephani U. Intravenous levetiracetam in clinical practice--Results from an independent registry. Seizure 2015; 29:109-13. [PMID: 26076852 DOI: 10.1016/j.seizure.2015.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/06/2015] [Accepted: 03/26/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Most common clinical studies with antiepileptic drugs do not reflect medical everyday practice due to their strict in- and exclusion criteria and specifications of treatment regimens. Here we present a large non-interventional registry with the intention to evaluate the spectrum of applications in daily use and the efficacy and tolerability of intravenously given levetiracetam (LEV-iv). METHODS In a prospective approach of 17 neurological and neuropediatric centres in Germany LEV-iv treated patients of all ages were included over a period of 10 months. The observational period was 10 days with daily documentation of LEV-iv administration, type and frequency of seizures, currently used drugs and doses, and adverse events (AEs). In addition, treatment efficacy and tolerability were assessed by patients and physicians at study end as well as practicability of LEV-iv using a five-step scale. RESULTS In 95 patients LEV-iv was administered, 93 were included into the analysis. The median LEV-iv dose was 1500 mg (range 110-6000 mg) per day. Median age was 66 years (range 0.7-90.3 years). The majority of patients (n=70, 75%) suffered from status epilepticus (SE, n=55, 59%) and acute seizure clusters (n=15, 16%). Of those with SE, 41 patients (75%) had SE for the first time. Acute seizure clusters and SE terminated in 83% after LEV-iv administration. A total of 29 adverse events were reported in 17 of the 95 patients from the safety set. Ten of these were at least possibly related to LEV-iv treatment. Slight decrease of blood pressure during the infusion (3 patients each) was captured most frequently. No serious side effect was observed. Physicians rated the efficacy and tolerability of LEV-iv treatment as good or very good in 78% and 82% of the cases, respectively. CONCLUSION In this large observational study of everyday practise the use of LEV-iv exhibited a remarkable good response and tolerability in patients with acute onset seizures (mostly SE). Further randomized controlled studies, like the established status epilepticus trial (ESET) are needed to confirm these findings.
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Affiliation(s)
- N Lang
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - W Esser
- Department of Neurology, Städtisches Klinikum, Karlsruhe, Germany
| | - S Evers
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
| | - C Kellinghaus
- Department of Neurology, Klinikum, Osnabrück, Germany
| | - A Nguento
- Department of Neurology, Asklepios Klinikum Uckermark, Schwedt, Germany
| | - U Schlegel
- Department of Neurology, Ruhr University, Bochum, Germany
| | - B Gaida
- Department of Neurology, University Hospital, Greifswald, Germany
| | - J Gburek-Augustat
- Department of Neuropediatrics, University Hospital, Tübingen, Germany
| | | | - L Burghaus
- Department of Neurology, University Hospital, Köln, Germany
| | - F Hoffmann
- Department of Neurology, Krankenhaus Martha-Maria, Halle, Germany
| | - B Fiedler
- Department of Neuropediatrics, University Hospital, Münster, Germany
| | - T Bast
- University Children's Hopsital, Heidelberg, Germany
| | - T Rehfeld
- Department of Neurology, Dietrich Bonhoeffer Klinikum, Neubrandenburg, Germany
| | - S Happe
- Department of Neurology, Klinik Maria Frieden, Telgte, Germany
| | - R J Seitz
- Department of Neurology, University Hospital, Düsseldorf, Germany
| | - R Boor
- Northern German Epilepsy Centre for Children and Adolescents, Raisdorf, Germany
| | - U Stephani
- Department of Neuropediatrics, University Hospital Schleswig-Holstein, Kiel, Germany.
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Abstract
Objective Polysomnographic investigations have shown an unspecific association between cluster headache and obstructive sleep apnea syndrome. The aim of this study was to investigate this association in a cluster episode compared with a symptom free interval, and to further characterize this association. Methods We investigated 42 patients with episodic ( n = 26) or chronic ( n = 16) cluster headache by means of polygraphic screening for sleep apnea and compared the data to 28 healthy control subjects matched according to age, sex, and BMI. The patients with episodic cluster headache were screened twice, once in a cluster episode and once in a symptom free interval. Results Patients with active cluster headache showed a significantly higher respiratory distress index (8.6 ± 16.0) compared with healthy control subjects (3.4 ± 2.1; p = 0.002). More patients fulfilled the criteria for an obstructive sleep apnea syndrome (29%) than control subjects (7%; p = 0.018). Patients only, but not the control subjects, had central apneas. These differences were only significant when measured during an active cluster episode but not during a symptom free interval. Conclusion Cluster headache is associated with a sleep apnea syndrome only in the active cluster episode. The increased rate of central apneas might be a result of involvement of the hypothalamus in the pathophysiology of cluster headache. Out of five anecdotal cases treated with nasal continuous positive airway pressure, only one patient showed benefit with respect to cluster headache attack frequency.
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Affiliation(s)
- Stefan Evers
- Department of Neurology, University of Münster, Germany
- Department of Neurology, Krankenhaus Lindenbrunn, Germany
| | - Birke Barth
- Department of Neurology, University of Münster, Germany
| | - Achim Frese
- Department of Neurology, University of Münster, Germany
- Akademie für Manuelle Medizin, Münster, Germany
| | | | - Svenja Happe
- Department of Neurology, Klinik Maria Frieden, Telgte, Germany
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Zinkhan M, Berger K, Hense S, Nagel M, Obst A, Koch B, Penzel T, Fietze I, Ahrens W, Young P, Happe S, Kantelhardt JW, Kluttig A, Schmidt-Pokrzywniak A, Pillmann F, Stang A. Agreement of different methods for assessing sleep characteristics: a comparison of two actigraphs, wrist and hip placement, and self-report with polysomnography. Sleep Med 2014; 15:1107-14. [PMID: 25018025 DOI: 10.1016/j.sleep.2014.04.015] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/29/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the agreement of sleep parameters measured by two actigraphs (SOMNOwatch plus, ActiGraph GT3X+) at two different placements (wrist, hip) and of self-reported sleep with polysomnography (PSG). METHODS We estimated agreement with PSG for total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), number of awakenings after sleep onset (NASO), and sleep efficiency (SE%) for 100 participants of the general population, aged 18-75 years by judging mean differences to PSG and intervals of agreement using Bland-Altman plots. RESULTS Mean difference to PSG for TST was 8.3 min (95% confidence intervals [CI] -7.4; 24.1) for SOMNOwatch plus (wrist), 39.8 min (95% CI 24.3; 55.3) for self-report, -79.0 min (95% CI -89.0; -68.9) for SOMNOwatch plus (hip), and -81.1 min (95% CI -91.9; -70.4) for GT3X+ (hip), respectively. The width of intervals of agreement differed with the placement of the devices. Mean differences to PSG were higher for hip-based measurements compared with wrist placement for most parameters. CONCLUSIONS Agreement of sleep parameters assessed by actigraphy with PSG differs with the placement of the device and is limited for hip-based measurements. Agreement of self-report with PSG is comparable to that of actigraphy for some parameters.
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Affiliation(s)
- Melanie Zinkhan
- Institute of Clinical Epidemiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Westphalian Wilhelms-University Münster, Münster, Germany
| | - Sabrina Hense
- Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - Maren Nagel
- Institute of Epidemiology and Social Medicine, Westphalian Wilhelms-University Münster, Münster, Germany
| | - Anne Obst
- Department of Internal Medicine B, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Beate Koch
- Department of Internal Medicine B, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Ingo Fietze
- Interdisciplinary Center of Sleep Medicine, Charité University Hospital, Berlin, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - Peter Young
- Department of Neurology - Sleep Medicine and Neuromuscular Disease, Westphalian Wilhelms-University Münster, Münster, Germany
| | - Svenja Happe
- Department of Clinical Neurophysiology, Klinikum Bremen-Ost, Bremen, Germany; Department of Neurology, Klinik Maria Frieden, Telgte, Germany
| | - Jan W Kantelhardt
- Institute of Physics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | | | - Frank Pillmann
- Department of Psychiatry and Psychotherapy, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Andreas Stang
- Institute of Clinical Epidemiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany; School of Public Health, Department of Epidemiology, Boston University, Boston, MA, USA
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13
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Pollmächer T, Wetter TC, Happe S, Richter K, Acker J, Riemann D. [Sleep medicine differential diagnostics in psychiatry and psychotherapy]. Nervenarzt 2013; 85:57-66. [PMID: 24356713 DOI: 10.1007/s00115-013-3895-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Complaints about disturbed sleep or increased daytime sleepiness are among the most frequent symptoms reported to psychiatrists by patients. Such complaints can be symptoms of an underlying psychiatric disorder or indicative of a separate or comorbid sleep disorder. Hence, basic knowledge in the differential diagnosis of sleep medicine pathologies is pivotal for psychiatrists and psychotherapists. In the present overview following a description of the diagnostic methods, the diagnostic work-up according to the major symptomatic clusters, namely disturbances in initiating and maintaining sleep, abnormal nocturnal movements and excessive daytime sleepiness will be presented.
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Affiliation(s)
- T Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Deutschland,
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15
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Thiedemann C, Bunten S, Happe S. Periodic leg movements during sleep in PLMD and RLS patients with and without pramipexole treatment. Somnologie 2013. [DOI: 10.1007/s11818-013-0622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Szentkirályi A, Völzke H, Hoffmann W, Happe S, Berger K. A time sequence analysis of the relationship between cardiovascular risk factors, vascular diseases and restless legs syndrome in the general population. J Sleep Res 2013; 22:434-42. [PMID: 23374090 DOI: 10.1111/jsr.12040] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 01/02/2013] [Accepted: 01/09/2013] [Indexed: 01/09/2023]
Abstract
Previous cross-sectional studies regarding the association of restless legs syndrome (RLS) with cardiovascular morbidity are controversial. Our aim was to evaluate prospectively the relationship of cardiovascular risk factors and vascular diseases with incident RLS in the general population. The results are from two prospective population-based cohort studies: the Dortmund Health Study (n = 1312, median follow-up of 2.1 years) and the Study of Health in Pomerania (n = 4308, median follow-up of 5.0 years). RLS status was assessed twice according to the minimal criteria. Diabetes, hypertension, myocardial infarction and stroke, as well as currently taken medications, were assessed as self-reports. Body mass index and serum total cholesterol were also measured. The independent risks associated with each outcome were estimated by multivariable logistic regression models adjusted for comorbidities and behavioural factors. Obesity was an independent risk factor of incident RLS in the Dortmund Health Study, and higher body mass index was an independent risk factor in both studies. Diabetes, hypertension and hypercholesterolaemia were independent predictors of incident RLS in the Study of Health in Pomerania. The vascular comorbidity index, defined by the number of concurrent cardiovascular risk factors and vascular diseases, showed a positive association with incident RLS in both studies. RLS at baseline was not a significant predictor of any subsequent cardiovascular risk factors and/or vascular diseases in any of the studies. Cardiovascular risk factors and diseases predict the subsequent development of RLS in the general population. The presence of RLS is not a significant risk factor of cardiovascular morbidity.
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Affiliation(s)
- András Szentkirályi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany; Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary.
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Happe S, Bunten S. Electrical and transcranial magnetic stimulation of the facial nerve: diagnostic relevance in acute isolated facial nerve palsy. Eur Neurol 2012; 68:304-9. [PMID: 23051862 DOI: 10.1159/000341624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 07/01/2012] [Indexed: 11/19/2022]
Abstract
UNLABELLED Unilateral facial weakness is common. Transcranial magnetic stimulation (TMS) allows identification of a conduction failure at the level of the canalicular portion of the facial nerve and may help to confirm the diagnosis. METHODS We retrospectively analyzed 216 patients with the diagnosis of peripheral facial palsy. The electrophysiological investigations included the blink reflex, preauricular electrical stimulation and the response to TMS at the labyrinthine part of the canalicular proportion of the facial nerve within 3 days after symptom onset. RESULTS A similar reduction or loss of the TMS amplitude (p < 0.005) of the affected side was seen in each patient group. Of the 216 patients (107 female, mean age 49.7 ± 18.0 years), 193 were diagnosed with Bell's palsy. Test results of the remaining patients led to the diagnosis of infectious [including herpes simplex, varicella zoster infection and borreliosis (n = 13)] and noninfectious [including diabetes and neoplasma (n = 10)] etiology. CONCLUSIONS A conduction block in TMS supports the diagnosis of peripheral facial palsy without being specific for Bell's palsy. SIGNIFICANCE These data shed light on the TMS-based diagnosis of peripheral facial palsy, an ability to localize the site of lesion within the Fallopian channel regardless of the underlying pathology.
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Affiliation(s)
- Svenja Happe
- Department of Clinical Neurophysiology, Klinikum Bremen-Ost, University of Göttingen, Bremen, Germany.
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LeProust E, Jeong K, Useche F, Corioni M, Giuffre A, Barboza J, Bagga R, Happe S, Roberts D. 610 Comprehensive DNA Methylation Profiling With the SureSelect Target Enrichment System. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Szentkiralyi A, Fendrich K, Hoffmann W, Happe S, Berger K. Socio-economic risk factors for incident restless legs syndrome in the general population. J Sleep Res 2012; 21:561-8. [PMID: 22369474 DOI: 10.1111/j.1365-2869.2012.01001.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Few and controversial data exist about the relationship between socio-economic status and restless legs syndrome, and prospective analyses are lacking. We aimed to explore the associations between socio-economic factors and incident restless legs syndrome in the general population. Two prospective population-based cohort studies were conducted: the Dortmund Health Study with a mean follow-up of 2.2 years; and the Study of Health in Pomerania with a mean follow-up of 5.2 years. The studies included 1312 subjects and 4308 subjects, respectively. Restless legs syndrome was assessed twice according to the standard minimal criteria. The modified Winkler Index of social class, education, job status, partnership and income were assessed by interviews at baseline. The risk of restless legs syndrome associated with each socio-economic factor was estimated by multivariable logistic regression adjusted for behavioural factors and co-morbidities. Female gender, being retired and unemployment were independent risk factors of incident restless legs syndrome in both studies. Low level of education and income were independently associated with incident restless legs syndrome only in the Dortmund Health Study, but not in the other study. Migrational background and shiftwork were further independent risk factors of restless legs syndrome that were only assessed in the Dortmund Health Study. People with less favourable socio-economic situation are at an increased risk of developing restless legs syndrome. Behavioural variables and co-morbidities did not explain this association, thus further studies are required to reveal the mechanism behind the proposed relationship.
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Affiliation(s)
- Andras Szentkiralyi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
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22
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Nitsche MA, Koschack J, Pohlers H, Hullemann S, Paulus W, Happe S. Effects of frontal transcranial direct current stimulation on emotional state and processing in healthy humans. Front Psychiatry 2012; 3:58. [PMID: 22723786 PMCID: PMC3377009 DOI: 10.3389/fpsyt.2012.00058] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 05/25/2012] [Indexed: 12/28/2022] Open
Abstract
The prefrontal cortex is involved in mood and emotional processing. In patients suffering from depression, the left dorsolateral prefrontal cortex (DLPFC) is hypoactive, while activity of the right DLPFC is enhanced. Counterbalancing these pathological excitability alterations by repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) improves mood in these patients. In healthy subjects, however, rTMS of the same areas has no major effect, and the effects of tDCS are mixed. We aimed to evaluate the effects of prefrontal tDCS on emotion and emotion-related cognitive processing in healthy humans. In a first study, we administered excitability-enhancing anodal, excitability-diminishing cathodal, and placebo tDCS to the left DLPFC, combined with antagonistic stimulation of the right frontopolar cortex, and tested acute emotional changes by an adjective checklist. Subjective emotions were not influenced by tDCS. Emotional face identification, however, which was explored in a second experiment, was subtly improved by a tDCS-driven excitability modulation of the prefrontal cortex, markedly by anodal tDCS of the left DLPFC for positive emotional content. We conclude that tDCS of the prefrontal cortex improves emotion processing in healthy subjects, but does not influence subjective emotional state.
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Affiliation(s)
- M A Nitsche
- Department Clinical Neurophysiology, Georg-August-University Goettingen, Germany
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23
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Szentkiralyi A, Fendrich K, Hoffmann W, Happe S, Berger K. Incidence of restless legs syndrome in two population-based cohort studies in Germany. Sleep Med 2011; 12:815-20. [DOI: 10.1016/j.sleep.2011.06.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/24/2011] [Accepted: 06/04/2011] [Indexed: 11/26/2022]
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Schirmacher A, Hor H, Heidbreder A, Happe S, Kelsch R, Kuhlenbäumer G, Meißner T, Mayer G, Young P. Sequence variants in circadian rhythmic genes in a cohort of patients suffering from hypersomnia of central origin. BIOL RHYTHM RES 2011. [DOI: 10.1080/09291016.2010.525382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Grundmann L, Rolke R, Nitsche MA, Pavlakovic G, Happe S, Treede RD, Paulus W, Bachmann CG. Effects of transcranial direct current stimulation of the primary sensory cortex on somatosensory perception. Brain Stimul 2011; 4:253-60. [DOI: 10.1016/j.brs.2010.12.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 11/18/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022] Open
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Scholz H, Benes H, Happe S, Bengel J, Kohnen R, Hornyak M. Psychological distress of patients suffering from restless legs syndrome: a cross-sectional study. Health Qual Life Outcomes 2011; 9:73. [PMID: 21933380 PMCID: PMC3187724 DOI: 10.1186/1477-7525-9-73] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 09/20/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restless legs syndrome (RLS) is a chronic disorder with substantial impact on quality of life similar to that seen in diabetes mellitus or osteoarthritis. Little is known about the psychological characteristics of RLS patients although psychological factors may contribute to unfavourable treatment outcome. METHODS In an observational cross-sectional design, we evaluated the psychological features of 166 consecutive RLS patients from three outpatient clinics, by means of the Symptom Checklist 90-R (SCL-90-R) questionnaire. Additionally, the Beck Depression Inventory-II (BDI-II) and the International RLS Severity Scale (IRLS) were measured. Both treated and untreated patients were included, all patients sought treatment. RESULTS Untreated patients (n = 69) had elevated but normal scores on the SCL-90-R Global Severity Index (GSI; p = 0.002) and on the sub-scales somatisation (p < 0.001), compulsivity (p = 0.003), depression (p = 0.02), and anxiety (p = 0.004) compared with a German representative sample. In the treated group, particularly in those patients who were dissatisfied with their actual treatment (n = 62), psychological distress was higher than in the untreated group with elevated scores for the GSI (p = 0.03) and the sub-scales compulsivity (p = 0.006), depression (p = 0.012), anxiety (p = 0.031), hostility (p = 0.013), phobic anxiety (p = 0.024), and paranoid ideation (p = 0.012). Augmentation, the most serious side effect of dopaminergic, i.e. first-line treatment of RLS, and loss of efficacy were accompanied with the highest psychological distress, as seen particularly in the normative values of the sub-scales compulsivity and anxiety. Generally, higher RLS severity was correlated with higher psychological impairment (p < 0.001). CONCLUSION Severely affected RLS patients show psychological impairment in multiple psychological domains which has to be taken into account in the treatment regimen.
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Affiliation(s)
- Hanna Scholz
- Interdisciplinary Pain Centre, University Medical Centre, Freiburg 79106, Germany.
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Abstract
Pain in the legs belongs to the five most frequent regional pain symptoms. Restless legs syndrome (RLS) presents a particular differential diagnosis for pain in the legs, which is characterized by a nocturnal urge to move the legs often associated with painful sensations in the legs. It is one of the most common neurological disorders and probably the leading cause of nocturnal pain in the legs. In this overview, the diagnosis and therapy of RLS as well as aspects of pain therapy of the disorder are presented. In addition, the differential diagnoses for exclusion of other specific causes of nocturnal pain in the legs are discussed.
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Affiliation(s)
- M Hornyak
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
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Bachmann CG, Rolke R, Scheidt U, Stadelmann C, Sommer M, Pavlakovic G, Happe S, Treede RD, Paulus W. Reply: Sensory profile in primary restless legs syndrome and restless legs syndrome associated with small fibre neuropathy. Brain 2011. [DOI: 10.1093/brain/awq292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schirmacher A, Heidbreder A, Happe S, Kelsch R, Meißner T, Mayer G, Young P. Positive association of a Cry1 polymorphism with EDS. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bunten S, Ochmann R, Dempewolf S, Lange B, Happe S. P 300 bei unterschiedlichen Schlafstörungen. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bachmann C, Nitsche M, Pfingsten M, Gersdorff N, Harder C, Baier P, Antal A, Treede R, Paulus W, Happe S. Diurnal time course of heat pain perception in healthy humans. Neurosci Lett 2011; 489:122-5. [DOI: 10.1016/j.neulet.2010.11.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 11/26/2022]
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Steinig J, Foraita R, Happe S, Heinze M. Perception of Sleep and Dreams in Alcohol-Dependent Patients during Detoxication and Abstinence. Alcohol Alcohol 2011; 46:143-7. [DOI: 10.1093/alcalc/agq087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bachmann CG, Muschinsky S, Nitsche MA, Rolke R, Magerl W, Treede RD, Paulus W, Happe S. Transcranial direct current stimulation of the motor cortex induces distinct changes in thermal and mechanical sensory percepts. Clin Neurophysiol 2010; 121:2083-9. [PMID: 20570558 DOI: 10.1016/j.clinph.2010.05.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Revised: 03/09/2010] [Accepted: 05/11/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this single-blinded, complete crossover study was to evaluate the effects of tDCS on thermal and mechanical perception, as assessed by quantitative sensory testing (QST). METHODS QST was performed upon the radial part of both hands of eight healthy subjects (3 female, 5 male, 25-41years of age). These subjects were examined before and after cathodal, anodal or sham tDCS, applied in a random order. TDCS was administered for 15min at a 1mA current intensity, with the active electrode placed over the left primary motor cortex and the reference electrode above the right orbit. RESULTS After cathodal tDCS, cold detection thresholds (CDT), mechanical detection thresholds (MDT), and mechanical pain thresholds (MPT) significantly increased in the contralateral hand, when compared to the baseline condition. CONCLUSIONS Cathodal tDCS temporarily reduced the sensitivity to A-fiber mediated somatosensory inputs. SIGNIFICANCE Impairment of these somatosensory percepts suggests a short-term suppression of lemniscal or suprathalamic sensory pathways following motor cortex stimulation by cathodal tDCS.
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Affiliation(s)
- Cornelius G Bachmann
- Department of Clinical Neurophysiology, Georg August-University, Goettingen, Germany.
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Nitsche MA, Jakoubkova M, Thirugnanasambandam N, Schmalfuss L, Hullemann S, Sonka K, Paulus W, Trenkwalder C, Happe S. Contribution of the Premotor Cortex to Consolidation of Motor Sequence Learning in Humans During Sleep. J Neurophysiol 2010; 104:2603-14. [PMID: 20844115 DOI: 10.1152/jn.00611.2010] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Motor learning and memory consolidation require the contribution of different cortices. For motor sequence learning, the primary motor cortex is involved primarily in its acquisition. Premotor areas might be important for consolidation. In accordance, modulation of cortical excitability via transcranial DC stimulation (tDCS) during learning affects performance when applied to the primary motor cortex, but not premotor cortex. We aimed to explore whether premotor tDCS influences task performance during motor memory consolidation. The impact of excitability-enhancing, -diminishing, or placebo premotor tDCS during rapid eye movement (REM) sleep on recall in the serial reaction time task (SRTT) was explored in healthy humans. The motor task was learned in the evening. Recall was performed immediately after tDCS or the following morning. In two separate control experiments, excitability-enhancing premotor tDCS was performed 4 h after task learning during daytime or immediately before conduction of a simple reaction time task. Excitability-enhancing tDCS performed during REM sleep increased recall of the learned movement sequences, when tested immediately after stimulation. REM density was enhanced by excitability-increasing tDCS and reduced by inhibitory tDCS, but did not correlate with task performance. In the control experiments, tDCS did not improve performance. We conclude that the premotor cortex is involved in motor memory consolidation during REM sleep.
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Affiliation(s)
- Michael A. Nitsche
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany; and
| | - Michaela Jakoubkova
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany; and
- Department of Neurology, First Medical Faculty of Charles University, Prague, Czech Republic
| | | | - Leonie Schmalfuss
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany; and
| | - Sandra Hullemann
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany; and
| | - Karel Sonka
- Department of Neurology, First Medical Faculty of Charles University, Prague, Czech Republic
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany; and
| | - Claudia Trenkwalder
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany; and
| | - Svenja Happe
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany; and
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Dempewolf S, Bunten S, Happe S. Epileptic discharges after sleep deprivation from the perspective of sleep. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bachmann CG, Rolke R, Scheidt U, Stadelmann C, Sommer M, Pavlakovic G, Happe S, Treede RD, Paulus W. Thermal hypoaesthesia differentiates secondary restless legs syndrome associated with small fibre neuropathy from primary restless legs syndrome. Brain 2010; 133:762-70. [DOI: 10.1093/brain/awq026] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dodel R, Happe S, Peglau I, Mayer G, Wasem J, Reese JP, Giani G, Geraedts M, Trenkwalder C, Oertel WH, Stiasny-Kolster K. Health economic burden of patients with restless legs syndrome in a German ambulatory setting. Pharmacoeconomics 2010; 28:381-393. [PMID: 20297866 DOI: 10.2165/11531030-000000000-00000] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The primary characteristics of restless legs syndrome (RLS), including severe sleep disorders, restlessness in the evening and discomfort while at rest, have substantial impact on normal daily activities. Because of the high prevalence of RLS in the general population, it is necessary to evaluate the economic impact of RLS. To determine the health economic burden of patients with RLS in Germany. A total of 519 RLS patients (mean age: 65.2 +/- 11.1 years) in different stages of disease were recruited in five health centres (university hospitals, district hospitals and office-based neurologists) by applying the diagnostic criteria of the International Restless Legs Syndrome Study Group. A questionnaire was administered that assessed healthcare resource consumption as well as socioeconomic, demographic, clinical and health status. In addition, the International RLS severity scale (IRLS), Epworth Sleepiness Scale (ESS), EQ-5D and Beck Depression Inventory (BDI) were addressed in the assessment. Direct and indirect costs (euro, year 2006 values) were derived from various German economic resources and calculated from the perspective of the healthcare and transfer payment providers. We calculated average total costs over the 3-month observation period. It was determined that average total costs were euro2090 for this period. The average direct medical and non-medical costs from the perspective of the health insurance provider were determined to be euro780, with euro300 attributed to drug costs and euro354 to hospitalization costs. Average total indirect costs amounted to euro1308 and were calculated based on productivity loss, using the human capital approach. As cost-driving factors we identified disease severity according to the IRLS (p < 0.01) and ESS (p < 0.04). Health-related quality of life was determined to be substantially affected by RLS; the mean EQ-5D visual analogue scale (VAS) was 55.6, considerably lower than that of the age-matched general population. RLS places a notable financial burden on society as well as on patients and their families. More detailed studies are needed to evaluate the health economic impact of this disorder.
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Affiliation(s)
- Richard Dodel
- Department of Neurology, Philipps-University Marburg, Marburg, Germany.
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Boentert M, Dziewas R, Heidbreder A, Happe S, Kleffner I, Evers S, Young P. Fatigue, reduced sleep quality and restless legs syndrome in Charcot-Marie-Tooth disease: a web-based survey. J Neurol 2009; 257:646-52. [PMID: 19937049 PMCID: PMC3128702 DOI: 10.1007/s00415-009-5390-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/07/2009] [Accepted: 11/09/2009] [Indexed: 11/28/2022]
Abstract
To investigate the prevalence of fatigue, daytime sleepiness, reduced sleep quality, and restless legs syndrome (RLS) in a large cohort of patients with Charcot-Marie-Tooth disease (CMT) and their impact on health-related quality of life (HRQoL). Participants of a web-based survey answered the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index, the Multidimensional Fatigue Inventory, and, if the diagnostic criteria of RLS were met, the International RLS Severity Scale. Diagnosis of RLS was affirmed in screen-positive patients by means of a standardized telephone interview. HRQoL was assessed by using the SF-36 questionnaire. Age- and sex-matched control subjects were recruited from waiting relatives of surgical outpatients. 227 adult self-reported CMT patients answered the above questionnaires, 42.9% were male, and 57.1% were female. Age ranged from 18 to 78 years. Compared to controls (n = 234), CMT patients reported significantly higher fatigue, a higher extent and prevalence of daytime sleepiness and worse sleep quality. Prevalence of RLS was 18.1% in CMT patients and 5.6% in controls (p = 0.001). RLS severity was correlated with worse sleep quality and reduced HRQoL. Women with CMT were affected more often and more severely by RLS than male patients. With regard to fatigue, sleep quality, daytime sleepiness, RLS prevalence, RLS severity, and HRQoL, we did not find significant differences between genetically distinct subtypes of CMT. HRQoL is reduced in CMT patients which may be due to fatigue, sleep-related symptoms, and RLS in particular. Since causative treatment for CMT is not available, sleep-related symptoms should be recognized and treated in order to improve quality of life.
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Affiliation(s)
- Matthias Boentert
- Department of Neurology, University Hospital Münster, Albert-Schweitzer-Str. 33, 48129, Münster, Germany.
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Lanz M, Steinig J, Haack H, Happe S. Psychogenic movement disorder mimicking RLS: A case report. Mov Disord 2009; 24:1549-50. [DOI: 10.1002/mds.22606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Möddel G, Bunten S, Dobis C, Kovac S, Dogan M, Fischera M, Dziewas R, Schäbitz WR, Evers S, Happe S. Intravenous levetiracetam: a new treatment alternative for refractory status epilepticus. J Neurol Neurosurg Psychiatry 2009; 80:689-92. [PMID: 19448097 DOI: 10.1136/jnnp.2008.145458] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The purpose of this study was to investigate the safety and efficacy of intravenous levetiracetam (LEV-iv) in refractory status epilepticus (SE). A retrospective chart review was performed on patients who received LEV-iv for treatment of SE (n = 36) and had failed at least one other antiepileptic drug. LEV-iv (median 3000 mg/day; range 1000-9000) was administered as a bolus loading (500-2000 mg per 30-60 min, n = 30) or as a continuous pump infusion (n = 6). SE was terminated in 69% ("responders"); 31% ("non-responders") remained in SE. Factors associated with failure were: dose escalation over 3000 mg/day, lack of bolus loading, treatment latency over 48 h, age over 80 years, non-convulsive SE with coma ("subtle SE"), periodic lateralised epileptiform discharges (PLEDs) on EEG, acute cerebral lesion and intubation narcosis. SE was terminated in all eight patients without brain lesion (p = 0.033), and in all seven patients with complex partial SE (p = 0.051). Outcome was favourable (ambulatory patients) in 48% (responders) compared with 0% (non-responders), and "adverse" (death or continuing coma/stupor) in 24% (responders) compared with 100% (non-responders). Mortality was 17% (responders 4%, non-responders 45%). No patient had cardiocirculatory side effects or worsening of SE. Two patients experienced nausea and vomiting during LEV-iv loading, leading to aspiration pneumonia in one. This study suggests that LEV-iv may be a safe and efficacious treatment of SE. Prospective and controlled trials are imperative to confirm these preliminary findings.
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Affiliation(s)
- G Möddel
- Department of Neurology, University of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
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Bachmann C, Rolke R, Sommer M, Happe S, Treede RD, Paulus W. Thermal hypoesthesia differentiates secondary RLS due to small fibre neuropathy from primary RLS. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Happe S, Reese JP, Stiasny-Kolster K, Peglau I, Mayer G, Klotsche J, Giani G, Geraedts M, Trenkwalder C, Dodel R. Assessing health-related quality of life in patients with restless legs syndrome. Sleep Med 2009; 10:295-305. [PMID: 18359664 DOI: 10.1016/j.sleep.2008.01.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 12/28/2007] [Accepted: 01/05/2008] [Indexed: 10/22/2022]
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Dempewolf S, Ahlborn M, Lanz M, Bunten S, Happe S. 113. Somatosensory evoked potentials elicited by lingual nerve stimulation. Clin Neurophysiol 2009. [DOI: 10.1016/j.clinph.2008.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Csifcsak G, Antal A, Hillers F, Levold M, Bachmann CG, Happe S, Nitsche MA, Ellrich J, Paulus W. Modulatory Effects of Transcranial Direct Current Stimulation on Laser-Evoked Potentials. Pain Med 2009; 10:122-32. [DOI: 10.1111/j.1526-4637.2008.00508.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Reese J, Happe S, Peglau I, Mayer G, Wasem J, Giani G, Geraedts M, Trenkwalder C, Stiasny-Kolster K, Dodel R. Economic burden and health-related quality of life in restless legs syndrome. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Happe S, Vennemann M, Evers S, Berger K. Treatment wish of individuals with known and unknown restless legs syndrome in the community. J Neurol 2008; 255:1365-71. [PMID: 18575924 DOI: 10.1007/s00415-008-0922-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 01/18/2008] [Accepted: 02/15/2008] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVES Restless legs syndrome (RLS) is a frequent sleep disorder with a prevalence of 5% to 15% in Caucasian populations. Dopaminergic treatment is known to reduce sensorimotor RLS symptoms and is approved for RLS, but not all patients ask for treatment. About 2% to 3% of patients presenting to a primary care physician require RLS-specific treatment. The overall treatment preference of RLS sufferers, however, is still unknown. The aim of this study was to assess the prevalence and treatment preference in patients with previously diagnosed and those with yet undiagnosed RLS in a population-based survey in Germany. DESIGN AND SETTING Cross-sectional health survey with face-to-face interviews with 1312 participants in the Dortmund Health Study. RLS was assessed with standardized, validated questions addressing the four minimal diagnostic criteria for RLS defined by the International Restless Legs Syndrome Study Group. PARTICIPANTS Participants were aged 25 to 75 years and were randomly selected from the city register. RESULTS The overall prevalence of individuals with a known doctor diagnosis of RLS was 2.3%. In addition, 6.5% fulfilled the four minimal criteria but did not know about this diagnosis yielding an overall prevalence of 8.8%. Prevalence was higher in women (10.2%) and German descendents (9.2%) compared to men (7.1%) and migrants (6.7%). Almost 60% of all RLS cases reported symptoms at least once a week. 33.3% of cases with a known RLS diagnosis and 14.1 % with an unknown diagnosis had an RLS treatment wish. The latter is determined by knowledge of the diagnosis, daily symptoms, diabetes and sleep disturbance. CONCLUSION About every fourth RLS case knows about the diagnosis and overall every fifth RLS case wishes medication to effectively reduce symptoms, corresponding to 1.6% of the whole study population.
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Affiliation(s)
- Svenja Happe
- Dept. of Clinical Neurophysiology, Klinikum Bremen-Ost/University of Göttingen, Züricher Strasse 40, 28325, Bremen, Germany.
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Bunten S, Happe S. Aktuelle Therapie der Narkolepsie. Akt Neurol 2008. [DOI: 10.1055/s-2008-1067382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Steinig J, Lanz M, Krügel R, Happe S. Breath holding – A rapid eye movement (REM) sleep parasomnia (catathrenia or expiratory groaning). Sleep Med 2008; 9:455-6. [DOI: 10.1016/j.sleep.2007.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 08/22/2007] [Accepted: 08/22/2007] [Indexed: 11/24/2022]
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