[Restless legs syndrome. Features and impact on sleep]

INTRODUCTION

Restless legs syndrome (RLS) is a chronic neurological disorder that has a negtive influence on sleep. We describe clinical spectrum, polysomnogram and impact on sleep of patients' series with RLS.

METHODS

We studied 49 patients with RLS. We analyse socio- demographic information, clinical features, therapy and impact on sleep. We realized differents questionnaire: Index of Severity of Sleep, Epworth Scale, Index-RLS, Questionnaire Quality of Life-RLS and Questionnaire from limitation of laboral productivity.

RESULTS

Mean age is 60.33+/-14.27 with similar distribution enter gender. They presented a positive family history in 36,73% with predominant in early onset of symptoms. Secondary causes more frequent associated were rheumatoid arthritis, iron-deficiency, uremia, pregnancy and polineuropathy. Significative prevalence of insomnia (73,43%) and periodic limb movement disorder (51,02%), obstructive sleep apnea syndrome (22,45%) and hipersomnia (22,45 %). Pharmacological treatment more used were dopaminergic drugs. We didn't find significant stadistic differences enter clinical feature and therapy, so tendency to better quality of life with dopaminergic drugs.

CONCLUSIONS

It's an neurological disorder with important delay in diagnosis. Early detection is needed because important impact on sleep efficiency and quality of life, and improvement with therapy, solely dopaminergic drugs.

[Neuroimaging and epilepsy]

The objective of magnetic resonance neuroimaging is to define the structural changes responsible for epileptogenic lesions and to rule out the presence of dual pathology when partial epileptic seizures are being studied. To this end, the individualization and optimization of protocols and sequences is indispensable. Structural images must be complemented by clinical evidence and function studies (EEG, SPECT, PET) in order to determine whether the structural lesion is responsible for the seizure and might eventually be excised. Spectroscopy provides biochemical information that is somewhat comparable to that obtained by biopsy of the epileptogenic zone. Spectroscopic images in the near future will provide clear "blind" views of these zones. Functional magnetic resonance images will presumably be of great help in the management of these patients.

Hypersomnia after tegmental pontine hematoma: case report

We describe polysomnographic studies of a 44 years-old man who showed a defect in the central nervous regulation of the sleep-waking cycle (SWC), hypoventilation and cardiovascular hyperactivity after a right-sided tegmental pontine hematoma. A significant increase in total sleep time mainly depending upon stage 1 + 2 was observed. Predominant unilateral damage to the medial and central region of the reticularis pontis oralis (Poo) nucleus, extending into the central part of the rostral reticularis pontis caudalis (Poc) nucleus, was presumably responsible for the hypersomnia in this patient.

[Pyknodysostosis: extreme cause of sleep apnea]

We describe a twentieth month old infant who had a pycnodysostosis syndrome. This malformation shows a loss of the normal mandible angle with generalized bone hyperdensification. The first produced and airway obstruction, with special relevance during sleeping hours. A polysomnography revealed an obstructive sleep apnea syndrome. The respiratory picture deteriorated with worsening of the airway obstruction, hypoxemia and finally pulmonary hypertension and cor pulmonale. A tracheostomy was performed, with resolution of the sleep apnea and pulmonary hypertension. The etiology, pathophysiologic consequences and surgical treatment of obstructive sleep apnea syndrome is reviewed.