Using near infrared light to manage symptoms associated with restless legs syndrome.

PubMed

Guffey, J Stephen; Motts, Susan; Barymon, Deanna; Wooten, Amber; Clough, Tim; Payne, Emily; Henderson, McCall; Tice, Neal

2016-01-01

The purpose of this study was to determine whether the application of near infrared (NIR) light could positively modulate symptoms associated with restless legs syndrome (RLS). Twenty-one subjects with RLS were treated with NIR three times weekly for four weeks. Baseline measures of: (1) international restless legs syndrome rating scale (IRLSRS) score; (2) Semmes Weinstein monofilament (SWM) test; (3) visual analog pain scale (VAS); (4) ankle-brachial index (ABI); and (5) sonographic imaging of the popliteal and posterior tibial arteries were compared to post-treatment values. NIR (850 nm) was delivered transcutaneously at 8 J/cm(2) to four locations on each leg and the plantar surface of each foot. A pre-test-post-test one group design was employed. Baseline and post-treatment measures were compared using either a dependent t-test when data were normal or the Wilcoxon signed rank test in the absence of normality. A significant improvement in IRLSRS scores was observed. Sensation improved from less than protective in 16.6% of sites tested at the baseline to 13.4% post-intervention. There was a significant improvement in ABI scores. VAS and sonographic imaging measures other than ABI remained unchanged. The use of NIR to modulate symptoms associated with RLS was supported by the data.

Actometry in measuring the symptom severity of restless legs syndrome.

PubMed

Tuisku, K; Holi, M M; Wahlbeck, K; Ahlgren, A J; Lauerma, H

2005-05-01

In a previous, controlled study we demonstrated that the general lower limb activity measured by three-channel actometry is a promising objective measure of restless legs syndrome (RLS) severity. In the present study we have further evaluated the method in measuring RLS symptom severity in an open, single-day pramipexole intervention with 15 RLS patients. Both our standardized actometric parameters (nocturnal lower limb activity and controlled rest activity) decreased significantly during the intervention in parallel with the subjectively reported relief of RLS symptoms.

Restless legs syndrome/Willis Ekbom disease: evaluation and treatment.

PubMed

Allen, Richard P

2014-04-01

Restless legs syndrome/Willis Ekbom disease (RLS/WED) has been recognized as a significant medical disorder since the 17th century. It was studied mostly in the last 50 years in relation to increasing interest in sleep medicine and health-related quality of life. This led to recognition that the disease is not well characterized as restless feelings in the legs. These symptoms are reported in many situations, but the subjective experience of RLS/WED patients differs from that experienced by others. Thus a new name has been introduced that avoids problems of symptom definition of a disease by naming it after those who first characterized it, i.e. 'Willis Ekbom disease'. This article emphasizes the importance of RLS/WED for psychiatry. The disease carries significant increased risk for depression and anxiety disorders. Treatment requires consideration of these co-morbid disorders. RLS/WED can exacerbate or even engender psychiatric disease, so treatment of psychiatric disease should also include consideration of RLS/WED. The need for attention to RLS/WED is particularly significant for depression. Most anti-depressants exacerbate or can even engender RLS/WED. Thus this article seeks to introduce RLS/WED in relation to psychiatric practice. It presents the RLS/WED disease, its overlap with psychiatry and the current treatment options.

Augmentation and impulsive behaviors in restless legs syndrome: Coexistence or association?

PubMed

Heim, Beatrice; Djamshidian, Atbin; Heidbreder, Anna; Stefani, Ambra; Zamarian, Laura; Pertl, Marie-Theres; Brandauer, Elisabeth; Delazer, Margarete; Seppi, Klaus; Poewe, Werner; Högl, Birgit

2016-07-05

To assess the frequency of impulse control disorders (ICDs) in patients with restless legs syndrome (RLS) with and without augmentation under dopaminergic therapy in a case-control study. Augmentation and ICDs are both serious complications of dopaminergic treatment of RLS but little is known about possible associations between these drug-induced disorders. In total, 58 patients with idiopathic RLS diagnosed according to the International Restless Legs Syndrome Study Group criteria were recruited. Of these, 35 patients had augmentation. The frequency of ICD symptoms was assessed using semi-structural interviews. Demographic variables did not differ between patients with RLS with and without augmentation but those with augmentation took higher dopaminergic medication than patients without augmentation. Twenty-three patients with RLS (39.7%) had ICD symptoms, with 12 patients (20.7%) having definitive ICDs. Patients with augmentation had an increased risk of expressing ICD symptoms (p = 0.007, odds ratio 5.64, 95% confidence interval 1.59-20.02). Patients with RLS with augmentation have an almost 6-fold increased risk of exhibiting ICD symptoms. This implies that augmentation and ICDs are related and may share a common pathophysiology. Moreover, our results have clinical implications, suggesting that patients with RLS with augmentation should be screened for ICD symptoms. © 2016 American Academy of Neurology.

Selected sleep disorders: restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy.

PubMed

Erman, Milton K

2006-12-01

Sleep disorders, including restless legs syndrome and periodic limb movement disorder, sleep apnea syndrome, and narcolepsy, are prevalent medical conditions, likely to be seen by practicing psychiatrists. Awareness of these conditions and their presentations, pathophysiology, and treatment allows psychiatrists to treat these conditions where appropriate, to minimize complications and health consequences associated with delayed diagnosis, and to reduce the burden of disease that these conditions may place on patients already experiencing primary psychiatric disorders.

Prevalence of restless legs symptoms according to depressive symptoms and depression type: a cross-sectional study.

PubMed

Auvinen, Piritta; Mäntyselkä, Pekka; Koponen, Hannu; Kautiainen, Hannu; Korniloff, Katariina; Ahonen, Tiina; Vanhala, Mauno

2018-01-01

Restless legs syndrome is a sensorimotor disorder and it is associated with several other diseases especially mental illnesses. To analyze the relationship between the symptoms of restless legs syndrome and the severity of depressive symptoms and the prevalence of restless legs symptoms in depression subtypes. A cross-sectional study of primary care patients in the Central Finland Hospital District. The prevalence of restless legs symptoms was studied in 706 patients with increased depressive symptoms and 426 controls without a psychiatric diagnosis by using a structured questionnaire. The depressive symptoms were evaluated with the Beck Depression Inventory (BDI) and the psychiatric diagnosis was confirmed by means of a diagnostic interview (Mini-International Neuropsychiatric Interview). The subjects with increased depressive symptoms were divided into three groups (subjects with depressive symptoms without a depression diagnosis, melancholic depression and non-melancholic depression). In the whole study population, the prevalence of restless legs symptoms increased with the severity of depressive symptoms. The prevalence of restless legs symptoms was highest in the melancholic and non-melancholic depressive patients (52 and 46%, respectively) and then in subjects with depressive symptoms without a depression diagnosis (43.4%), but the prevalence was also substantial (24.6%) in subjects without a psychiatric diagnosis. Restless legs symptoms are very common in primary care among subjects with depression, regardless of the depression type. The prevalence of restless legs symptoms increased with increasing severity of depressive symptoms, regardless of the diagnosis. These findings should be considered in clinical evaluation and treatment of patients visiting their physician due to restless legs or depressive symptoms.

Increased electroencephalographic high frequencies during the sleep onset period in patients with restless legs syndrome.

PubMed

Ferri, Raffaele; Cosentino, Filomena I I; Manconi, Mauro; Rundo, Francesco; Bruni, Oliviero; Zucconi, Marco

2014-08-01

To analyze the electroencephalographic (EEG) spectral content in untreated patients with restless legs syndrome (RLS) during the sleep onset period (SOP) and during the quiet wakefulness preceding sleep, in order to test the hypothesis that a state of hyperarousal might be present during the SOP with RLS. Sleep Research Centre. Twenty-seven untreated consecutive patients with RLS (mean age = 53.6 y), 11 untreated consecutive patients with primary insomnia (mean age = 58.9 y), and 14 normal controls (mean age = 50.3 y). SOP was defined as the 10-min period centered with the occurrence of the first sleep spindle in the EEG, and then subdivided into SOP-1 (period of 5 min before the first spindle) and SOP-2 (period of 5 min following). Leg movements occurring during SOP were counted and used as a covariate in the statistical analysis. Also, one period of 1 min of artifact-free quiet wakefulness after lights off was identified. EEG spectral analysis was run during these periods using the C3/A2 or C4/A1 channel. Increased EEG alpha and beta bands and/or beta/delta ratio in RLS versus normal controls, during both wakefulness preceding sleep and SOP (both parts SOP-1 and SOP-2) were found, which were, however, smaller than the increases found in patients with insomnia. The results of this study support the hypothesis of the presence of a state of hyperarousal in restless legs syndrome (RLS) during the sleep onset period. Treatment for RLS might need to take these findings into consideration. Ferri R, Cosentino FI, Manconi M, Rundo F, Bruni O, Zucconi M. Increased electroencephalographic high frequencies during the sleep onset period in patients with restless legs syndrome.

Restless legs syndrome: an early clinical feature of Parkinson disease in men.

PubMed

Wong, Janice C; Li, Yanping; Schwarzschild, Michael A; Ascherio, Alberto; Gao, Xiang

2014-02-01

The association between restless legs syndrome (RLS) and Parkinson disease has been extensively studied, but the temporal relationship between the two remains unclear. We thus conduct the first prospective study to examine the risk of developing Parkinson disease in RLS. Prospective study from 2002-2010. United States. There were 22,999 US male health professionals age 40-75 y enrolled in the Health Professionals Follow-up Study without Parkinson disease, arthritis, or diabetes mellitus at baseline. RLS was assessed in 2002 using a set of standardized questions recommended by the International RLS Study Group. Incident Parkinson disease was identified by biennial questionnaires and then confirmed by review of participants' medical records by a movement disorder specialist. We documented 200 incident Parkinson disease cases during 8 y of follow-up. Compared to men without RLS, men with RLS symptoms who had symptoms greater than 15 times/mo had higher risk of Parkinson disease development (adjusted relative risk = 1.47; 95% confidence interval: 0.59, 3.65; P = 0.41). This was statistically significant only for cases diagnosed within 4 y of follow-up (adjusted relative risk = 2.77; 95% confidence interval: 1.08, 7.11; P = 0.03). Severe restless legs syndrome may be an early feature of Parkinson disease.

Restless legs syndrome and pregnancy or delivery complications in China: a representative survey.

PubMed

Liu, Gangqiong; Li, Ling; Zhang, Jinying; Xue, Rui; Zhao, Xiaoyan; Zhu, Kui; Wang, Yunzhe; Xiao, Lili; Shangguan, Jiahong

2016-01-01

To perform a detailed epidemiological study of Chinese women and the relationship between restless legs syndrome (RLS) in pregnancy and any associated complications during delivery. A total of 3874 pregnant women (18-40 years) who had delivered babies at The First Affiliated Hospital of Zhengzhou University from May 2011 to May 2014 were enrolled in the study. Using a face-to-face interview questionnaire, data were collected pertaining to RLS incidence in pregnancy and any associated complications during delivery. The relationship between RLS frequency and pregnancy or delivery complications was further investigated. Among 12.3% of the eligible participants, RLS prevalence occurred at least weekly. Older pregnant women were more likely to suffer from RLS. Individuals who experienced RLS at least weekly reported a statistically higher frequency of excessive daytime sleepiness and an increased prevalence of hypertension, cardiovascular disease, and preeclampsia compared with those without RLS. The study revealed that RLS was frequent in Chinese pregnant women, especially in those with pregnancy or delivery complications such as hypertension, cardiovascular disease, and preeclampsia. Restless legs syndrome was also associated with excessive daytime sleepiness. Copyright © 2015 Elsevier B.V. All rights reserved.

Pre-pregnancy Restless Legs Syndrome (Willis-Ekbom Disease) Is Associated with Perinatal Depression

PubMed Central

Wesström, Jan; Skalkidou, Alkistis; Manconi, Mauro; Fulda, Stephany; Sundström-Poromaa, Inger

2014-01-01

Objectives: Both restless legs syndrome ([RLS], also known as Willis-Ekbom Disease [WED]) and depression are common during pregnancy. However, no prior studies have assessed if pregnant women with RLS have an elevated risk of depression during and/or after pregnancy. Methods: 1,428 women who were pregnant in gestational week 16-17 were asked to participate in a longitudinal survey. They were followed by web-based questionnaires in gestational week 17 and 32, and 6 weeks after delivery. Data were also retrieved from prenatal and birth records. Two different sets of criteria were used to examine the prevalence of RLS in the cohort (International Restless Legs Syndrome Society Group standard criteria and the later developed CH-RLSQ11 questionnaire). The latter questionnaire attempts to exclude those with common “mimics” of RLS. Results: Adjusted odds ratio for depression in gestational week 17, 32, and postpartum week 6 in relation to pre-pregnancy RLS onset and moderate to severe symptom severity were 4.74 (2.30 – 9.76), 3.67 (1.85 – 7.28), and 2.58 (1.28 – 5.21), respectively. No significant associations were seen in pregnant women with de novo RLS during pregnancy. When using the standard diagnostic RLS criteria and frequency of symptoms more than 2-3 days per week, the prevalence of RLS was 12.3%. With the CH-RLSQ11 questionnaire and the same threshold for frequency of symptoms the prevalence was 6.5%. Conclusion: Women with RLS onset before pregnancy with moderate or severe symptoms had an increased risk of both antenatal and postnatal depression. The self-reported prevalence of RLS during pregnancy is lower when a questionnaire dealing with “mimics” is used. Citation: Wesström J, Skalkidou A, Manconi M, Fulda S, Sundström-Poromaa I. Pre-pregnancy restless legs syndrome (Willis-Ekbom Disease) is associated with perinatal depression. J Clin Sleep Med 2014;10(5):527-533. PMID:24812538

Restless legs syndrome, rapid eye movement sleep behavior disorder, and hypersomnia in patients with two parkin mutations.

PubMed

Limousin, Nadège; Konofal, Eric; Karroum, Elias; Lohmann, Ebba; Theodorou, Ioannis; Dürr, Alexandra; Arnulf, Isabelle

2009-10-15

Parkin gene mutations cause a juvenile parkinsonism. Patients with these mutations may commonly exhibit REM sleep behaviour disorders, but other sleep problems (insomnia, sleepiness, restless legs syndrome) have not been studied. The aim of this study was to evaluate the sleep-wake phenotype in patients with two parkin mutations, compared with patients with idiopathic Parkinson's disease (iPD). Sleep interview and overnight video-polysomnography, followed by multiple sleep latency tests, were assessed in 11 consecutive patients with two parkin mutations (aged 35-60 years, from seven families) and 11 sex-matched patients with iPD (aged 51-65 years). Sleep complaints in the parkin group included insomnia (73% patients versus 45% in the iPD group), restless legs syndrome (45%, versus none in the iPD group, P = 0.04), and daytime sleepiness (45%, versus 54% in the iPD group). Of the parkin patients, 45% had REM sleep without atonia, but only 9% had a definite REM sleep behavior disorder. All sleep measures were similar in the parkin and iPD groups. Two parkin siblings had a central hypersomnia, characterized by mean daytime sleep latencies of 3 min, no sleep onset REM periods, and normal nighttime sleep. Although the patients with two parkin mutations were young, their sleep phenotype paralleled the clinical and polygraphic sleep recording abnormalities reported in iPD, except that restless legs syndrome was more prevalent and secondary narcolepsy was absent.

Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients.

PubMed

Moreira, N C V; Damasceno, R S; Medeiros, C A M; Bruin, P F C de; Teixeira, C A C; Horta, W G; Bruin, V M S de

2008-10-01

We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 +/- 14) with disease from 0.4 to 23 years (6.7 +/- 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 +/- 2.0). RLS was detected in 12 cases (27%). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52%) and excessive daytime sleepiness in 3 cases (6.8%). Fatigue was present in 32 subjects (73%) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.

Daytime symptoms of restless legs syndrome--clinical characteristics and rotigotine effectiveness.

PubMed

Takahashi, Masayoshi; Ikeda, Junji; Tomida, Takayuki; Hirata, Koichi; Hattori, Nobutaka; Inoue, Yuichi

2015-07-01

To elucidate the prevalence and clinical characteristics of daytime restless legs syndrome (RLS) among patients with idiopathic RLS and investigate the effectiveness of rotigotine for daytime RLS. In 256 enrolled RLS patients, we investigated factors associated with the presence of RLS symptoms throughout the day. We also assessed the duration of daytime RLS symptoms at hourly intervals, time of initial symptom onset during the day, and associations between duration of daytime and nighttime RLS symptoms. In addition, we compared changes in duration and frequency of RLS symptoms during daytime and nighttime after randomly assigning patients to a 13-week treatment with rotigotine, a dopamine agonist patch with 24-hour action, or placebo. Eighty-one (31.6%) patients had daytime RLS symptoms. Only the International Restless Legs Syndrome Study Group rating scale total score was significantly associated with the presence of daytime RLS symptoms (p < 0.01) on multiple logistic regression analysis. Daytime RLS symptom onset was at 6 a.m. in 44.4% of patients; symptom duration increased significantly toward nighttime. There was a significant positive association between duration of daytime and nighttime RLS symptoms (p < 0.0001) and a greater statistically significant reduction of daytime RLS symptom duration with rotigotine treatment than with placebo (p = 0.03). Daytime symptoms are frequent in patients with RLS and may be associated with increased severity of the disorder and prolonged nighttime RLS symptoms. Rotigotine could become an important treatment choice for daytime symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.

Safinamide for the treatment of Parkinson's disease, epilepsy and restless legs syndrome.

PubMed

Chazot, Paul L

2007-07-01

Merck Serono SA (formerly Serono), under license from Newron Pharmaceuticals SpA (following its acquisition of the rights from Pharmacia and Upjohn AB [now Pfizer Inc]), is developing the oral alpha-aminoamide derivative of milacemide, safinamide, a monoamine oxidase-B and glutamate release inhibitor, for the potential treatment of Parkinson's disease, epilepsy and restless legs syndrome. In March 2007, plans to develop the agent for the potential treatment of other cognitive disorders, such as Alzheimer's disease, were being finalized and testing was expected to begin before the end of that year.

Efficacy, safety and risk of augmentation of rotigotine for treating restless legs syndrome.

PubMed

Inoue, Yuichi; Hirata, Koichi; Hayashida, Kenichi; Hattori, Nobutaka; Tomida, Takayuki; Garcia-Borreguero, Diego

2013-01-10

The present study aimed to examine the long-term efficacy and safety of rotigotine treatment for restless legs syndrome (RLS), as well as the rate of clinically significant augmentation, in a 1-year open-label study of Japanese subjects. Japanese patients with RLS who had been treated with rotigotine or placebo in a double-blind trial were enrolled in a 1-year, open-label, uncontrolled extension study and treated with rotigotine at a dose of up to 3 mg/24 h after an 8-week titration phase. Outcomes included International Restless Legs Syndrome Study Group rating scale (IRLS scale), Pittsburgh Sleep Quality Index (PSQI), safety, and investigator-/expert panel-assessed augmentation (including Augmentation Severity Rating Scale). Overall, 185 patients entered the open-label study and 133 completed the study. IRLS and PSQI total scores improved throughout the 52-week treatment period (IRLS, from 23.2±5.1 to 7.8±7.6 and PSQI, from 8.0±3.1 to 5.0±2.9). Treatment-emergent adverse events were mild to moderate in severity, and included application site reactions (52.4%) and nausea (28.6%). Clinically significant augmentation occurred in five patients (2.7%). These results indicate a good long-term efficacy of rotigotine for treating RLS, with a relatively low risk of clinically significant augmentation. Copyright © 2012 Elsevier Inc. All rights reserved.

Treatment of pediatric restless legs syndrome.

PubMed

Amos, Louella B; Grekowicz, Megan L; Kuhn, Evelyn M; Olstad, Jenna D; Collins, Maureen M; Norins, Nan A; D'Andrea, Lynn A

2014-04-01

The primary aim was to determine if iron supplementation effectively treats children with restless legs syndrome (RLS), the time to improvement or resolution of symptoms, and patient characteristics (family history of RLS, secondary sleep disorders, medical diagnoses, and/or mental health diagnoses) that may affect outcome. METHODS.: This was a retrospective chart review of children between 5 and 18 years old who were diagnosed with RLS at the pediatric sleep disorders clinic at Children's Hospital of Wisconsin in Milwaukee, Wisconsin. Documented RLS treatment approaches included supplemental iron, nonpharmacologic interventions, melatonin, gabapentin, clonidine, and dopamine agonists (pramipexole and ropinirole). Ninety-seven children were diagnosed with RLS; 60.8% of children were between 5 and 11 years old. Most children (65%) received iron either as monotherapy or in combination with other treatments. Approximately 80% of the children who received iron and had follow-up had improvement or resolution of their symptoms. The median baseline ferritin level was 22.7 ng/mL, and 71% of children had a ferritin level less than 30 ng/mL. The median time to improvement or resolution of symptoms was 3.8 months. Supplemental iron as monotherapy or in combination with other treatments is effective in treating pediatric RLS. A prospective study could help determine if the initial ferritin level and degree of change in the ferritin level impact response to iron treatment. It is also important to study the long-term outcomes in these patients.

Restless legs syndrome in blood donors.

PubMed

Ulfberg, Jan; Nyström, Birgitta

2004-03-01

Restless legs syndrome (RLS) may be a cause of significant sleep disturbance. In a Swedish survey, the prevalence of RLS has been estimated to be 5.8% among men and 11.4% among women. Blood donation may result in iron deficiency, which is hypothesized to be one substantial cause of RLS. Nine hundred and forty-six (618 men, 328 women) consecutive blood donors aged 18-64 years, who attended a blood donation unit in mid-Sweden, answered a questionnaire that included questions about sleep habits. Frequency of blood donation was recorded and intake of iron tablets was assessed. Red blood cell distribution width (RDW) was also recorded. The value of RDW increases in relation to iron deficiency. RLS affected 14.7% of male and 24.7% of female blood donors. The mean intake of iron among the blood donors after each blood donation was only 781 mg, although the recommended intake is 2000 mg. Among the women, 7.4% presented an RDW of >14.5%, which strongly indicates iron deficiency. In this group of women, 37.5% were affected by RLS. The female RLS-sufferers were more affected than the female non-RLS subjects by problems initiating sleep (P=0.006 maintaining sleep (P<0.0001) and were also less refreshed upon awakening (P<0.001). This study showed that RLS was common among female blood donors. Women with RLS were more iron-deficient than those without and were affected by impaired sleep.

Pregabalin Versus Pramipexole: Effects on Sleep Disturbance in Restless Legs Syndrome

PubMed Central

Garcia-Borreguero, Diego; Patrick, Jeffrey; DuBrava, Sarah; Becker, Philip M.; Lankford, Alan; Chen, Crystal; Miceli, Jeffrey; Knapp, Lloyd; Allen, Richard P.

2014-01-01

Study Objectives: To compare pregabalin versus placebo and pramipexole for reducing restless legs syndrome (RLS)-related sleep disturbance. Design: Randomized, double-blinded, crossover trial. Setting: Twenty-three US sleep centers. Participants: Eighty-five individuals with moderate to severe idiopathic RLS and associated sleep disturbance. Interventions: Participants were randomized across 6 treatment sequences comprising three 4-week periods on pregabalin 300 mg/day (n = 75), pramipexole 0.5 mg/day (n = 76), or placebo (n = 73). Measurements and Results: Polysomnography was conducted over 2 nights at the end of each period. Primary (wake after sleep onset [WASO], pregabalin vs placebo) and key secondary endpoints were analyzed for statistical significance, with descriptive statistics for other endpoints. Pregabalin improved sleep maintenance, demonstrated by reductions in WASO (-27.1 min vs placebo [P < 0.0001]; -26.9 vs pramipexole) and number of awakenings after sleep onset (-2.7 vs placebo; -7.9 vs pramipexole [P < 0.0001]) by polysomnography, and an increase in subjective total sleep time (30.8 min vs placebo [P < 0.0001]; 26.8 vs pramipexole). Pregabalin also increased slow wave sleep duration (20.9 min vs placebo; 32.1 vs pramipexole [P < 0.0001]). Reduction in periodic limb movement arousal index (PLMAI) with pregabalin was similar to pramipexole and greater than placebo (-3.7 PLMA/h [P < 0.0001]), although reduction in total PLM in sleep was less than for pramipexole. Conclusions: This study demonstrated improvements in objective and subjective measures of sleep maintenance and sleep architecture with pregabalin compared with placebo and pramipexole. Effects of pregabalin on periodic limb movement arousal index were comparable to pramipexole. Trial Registration: ClinicalTrials.gov identifier, NCT00991276; http://clinicaltrials.gov/show/NCT00991276 Citation: Garcia-Borreguero D; Patrick J; DuBrava S; Becker PM; Lankford A; Chen C; Miceli J; Knapp L; Allen

Polysomnographic record and successful management of augmentation in restless legs syndrome/Willis-Ekbom disease.

PubMed

Maestri, Michelangelo; Fulda, Stephany; Ferini-Strambi, Luigi; Zucconi, Marco; Marelli, Sara; Staedler, Claudio; Bassetti, Claudio L; Manconi, Mauro

2014-05-01

Dopamine agonists (DAs) represent the first-line treatment in restless legs syndrome (RLS); however, in the long term, a substantial proportion of patients will develop augmentation, which is a severe drug-related exacerbation of symptoms and the main reason for late DA withdrawal. Polysomnographic features and mechanisms underlining augmentation are unknown. No practice guidelines for management of augmentation are available. A clinical case series of 24 consecutive outpatients affected by RLS with clinically significant augmentation during treatment with immediate-release DA was performed. All patients underwent a full-night polysomnographic recording during augmentation. A switchover from immediate-release DAs (l-dopa, pramipexole, ropinirole, rotigotine) to the long-acting, extended-release formula of pramipexole was performed. Fifty percent of patients presented more than 15 periodic limb movements per hour of sleep during augmentation, showing longer sleep latency and shorter total sleep time than subjects without periodic limb movements. In all patients, resolution of augmentation was observed within two to four weeks during which immediate-release dopamine agonists could be completely withdrawn. Treatment efficacy of extended-release pramipexole has persisted, thus far, over a mean follow-up interval of 13 months. Pramipexole extended release could be an easy, safe, and fast pharmacological option to treat augmentation in patients with restless legs syndrome. As such it warrants further prospective and controlled investigations. This observation supports the hypothesis that the duration of action of the drug plays a key role in the mechanism of augmentation. Copyright © 2014 Elsevier B.V. All rights reserved.

Restless Legs Syndrome, Sleep, and Quality of Life among Adolescents and Young Adults

PubMed Central

Silva, Graciela E.; Goodwin, James L.; Vana, Kimberly D.; Vasquez, Monica M.; Wilcox, Peter G.; Quan, Stuart F.

2014-01-01

Objective: Clinical reports in children implicate restless legs syndrome (RLS) with sleep and behavior problems. However, population-based studies on this association in adolescents and young adults are limited. Furthermore, few studies have evaluated the association between symptoms consistent with RLS and quality of life (QoL). Study Design: This cross-sectional study included 214 Caucasian and Hispanic adolescents and young adults aged 12-20 years. Symptoms consistent with RLS were based on four essential criteria and if the symptoms occurred ≥ 5 days/ month. Trouble falling asleep was present if reported “yes, still have the problem.” Quality of life (QoL) was assessed using the Pediatric QoL Inventory. Three summary QoL scores ranging from 0-100 were evaluated; higher scores indicated better QoL. Results: Participants were 50% male and 68.1% Caucasian. Prevalence of RLS was 8.4% (n = 18). RLS was associated with trouble falling asleep (OR = 3.1, p = 0.049), and trouble falling asleep was associated with worse Psychosocial Health scores (Coeff. −5.6, p = 0.004) and Total Scale scores for quality of life (Coeff. −4.6, p = 0.007). Conclusions: The prevalence of symptoms consistent with RLS in this community-based sample of adolescents and young adults, aged 12-20, is comparable to rates reported in older cohorts. Symptoms consistent with RLS may be associated with trouble falling asleep and psychosocial distress that may contribute to a lower health-related quality of life. Citation: Silva GE, Goodwin JL, Vana KD, Vasquez MM, Wilcox PG, Quan SF. Restless legs syndrome, sleep, and quality of life among adolescents and young adults. J Clin Sleep Med 2014;10(7):779-786. PMID:25024656

Iron, dopamine, genetics, and hormones in the pathophysiology of restless legs syndrome.

PubMed

Khan, Farhan H; Ahlberg, Caitlyn D; Chow, Christopher A; Shah, Divya R; Koo, Brian B

2017-08-01

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.

Restless Legs Syndrome in Adults in Peking Union Medical College Hospital.

PubMed

Chen, Jian-Hua; Huang, Rong; Luo, Jin-Mei; Xiao, Yi; Zhong, Xu; Liu, Xiu-Qin

2016-10-10

Objective To investigate the clinical characteristics of restless legs syndrome (RLS) in adults in Peking Union Medical College Hospital and explore the sleep quality,fatigue degree,daytime sleepiness,disease severity,depression and anxiety of RLS patients.Methods Totally 4739 consecutive patients who visited the outpatient departments with any sleep complaint or leg discomforts were recruited in the study. Patients under 18 years were excluded. All participants answered RLS questionnaire. The subjects fulfilled all four criteria would be followed up and given advanced examinations to rule out secondary RLS and RLS mimics. Primary RLS patients were evaluated with International Restless Legs Scale (IRLS),Pittsburgh Sleep Quality Index (PSQI),Fatigue Severity Scale (FSS),Epworth Sleepiness Scale (ESS),and Hospital Anxiety and Depression Scale for depression and anxiety (HADD and HADA). Another two groups of age-and gender-matched healthy subjects and non-RLS insomnia patients were served as normal and non-RLS insomnia controls.Results There were 162 (3.42%,162/4739) subjects fulfilling all four criteria for RLS; 42 (0.89%,42/4739) subjects were diagnosed as primary RLS and 33 (0.70%,33/4739) as RLS mimics. In primary RLS patients,41(97.6%) were found to be with poor sleep,13 (31.0%) with anxiety,and 4(9.5%) with depression. The scores of PSQI(q=11.69,P=0.000),HADA(q=8.02,P=0.000),and HADD(q=6.60,P=0.000)in primary RLS patients were significantly higher than those in normal controls. The scores of FSS(q=3.74,P=0.001),ESS(q=2.97,P=0.012),and HADD(q=4.15,P=0.000) in primary RLS patients were significantly lower than those in non-RLS insomnia controls. The scores of HADA and HADD were significantly correlated with those of PSQI(r=0.340,P=0.028;r=0.383,P=0.012),FSS(r=0.445,P=0.003;r=0.511,P=0.001),and IRLS(r=0.477,P=0.001;r=0.578,P=0.000). Conclusions RLS should be considered in the patients with any sleep-related complaint or leg discomforts. Primary RLS patients suffer

Acupuncture for restless legs syndrome.

PubMed

Cui, Ye; Wang, Yin; Liu, Zhishun

2008-10-08

Restless legs syndrome (RLS) is a common movement disorder for which patients may seek treatment with acupuncture. However, the benefits of acupuncture in the treatment of RLS are unclear and have not been evaluated in a systematic review until now. To evaluate the efficacy and safety of acupuncture therapy in patients with RLS. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007), MEDLINE (January 1950 to February 2007), EMBASE (January 1980 to 2007 Week 8), Chinese Biomedical Database (CBM) (1978 to February 2007), China National Knowledge Infrastructure (CNKI) (1979 to February 2007), VIP Database (1989 to February 2007), Japana Centra Revuo Medicina (1983 to 2007) and Korean Medical Database (1986 to 2007). Four Chinese journals, relevant academic conference proceedings and reference lists of articles were handsearched. Randomized controlled trials and quasi-randomized trials comparing acupuncture with no intervention, placebo acupuncture, sham acupuncture, pharmacological treatments, or other non-acupuncture interventions for primary RLS were included. Trials comparing acupuncture plus non-acupuncture treatment with the same non-acupuncture treatment were also included. Trials that only compared different forms of acupuncture or different acupoints were excluded. Two authors independently identified potential articles, assessed methodological quality and extracted data. Relative risk (RR) was used for binary outcomes and weighted mean difference for continuous variables. Results were combined only in the absence of clinical heterogeneity. Fourteen potentially relevant trials were identified initially, but twelve of them did not meet the selection criteria and were excluded. Only two trials with 170 patients met the inclusion criteria. No data could be combined due to clinical heterogeneity between trials. Both trials had methodological and/or reporting shortcomings. No significant difference was detected

Restless legs syndrome in patients with Parkinson's disease: a comparative study on prevalence, clinical characteristics, quality of life and nutritional status.

PubMed

Fereshtehnejad, S-M; Shafieesabet, M; Shahidi, G A; Delbari, A; Lökk, J

2015-04-01

Restless legs syndrome (RLS) is a common neurological disorder that can coexist with Parkinson's disease (PD). However, the association between these two movement disorders is quite poorly explored and previous findings are controversial in different aspects. To compare prevalence of RLS in Iranian PD population with a matched control group and to investigate the impact of comorbid RLS on quality of life (QoL), nutritional status, and clinical characteristics in PD population. This study was conducted on 108 individuals with idiopathic PD (IPD) and 424 matched controls. RLS was diagnosed using the International Restless Legs Syndrome Study Group (IRLSSG) criteria. Further assessments were performed on clinical characteristics, PD severity scales, psychiatric features, nutritional status, fatigue, and QoL in PD patients with and without RLS. Restless legs syndrome was significantly more common among the patients with IPD (14.8%) compared to the controls (7.5%) [OR = 2.1 (95% CI: 1.1-4.0)]. IPD subjects with RLS had significantly higher anxiety score [10.1 (SD = 5.1) vs 5.9 (SD = 5.0); P = 0.003], worse nutritional status [23.7 (SD = 2.7) vs 25.4 (SD = 3.7); P = 0.008], and poorer QoL [26.9 (SD = 13.1) vs 17.0 (SD = 13.2); P = 0.006]. The number of positive answers to the IRLSSG diagnostic criteria had significant direct correlation with unpredictability of the off periods and the presence of symptomatic orthostasis. Our study demonstrated a higher prevalence of RLS in patients with PD compared to general population. PD patients with RLS suffer from more anxiety, worse nutritional status, and worse QoL. RLS negatively accompanies with psychiatric problems, emotional behaviors, stigma, and cognitive impairment. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Sleep Disorders, Restless Legs Syndrome, and Uremic Pruritus: Diagnosis and Treatment of Common Symptoms in Dialysis Patients

PubMed Central

Scherer, Jennifer S.; Combs, Sara A.; Brennan, Frank

2017-01-01

Maintenance dialysis patients experience a high burden of physical and emotional symptoms that directly affect their quality of life and health care utilization. In this review, we specifically highlight common troublesome symptoms affecting dialysis patients: insomnia, restless legs syndrome, and uremic pruritus. Epidemiology, pathophysiology, and evidence-based current treatment are reviewed with the goal of providing a guide for diagnosis and treatment. Finally, we identify multiple additional areas of further study needed to improve symptom management in dialysis patients. PMID:27693261

Association Between Vitamin D Receptor rs731236 (Taq1) Polymorphism and Risk for Restless Legs Syndrome in the Spanish Caucasian Population

PubMed Central

Jiménez-Jiménez, Félix Javier; García-Martín, Elena; Alonso-Navarro, Hortensia; Martínez, Carmen; Zurdo, Martín; Turpín-Fenoll, Laura; Millán-Pascual, Jorge; Adeva-Bartolomé, Teresa; Cubo, Esther; Navacerrada, Francisco; Rojo-Sebastián, Ana; Rubio, Lluisa; Ortega-Cubero, Sara; Pastor, Pau; Calleja, Marisol; Plaza-Nieto, José Francisco; Pilo-De-La-Fuente, Belén; Arroyo-Solera, Margarita; García-Albea, Esteban; Agúndez, José A.G.

2015-01-01

Abstract Several recent works suggest a possible role of vitamin D deficiency in the etiology or restless legs syndrome (RLS). We analyzed the possible relationship of 2 common single nucleotide polymorphisms (SNPs) in the vitamin D3 receptor (VDR) gene with the risk for RLS. We studied the genotype and allelic variant frequencies of VDR rs2228570 and VDR rs731236 SNPs in 205 RLS patients and 445 healthy controls using a TaqMan essay. The frequencies of the rs731236AA genotype and the allelic variant rs731236A were significantly lower in RLS patients than in controls (P < 0.005 and < 0.01, respectively). Restless legs syndrome patients carrying the allelic variant rs731236G had an earlier age at onset, and those carrying the rs731236GG genotype had higher severity of RLS, although these data disappeared after multivariate analyses. None of the SNPs studied was related with the positivity of family history of RLS. These results suggest a modest, but significant association between VDR rs731236 SNP and the risk for RLS. PMID:26632733

Association Between Vitamin D Receptor rs731236 (Taq1) Polymorphism and Risk for Restless Legs Syndrome in the Spanish Caucasian Population.

PubMed

Jiménez-Jiménez, Félix Javier; García-Martín, Elena; Alonso-Navarro, Hortensia; Martínez, Carmen; Zurdo, Martín; Turpín-Fenoll, Laura; Millán-Pascual, Jorge; Adeva-Bartolomé, Teresa; Cubo, Esther; Navacerrada, Francisco; Rojo-Sebastián, Ana; Rubio, Lluisa; Ortega-Cubero, Sara; Pastor, Pau; Calleja, Marisol; Plaza-Nieto, José Francisco; Pilo-De-La-Fuente, Belén; Arroyo-Solera, Margarita; García-Albea, Esteban; Agúndez, José A G

2015-11-01

Several recent works suggest a possible role of vitamin D deficiency in the etiology or restless legs syndrome (RLS). We analyzed the possible relationship of 2 common single nucleotide polymorphisms (SNPs) in the vitamin D3 receptor (VDR) gene with the risk for RLS.We studied the genotype and allelic variant frequencies of VDR rs2228570 and VDR rs731236 SNPs in 205 RLS patients and 445 healthy controls using a TaqMan essay.The frequencies of the rs731236AA genotype and the allelic variant rs731236A were significantly lower in RLS patients than in controls (P < 0.005 and < 0.01, respectively). Restless legs syndrome patients carrying the allelic variant rs731236G had an earlier age at onset, and those carrying the rs731236GG genotype had higher severity of RLS, although these data disappeared after multivariate analyses. None of the SNPs studied was related with the positivity of family history of RLS.These results suggest a modest, but significant association between VDR rs731236 SNP and the risk for RLS.

Long-term safety and efficacy of rotigotine transdermal patch for moderate-to-severe idiopathic restless legs syndrome: a 5-year open-label extension study.

PubMed

Oertel, Wolfgang; Trenkwalder, Claudia; Beneš, Heike; Ferini-Strambi, Luigi; Högl, Birgit; Poewe, Werner; Stiasny-Kolster, Karin; Fichtner, Andreas; Schollmayer, Erwin; Kohnen, Ralf; García-Borreguero, Diego

2011-08-01

Safety and efficacy of non-ergot dopamine agonists for the treatment of idiopathic restless legs syndrome have been shown in short-term trials. We did a prospective open-label extension of a 6-week, double-blind randomised trial to assess the safety, tolerability, and efficacy of rotigotine transdermal patch for up to 5 years in patients with restless legs syndrome. Patients (aged 18-75 years) with moderate-to-severe idiopathic restless legs syndrome were treated with once-daily rotigotine transdermal patch in 33 centres in Austria, Germany, and Spain between July 31, 2003, and April 15, 2009. The dose was titrated in weekly increments (up to 4 weeks) from 0·5 mg/24 h to a maximum of 4 mg/24 h, and was followed by up to 5 years of maintenance at the optimum dose. Primary safety outcomes included occurrence of adverse events and dropouts. Efficacy assessments were secondary and included the International Restless Legs Syndrome study group severity rating scale (IRLS). Augmentation of symptoms was assessed by means of standard diagnostic criteria and was confirmed by an international expert panel. All patients who received at least one dose of study drug were included in assessments. This study is registered with ClinicalTrials.gov, number NCT00498186. 295 patients entered the open-label study, of whom 126 (43%) completed 5 years of follow-up. 169 (57%) patients discontinued treatment, 89 (30%) because of adverse events and 31 (11%) because of lack of efficacy. 70 patients (24%) discontinued during year 1 of maintenance. The most common adverse events were application site reactions, which occurred in 37% (106/290) of patients in year 1, 17% (38/220) of patients in year 2, 14% (27/191) of patients in year 3, and in less than 6% of patients during year 4 (8/159) and year 5 (8/147). 56 patients (19%) discontinued because of application site reactions. Mean rotigotine dose was 2·43 mg/24 h (SD 1·21) after initial titration and 3·09 mg/24 h (1·07) at the end of

Diagnostic standards for dopaminergic augmentation of restless legs syndrome: report from a World Association of Sleep Medicine-International Restless Legs Syndrome Study Group consensus conference at the Max Planck Institute.

PubMed

García-Borreguero, Diego; Allen, Richard P; Kohnen, Ralf; Högl, Birgit; Trenkwalder, Claudia; Oertel, Wolfgang; Hening, Wayne A; Paulus, Walter; Rye, David; Walters, Arthur; Winkelmann, Juliane; Earley, Christopher J

2007-08-01

Augmentation of symptom severity is the main complication of dopaminergic treatment of restless legs syndrome (RLS). The current article reports on the considerations of augmentation that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored Consensus Conference in April 2006 at the Max Planck Institute (MPI) in Munich, Germany, the conclusions of which were endorsed by the International RLS Study Group (IRLSSG) and the World Association of Sleep Medicine (WASM). The Consensus Conference sought to develop a better understanding of augmentation and generate a better operational definition for its clinical identification. Current concepts of the pathophysiology, clinical features, and therapy of RLS augmentation were evaluated by subgroups who presented a summary of their findings for general consideration and discussion. Recent data indicating sensitivity and specificity of augmentation features for identification of augmentation were also evaluated. The diagnostic criteria of augmentation developed at the National Institutes of Health (NIH) conference in 2002 were reviewed in light of current data and theoretical understanding of augmentation. The diagnostic value and criteria for each of the accepted features of augmentation were considered by the group. A consensus was then developed for a revised statement of the diagnostic criteria for augmentation. Five major diagnostic features of augmentation were identified: usual time of RLS symptom onset each day, number of body parts with RLS symptoms, latency to symptoms at rest, severity of the symptoms when they occur, and effects of dopaminergic medication on symptoms. The quantitative data available relating the time of RLS onset and the presence of other features indicated optimal augmentation criteria of either a 4-h advance in usual starting time for RLS symptoms or a combination of the occurrence of other features. A paradoxical response to changes in medication dose also indicates

Restless Leg Syndrome in Different Types of Demyelinating Neuropathies: A Single-Center Pilot Study

PubMed Central

Luigetti, Marco; Del Grande, Alessandra; Testani, Elisa; Bisogni, Giulia; Losurdo, Anna; Giannantoni, Nadia Mariagrazia; Mazza, Salvatore; Sabatelli, Mario; Della Marca, Giacomo

2013-01-01

Objective: to determine the prevalence of restless legs syndrome (RLS) in a cohort of patients with demyelinating neuropathies. Methods: Patients were retrospectively recruited from our cohort of different forms of demyelinating neuropathies, including chronic inflammatory demyelinating neuropathy (CIDP), Charcot-Marie-Tooth 1A (CMT1A), and hereditary neuropathy with liability to pressure palsies (HNPP) referred to our Department of Neurology in a 10-year period. The validated 4-item RLS questionnaire was used for diagnosis of RLS. All patients with RLS who fulfilled criteria underwent a suggested immobilization test to confirm the diagnosis. A group of outpatients referred to the sleep disorders unit and data from published literature were used as controls. Results: Prevalence of RLS in demyelinating neuropathy group was higher than prevalence observed in control population (p = 0.0142) or in the literature data (p = 0.0007). In particular, in comparison with both control population and literature data, prevalence of RLS was higher in CIDP group (p = 0.0266 and p = 0.0063, respectively) and in CMT1A group (p = 0.0312 and p = 0.0105, respectively), but not in HNPP (p = 1.000 and p = 0.9320, respectively). Conclusions: our study confirms a high prevalence of RLS in inflammatory neuropathies as CIDP and, among inherited neuropathies, in CMT1A but not in HNPP. Considering that this is only a small cohort from a single-center retrospective experience, the link between RLS and neuropathy remains uncertain, and larger multicenter studies are probably needed to clarify the real meaning of the association between RLS and neuropathy. Citation: Luigetti M; Del Grande A; Testani E; Bisogni G; Losurdo A; Giannantoni NM; Mazza S; Sabatelli M; Della Marca G. Restless leg syndrome in different types of demyelinating neuropathies: a single-center pilot study. J Clin Sleep Med 2013;9(9):945-949. PMID:23997707

Restless legs syndrome and pregnancy: prevalence, possible pathophysiological mechanisms and treatment

PubMed Central

Gupta, R.; Dhyani, M.; Kendzerska, T.; Pandi-Perumal, S. R.; BaHammam, A. S.; Srivanitchapoom, P.; Pandey, S.; Hallett, M.

2017-01-01

Restless legs syndrome (RLS) is a common sleep disorder that may be associated with pregnancy. Studies have found that the prevalence of RLS among pregnant women ranged from 10 to 34%. Typically, there is complete remission of symptoms soon after parturition; however, in some patients, they may continue postpartum. RLS has been shown to be associated with a number of complications in pregnancy including preeclampsia and increased incidence of Cesarean sections. Although multiple hypotheses have been proposed to explain this association, each individual hypothesis cannot completely explain the whole pathogenesis. Present understanding suggests that a strong family history, low serum iron and ferritin level, and high estrogen level during pregnancy might play important roles. Vitamin D deficiency and calcium metabolism may also play a role. Medical treatment of RLS during pregnancy is difficult and challenging considering the risks to mother and fetus. However, in some cases, the disease may be severe enough to require treatment. PMID:26482928

Pain, opioids, and sleep: implications for restless legs syndrome treatment.

PubMed

Trenkwalder, Claudia; Zieglgänsberger, Walter; Ahmedzai, Sam H; Högl, Birgit

2017-03-01

Opioid receptor agonists are known to relieve restless legs syndrome (RLS) symptoms, including both sensory and motor events, as well as improving sleep. The mechanisms of action of opioids in RLS are still a matter of speculation. The mechanisms by which endogenous opioids contribute to the pathophysiology of this polygenetic disorder, in which there are a number of variants, including developmental factors, remains unknown. A summary of the cellular mode of action of morphine and its (partial) antagonist naloxone via α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors and the involvement of dendritic spine activation is described. By targeting pain and its consequences, opioids are the first-line treatment in many diseases and conditions with both acute and chronic pain and have thus been used in both acute and chronic pain conditions over the last 40 years. Addiction, dependence, and tolerability of opioids show a wide variability interindividually, as the response to opioids is influenced by a complex combination of genetic, molecular, and phenotypic factors. Although several trials have now addressed opioid treatment in RLS, hyperalgesia as a complication of long-term opioid treatment, or opioid-opioid interaction have not received much attention so far. Therapeutic opioids may act not only on opioid receptors but also via histamine or N-methyl-d-aspartate (NMDA) receptors. In patients with RLS, one of the few studies investigating opioid bindings found that possible brain regions involved in the severity of RLS symptoms are similar to those known to be involved in chronic pain, such as the medial pain system (medial thalamus, amygdala, caudate nucleus, anterior cingulate gyrus, insular cortex, and orbitofrontal cortex). The results of this diprenorphine positron emission tomography study suggested that the more severe the RLS, the greater the release of endogenous opioids. Since 1993, when the first small controlled study was performed with

Restless Genital Syndrome Induced by Milnacipran.

PubMed

Miyake, Keita; Takaki, Manabu; Sakamoto, Shinji; Kawada, Kiyohiro; Inoue, Shinichiro; Yamada, Norihito

Restless genital syndrome (RGS) includes discomfort, pain, numbness, vibration, restlessness, or a burning sensation involving the vagina, perineum, pelvis, penis, and proximal portion of the lower limbs in patients. The RGS has been sometimes reported in Parkinson disease. In patients without Parkinson disease, RGS is also known as persistent genital arousal disorder (PSAS), which includes uncontrollable genital arousal, with or without orgasm or genital engorgement, unrelated to sexual desire. Although withdrawal from selective serotonin reuptake inhibitors antidepressants is reported to induce PSAS, there is no report of RGS or PSAS induced by antidepressants. We obtained the consent for the presentation and have not identified individuals for ethical reasons. We first report a woman patient with depression induced RGS by milnacipran (MLN). We discuss the relationship with restless legs syndrome and the difference from akathisia. It is highly possible MLN affected her RGS because she experienced RGS for the first time after the dose of MLN was increased. A limitation of this report is that we stopped MLN and administered gabapentin enacarbil immediately. We should join MLN to the list of compounds suspected of inducing RGS.

Prevalence and Characteristics of Periodic Limb Movements during Sleep in Korean Adult Patients with Restless Legs Syndrome

PubMed Central

Shin, Jung-won; Koo, Yong Seo; Lee, Byeong Uk; Shin, Won Chul; Lee, Sang Kun; Cho, Yong Won; Jung, Ki-Young

2016-01-01

Study Objectives: The aim of this study was to investigate the prevalence and characteristics of periodic limb movements during sleep (PLMS) in Korean patients with restless legs syndrome (RLS). Methods: Unmedicated adult patients with idiopathic RLS (n = 354) who underwent polysomnography at three major sleep centers in tertiary hospitals were included. Characteristics of PLMS in RLS were analyzed using the time structure of polysomnographically recorded leg movements and periodicity indices (PIs). RLS severity and subjective sleep quality were assessed. Results: Out of 354 patients with idiopathic RLS (mean age: 52.9 ± 12.0 years), 150 patients (42.3%) had RLS with a PLMS index greater than 15 events/h, and 204 (57.9%) had a PLMS index greater than 5 events/h. The distribution of inter-LM intervals was bimodal, and high PIs (0.86 ± 0.10) were observed in patients with RLS and PLMS (PLMS index > 15 events/h). The PLMS index was positively correlated with age (r = 0.228; p < 0.001), the periodic limb movements in wakefulness index (r = 0.455, p < 0.001) and arousal index (r = 0.174, p = 0.014), but not with RLS severity and parameters of sleep quality. In multivariate analysis, age and male gender were independently associated with PLMS > 15 events/h. Conclusions: The prevalence of PLMS in Korean patients with RLS was lower than that observed in Western countries, but the characteristics of PLMS were not different. Ethnic differences and/or different genetic backgrounds may contribute to the varying prevalence of PLMS in RLS. Citation: Shin JW, Koo YS, Lee BU, Shin WC, Lee SK, Cho YW, Jung KY. Prevalence and characteristics of periodic limb movements during sleep in Korean adult patients with restless legs syndrome. J Clin Sleep Med 2016;12(8):1089–1097. PMID:27306390

High Prevalence of Restless Legs Syndrome among Patients with Fibromyalgia: A Controlled Cross-Sectional Study

PubMed Central

Viola-Saltzman, Mari; Watson, Nathaniel F.; Bogart, Andy; Goldberg, Jack; Buchwald, Dedra

2010-01-01

Study Objectives: To investigate the prevalence of restless legs syndrome (RLS) in fibromyalgia (FM) and determine the presence and amount of sleep disruption in FM patients with RLS. RLS and FM have been associated in uncontrolled studies using a variety of RLS definitions. We explored this relationship using a cross-sectional study design. Methods: FM cases that met the American College of Rheumatology diagnostic criteria were recruited through an academic referral clinic and advertising. Pain- and fatigue-free controls were recruited from the Seattle metropolitan area. We enrolled 172 FM patients (mean age 50 years, 93% female) and 63 pain- and fatigue-free controls (mean age 41 years, 56% female). RLS was ascertained by a self-administered validated diagnostic interview. Results: The age- and gender-adjusted prevalence of RLS was higher in the FM group than the control group (33.0%; 95% CI: 25.9, 40.1 vs. 3.1%; 95% CI: 0.0, 7.4; p = 0.001). Likewise, the FM group was more likely to report RLS (OR = 11.7; 95% CI: 2.6, 53.0), even after adjusting for age and gender. The mean Pittsburgh Sleep Quality Index score was higher among FM patients with RLS than those without (11.8 vs. 9.9; p = 0.01) but subjective limb pain measures did not differ between these 2 groups. Conclusions: There is a higher prevalence and odds of RLS in those with FM compared to controls. Clinicians should routinely query FM patients regarding RLS symptoms because treatment of RLS can potentially improve sleep and quality of life in these patients. Citation: Viola-Saltzman M; Watson NF; Bogart A; Goldberg J; Buchwald D. High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study. J Clin Sleep Med 2010;6(5):423-427. PMID:20957840

[Paraesthesia in the legs].

PubMed

Eisensehr, Ilonka

2007-10-18

Paraesthesia in the legs can have numerous causes. In addition to the restless legs syndrome, other primary causes include venous insufficiency in the leg, propriospinal myoclonus, nocturnal leg cramps, peripheral polyneuropathy that affects mostly the legs or neuroleptic drug-induced akathisia. Through detailed questioning of the patient, restless legs syndrome can be specifically distinguished from the other named differential diagnoses.

Postural control in restless legs syndrome with medication intervention using pramipexole.

PubMed

Ahlgrén-Rimpiläinen, Aulikki; Lauerma, Hannu; Kähkönen, Seppo; Aalto, Heikki; Tuisku, Katinka; Holi, Matti; Pyykkö, Ilmari; Rimpiläinen, Ilpo

2014-02-01

Central dopamine regulation is involved in postural control and in the pathophysiology of restless legs syndrome (RLS) and Parkinson's disease (PD). Postural control abnormalities have been detected in PD, but there are no earlier studies with regard to RLS and postural control. Computerized force platform posturography was applied to measure the shift and the velocity (CPFV) of center point of forces (CPF) with eyes open (EO) and eyes closed (EC) in controls (n = 12) and prior and after a single day intervention with pramipexole in RLS subjects (n = 12). CPFV (EO) was significantly lower in the RLS group (p < 0.05) than in controls. After pramipexole intake, the difference disappeared and the subjective symptom severity diminished. Pramipexole did not significantly influence CPFV (EC) or CPF shift direction. Subjects with RLS used extensively visual mechanisms to control vestibule-spinal reflexes to improve or compensate the postural stability. Further research is needed to clarify altered feedback in the central nervous system and involvement of dopamine and vision in the postural control in RLS.

Restless Leg Syndrome and Sleep Quality in Lumbar Radiculopathy Patients

PubMed Central

Terzi, Murat; Akpinar, Kursad; Paksoy, Kemal; Cebeci, Ibrahim; Iyigun, Omer

2014-01-01

Background. To investigate the frequency of restless leg syndrome (RLS), sleep quality impairment, depression, fatigue, and sleep behavior disorder and to determine the effects of surgery on these parameters in radiculopathy patients resistant to conservative treatment. Methods. The present study included 66 lumbar radiculopathy patients, who were resistant to conservative treatment and had indication of surgery. Five different questionnaires were performed to assess depression (the Beck Depression Inventory (BDI)), sleep quality (the Pittsburgh Sleep Quality Index (PSQI)), fatigue (the Fatigue Severity Scale (FSS)), and presence of RLS and rapid eye movement sleep behavior disorder (RBD). The same questionnaires were also performed on a control group (n = 61). Results. Of the radiculopathy patients, 68.1% had RLS and 92.4% had fatigue. Of the controls, 16.4% had RLS and 59% had fatigue. RBD was present in 8 (12.1%) patients and 3 (4.9%) controls. The PSQI revealed that sleep quality was impaired in 46 (69.7%) patients and 35 (57.4%) controls (P > 0.05). The number of individuals having substantial depression according to the BDI was significantly higher in the patients than in the controls. Conclusions. There was a significant increase in the frequency of RLS, which was significantly decreased in the postoperative period in the radiculopathy patients. PMID:25110396

Restless legs syndrome is common among female patients with fibromyalgia.

PubMed

Stehlik, Romana; Arvidsson, Lennart; Ulfberg, Jan

2009-01-01

The prevalence of restless legs syndrome (RLS) among the general population is 2-15%, and with fibromyalgia syndrome (FMS) 2%. Both RLS and FMS are more common among women. The aim of our study was to evaluate the prevalence of RLS in a group of female patients diagnosed with FMS and to compare the occurrence of symptoms of daytime sleepiness and experienced sleep disorders between fibromyalgia patients with or without RLS. Three hundred and thirty-two female patients, 20-60 years old, diagnosed with FMS at Skonviks Rehab between 2002 and 2006, answered a questionnaire mailed to their home address. The questionnaire consisted of the international RLS study group criteria as well as of questions concerning symptoms of insomnia and daytime sleepiness measured according to the Epworth Sleepiness Scale. Nearly 64% of the women were also suffering from RLS. More patients suffering from both RLS and FMS were affected by problems of initiating and maintaining sleep than those suffering from FMS only. More patients suffering from both RLS and FMS did not feel refreshed on awakening compared with those suffering from FMS without RLS. The patients with concomitant RLS and FMS were more often hypersomnolent than those suffering from FMS only. This study shows that 64% of a group of female patients diagnosed with fibromyalgia also concurrently suffered from RLS. Compared with patients who suffer from FMS only, patients with both FMS and RLS more often experience sleep disturbances and pronounced daytime sleepiness. 2008 S. Karger AG, Basel.

Quantitative rest activity in ambulatory monitoring as a physiological marker of restless legs syndrome: a controlled study.

PubMed

Tuisku, Katinka; Holi, Matti Mikael; Wahlbeck, Kristian; Ahlgren, Aulikki Johanna; Lauerma, Hannu

2003-04-01

An objective marker of restless legs syndrome (RLS) is needed for developing diagnostic tools and monitoring symptoms. Actometric ambulatory monitoring of 15 RLS patients and 15 healthy controls was undertaken in order to differentiate between RLS-related motor symptoms and normal motor activity. Nocturnal lower-limb activity per minute differentiated and discriminated between groups with no overlap, whereas the periodic limb movement index and the controlled rest activity during sitting showed less discriminative power. The naturalistic recording of nocturnal activity by actometry may prove useful for assessing the severity of RLS and for finding an objective marker to support the diagnosis of RLS. Copyright 2002 Movement Disorder Society

Comorbidities, medications and depressive symptoms in patients with restless legs syndrome and migraine.

PubMed

Ferreira, Karen S; Eckeli, Alan; Dach, Fabíola; Speciali, José G

2013-02-01

The pathophysiology of migraine and restless legs syndrome (RLS) seems to involve inherited mechanism and dysfunction of the dopaminergic system. Previous articles have shown that the frequency of RLS is higher in migraine patients than in controls. We conducted a study to evaluate comorbidities, medication used and depressive symptoms that can explain the relation between migraine and RLS. A case-control study was performed in which patients with migraine (n=72) and a control group without migraine (n=72) were interviewed. Data including RLS diagnosis, depressive symptoms, comorbidities and drugs used were evaluated. There was a significant association between migraine and RLS (p=0.01), but comorbidities such as diabetes, hypertension, anemia and drugs used did not explain this association. Depression scores, as measured by the Beck Depression Inventory, were higher in migraine patients with RLS (p =0.04). No specific factors explaining the association between migraine and RLS were found. Symptoms of depression were more frequent in patients with migraine and RLS.

[Clinical features of idiopathic restless legs syndrome in Japanese patients].

PubMed

Kume, Akito; Kume, Hideaki

2010-06-01

Little is known about the diagnosis and management of restless legs syndrome (RLS) in Japanese neurology clinics. To validate the diagnostic criteria of the International RLS Study Group (IRLSSG) and the treatment algorithm of the Mayo Clinic in a Japanese neurology clinic setting and to clarify the features of Japanese patients with idiopathic RLS. Patients with RLS symptoms were examined by a neurologist and the assessment included neurological examination, tests for periodic limb movements (PLM) and dopaminergic response, and the clinical diagnosis was made according to IRLSSG diagnostic criteria. Patients diagnosed with idiopathic RLS were treated with dopaminergic agents and the efficacy was evaluated. The study subjects were 151 Japanese patients who presented with RLS symptoms. Idiopathic RLS was diagnosed in 113 patients, secondary RLS in 16 and RLS mimics in 22. The cause of RLS mimics was either myelopathy, radiculopathy or neuropathy in 11 patients. The mean age of patients with idiopathic RLS was 50.1 (SD 20.0) years, 63% were woman, 97% had daily RLS, 31% had family history (40% of the early-onset subgroup), 86% reported unpleasant sensations in the lower legs, 43% had PLM in the daytime suggested immobilization test, 81% suffered from insomnia, 49% had limitations of work and activities, 71% reported impaired mood, 27% had consulted physicians about their symptoms, 4% had been diagnosed with RLS, 73% improved after dopaminergic treatments, and 33% experienced complete remission. The clinical features of Japanese patients with idiopathic RLS were identical to those reported in western countries, which suggests that IRLSSG diagnostic criteria and Mayo Clinic treatment algorism are valid in Japanese neurology clinics. Both patients and physicians were not fully aware of RLS in this country. Neurological examination was important in excluding RLS mimics and making a diagnosis of RLS.

Multicenter Case-Control Study on Restless Legs Syndrome in Multiple Sclerosis: the REMS Study

PubMed Central

Manconi, Mauro; Ferini-Strambi, Luigi; Filippi, Massimo; Bonanni, Enrica; Iudice, Alfonso; Murri, Luigi; Gigli, Gian Luigi; Fratticci, Lara; Merlino, Giovanni; Terzano, Giovanni; Granella, Franco; Parrino, Liborio; Silvestri, Rosalia; Aricò, Irene; Dattola, Vincenzo; Russo, Giovanna; Luongo, Carmela; Cicolin, Alessandro; Tribolo, Antonella; Cavalla, Paola; Savarese, Mariantonietta; Trojano, Maria; Ottaviano, Salvatore; Cirignotta, Fabio; Simioni, Valentina; Salvi, Fabrizio; Mondino, Fiorella; Perla, Franco; Chinaglia, Giorgia; Zuliani, Cristina; Cesnik, Edward; Granieri, Enrico; Placidi, Fabio; Palmieri, Maria Giuseppina; Manni, Raffaele; Terzaghi, Michele; Bergamaschi, Roberto; Rocchi, Raffaele; Ulivelli, Monica; Bartalini, Sabina; Ferri, Raffaele; Fermo, Salvatore Lo; Ubiali, Emilio; Viscardi, Massimo; Rottoli, Mariarosa; Nobili, Lino; Protti, Alessandra; Ferrillo, Franco; Allena, Marta; Mancardi, Gianluigi; Guarnieri, Biancamaria; Londrillo, Francesco

2008-01-01

Study objectives: To verify the existence of a symptomatic form of restless legs syndrome (RLS) secondary to multiple sclerosis (MS) and to identify possible associated risk factors. Design: Prospective, multicenter, case-control epidemiologic survey. Settings: Twenty sleep centers certified by the Italian Association of Sleep Medicine. Patients: Eight hundred and sixty-one patients affected by MS and 649 control subjects. Interventions: N/A. Measures and results: Data regarding demographic and clinical factors, presence and severity of RLS, the results of hematologic tests, and visual analysis of cerebrospinal magnetic resonance imaging studies were collected. The prevalence of RLS was 19% in MS and 4.2% in control subjects, with a risk to be affected by RLS of 5.4 (95%confidence interval: 3.56–8.26) times greater for patients with MS than for control subjects. In patients with MS, the following risk factors for RLS were significant: older age; longer MS duration; the primary progressive MS form; higher global, pyramidal, and sensory disability; and the presence of leg jerks before sleep onset. Patients with MS and RLS more often had sleep complaints and a higher intake of hypnotic medications than patients with MS without RLS. RLS associated with MS was more severe than that of control subjects. Conclusions: RLS is significantly associated with MS, especially in patients with severe pyramidal and sensory disability. These results strengthen the idea that the inflammatory damage correlated with MS may induce a secondary form of RLS. As it does in idiopathic cases, RLS has a significant impact on sleep quality in patients with MS; therefore, it should be always searched for, particularly in the presence of insomnia unresponsive to treatment with common hypnotic drugs. Citation: Manconi M; Ferini-Strambi L; Filippi M; Bonanni E; Iudice A; Murri L; Gigli GL; Fratticci L; Merlino G; Terzano G; Granella F; Parrino L; Silvestri R; Aricò I; Dattola V; Russo G; Luongo

Efficacy of vitamins C, E, and their combination for treatment of restless legs syndrome in hemodialysis patients: a randomized, double-blind, placebo-controlled trial.

PubMed

Sagheb, Mohammad Mahdi; Dormanesh, Banafshe; Fallahzadeh, Mohammad Kazem; Akbari, Hamideh; Sohrabi Nazari, Sahar; Heydari, Seyed Taghi; Behzadi, Saeed

2012-05-01

Restless legs syndrome (RLS) is a common disorder in hemodialysis patients that leads to insomnia and impaired quality of life. Because high oxidative stress has been implicated in the pathogenesis of RLS, we sought to evaluate the efficacy of vitamins C and E and their combination in reducing the severity of RLS symptoms in hemodialysis patients in this randomized, double-blind, placebo-controlled, four-arm parallel trial. Sixty stable hemodialysis patients who had all four diagnostic criteria for RLS developed by the International Restless Legs Syndrome Group with no acute illness or history of renal stone were randomly allocated to four fifteen-patient parallel groups to receive vitamin C (200 mg) and vitamin E (400 mg), vitamin C (200 mg) and placebo, vitamin E (400 mg) and placebo, and double placebo daily for eight weeks. International Restless Legs Scale (IRLS) scores were measured for all patients at baseline and at the end of treatment phase. The primary outcome was absolute change in IRLS sum score from baseline to the end of treatment phase. Means of IRLS sum score decreased significantly in the vitamins C and E (10.3 ± 5.3, 95% CI: 7.4-13.3), vitamin C and placebo (10 ± 3.5, 95% CI: 8.1-11.9), and vitamin E and placebo groups (10.1 ± 6, 95% CI: 6.8-13.5) compared with the double placebo group (3.1 ± 3, 95% CI: 1.5-4.8), (P<0.001); however, no differences were observed between these treatment groups. Vitamins C and E and their combination are safe and effective treatments for reducing the severity of RLS in hemodialysis patients over the short-term. Copyright © 2012 Elsevier B.V. All rights reserved.

Iron and restless legs syndrome: Treatment, genetics and pathophysiology

PubMed Central

Connor, James R.; Patton, Stephanie; Oexle, Konrad; Allen, Richard

2017-01-01

In this article, we review the original findings from MRI and autopsy studies that demonstrated brain iron status is insufficient in individuals with restless legs syndrome (RLS). The concept of deficient brain iron status is supported by proteomic studies from cerebrospinal fluid (CSF) and from the clinical findings where intervention with iron, either dietary or intravenous, can improve RLS symptoms. Therefore, we include a section on peripheral iron status and how peripheral status may influence both the RLS symptoms and treatment strategy. Given the impact of iron in RLS, we have evaluated genetic data to determine if genes are directly involved in iron regulatory pathways. The result was negative. In fact, even the HFE mutation C282Y could not be shown to have a protective effect. Lastly, a consistent finding in conditions of low iron is increased expression of proteins in the hypoxia pathway. Although there is lack of clinical data that RLS patients are hypoxic, there are intriguing observations that environmental hypoxic conditions worsen RLS symptoms; in this chapter we review very compelling data for activation of hypoxic pathways in the brain in RLS patients. In general, the data in RLS point to a pathophysiology that involves decreased acquisition of iron by cells in the brain. Whether the decreased ability is genetically driven, activation of pathways (eg, hypoxia) that are designed to limit cellular uptake is unknown at this time; however, the data strongly support a functional rather than structural defect in RLS, suggesting that an effective treatment is possible. PMID:28057495

Comorbidity in restless legs syndrome among a sample of Swedish adults.

PubMed

Ulfberg, Jan; Bjorvatn, Björn; Leissner, Lena; Gyring, Jens; Karlsborg, Merete; Regeur, Lisbeth; Skeidsvoll, Håvard; Polo, Olli; Partinen, Markku

2007-11-01

Restless legs syndrome (RLS) is a neurological movement disorder, which often causes sleep problems. However, the comorbidity of this disorder is not well known. This study aimed to document the prevalence of RLS in the general population of Sweden and to identify factors associated with this condition. A cross-sectional study was performed in Sweden. One thousand subjects aged 18-90 years old underwent telephone interviews. The questionnaire assessed such factors as sleep variables, depressive mood, treatment of diabetes mellitus, and treatment with drugs for depression during the previous four-week period. RLS was diagnosed based on the minimal criteria provided by the International RLS Study Group. The prevalence of RLS was 5% (5.7% in women, 3.5% in men). Severe or very severe RLS symptoms during the previous week were noted by 64% of the RLS subjects. Factors associated with RLS were insomnia, excessive daytime sleepiness, periodic limb movements in sleep, and depressed mood. Those affected by RLS were not more often consumers of drugs for depression than non-RLS subjects. RLS is prevalent in the general population in Sweden. RLS negatively influenced sleep and was associated with depressed mood. Antidepressive drug treatment was not associated with RLS.

Susceptible genes of restless legs syndrome in migraine.

PubMed

Fuh, Jong-Ling; Chung, Ming-Yi; Yao, Shu-Chih; Chen, Ping-Kun; Liao, Yi-Chu; Hsu, Chia-Lin; Wang, Po-Jen; Wang, Yen-Feng; Chen, Shih-Pin; Fann, Cathy S-J; Kao, Lung-Sen; Wang, Shuu-Jiun

2016-10-01

Objective Several genetic variants have been found to increase the risk of restless legs syndrome (RLS). The aim of the present study was to determine if these genetic variants were also associated with the comorbidity of RLS and migraine in patients. Methods Thirteen single-nucleotide polymorphisms (SNPs) at six RLS risk loci ( MEIS1, BTBD9, MAP2K5, PTPRD, TOX3, and an intergenic region on chromosome 2p14) were genotyped in 211 migraine patients with RLS and 781 migraine patients without RLS. Association analyses were performed for the overall cohort, as well as for the subgroups of patients who experienced migraines with and without aura and episodic migraines (EMs) vs. chronic migraines (CMs). In order to verify which genetic markers were potentially related to the incidence of RLS in migraine patients, multivariate regression analyses were also performed. Results Among the six tested loci, only MEIS1 was significantly associated with RLS. The most significant SNP of MEIS1, rs2300478, increased the risk of RLS by 1.42-fold in the overall cohort ( p = 0.0047). In the subgroup analyses, MEIS1 augmented the risk of RLS only in the patients who experienced EMs (odds ratio (OR) = 1.99, p = 0.0004) and not those experiencing CMs. Multivariate regression analyses further showed that rs2300478 in MEIS1 (OR = 1.39, p = 0.018), a CM diagnosis (OR = 1.52, p = 0.022), and depression (OR = 1.86, p = 0.005) were independent predictors of RLS in migraine. Conclusions MEIS1 variants were associated with an increased risk of RLS in migraine patients. It is possible that an imbalance in iron homeostasis and the dopaminergic system may represent a link between RLS incidence and migraines.

Restless legs syndrome, pica, and iron status in blood donors.

PubMed

Spencer, Bryan R; Kleinman, Steven; Wright, David J; Glynn, Simone A; Rye, David B; Kiss, Joseph E; Mast, Alan E; Cable, Ritchard G

2013-08-01

The association of blood donation-related iron deficiency with pica or restless legs syndrome (RLS) remains poorly elucidated. This study evaluated the prevalence of RLS and pica in blood donors completing the REDS-II Iron Status Evaluation (RISE) study. RISE enrolled 2425 blood donors in a prospective cohort study; 1334 donors provided blood samples to characterize iron status and answered a questionnaire inquiring into symptoms of RLS and pica at a final visit after 15 to 24 months of follow-up. Associations between both conditions and iron status were evaluated. There were 9 and 20% of donors reporting symptoms of probable or probable/possible RLS, respectively. Iron depletion and donation intensity were not predictive of RLS. Pica was reported by 65 donors (5.5%), half of whom reported daily cravings. Prevalence of pica increased with degree of iron depletion in women (2% in iron-replete females, 13% in those with ferritin < 12 ng/mL), but not in men. Probable RLS and pica coexpressed in eight individuals, but no more frequently than expected by chance. RLS and pica have been associated with iron deficiency in nondonor populations. This study indicates a potentially high prevalence of RLS in frequent blood donors but shows no association with iron status or donation intensity. Low iron stores were associated with higher prevalence of pica, but only in females. Furthermore, the results are incompatible with RLS and pica sharing a common pathophysiology. © 2013 American Association of Blood Banks.

Augmentation in the treatment of restless legs syndrome with transdermal rotigotine.

PubMed

Beneš, Heike; García-Borreguero, Diego; Ferini-Strambi, Luigi; Schollmayer, Erwin; Fichtner, Andreas; Kohnen, Ralf

2012-06-01

To assess the risk of augmentation under treatment with the transdermally delivered dopamine agonist rotigotine for restless legs syndrome (RLS). Experts in RLS augmentation retrospectively reviewed data from two double-blind, placebo-controlled 6-month trials (745 rotigotine and 214 placebo subjects, NCT00136045 and NCT00135993) and from two open-label 1-year trials (620 rotigotine subjects, NCT00498108 and NCT00263068). All study visits were systematically evaluated applying the Max Planck Institute (MPI) criteria for the diagnosis of both augmentation and clinically relevant augmentation. MPI criteria for augmentation were met on at least one visit by 8.2% of all subjects in the double-blind trials with 12 subjects meeting the criteria for clinically relevant augmentation: 11 under rotigotine (1.5%) and one under placebo treatment. In the open-label trials, 9.7% of all subjects met the MPI criteria for augmentation and 2.9% met the criteria for clinically relevant augmentation. None of the patients treated with rotigotine for up to 1.5 years (double-blind plus open-label trial) discontinued prematurely owing to augmentation. Neither could dose-dependency or a time pattern for clinically relevant augmentation episodes be detected. Our analyses suggest that the risk for clinically relevant augmentation for the duration of up to 18 months of rotigotine treatment is low. Copyright © 2012 Elsevier B.V. All rights reserved.

A method to switch from oral dopamine agonists to rotigotine in patients with restless legs syndrome and mild augmentation.

PubMed

Winkelman, John W; Mackie, Susan E; Mei, Leslie A; Platt, Samuel; Schoerning, Laura

2016-08-01

We examined the short- and long-term efficacy and tolerability of a cross-titration algorithm from oral dopamine agonists to the rotigotine transdermal patch in patients dissatisfied with their restless legs syndrome (RLS) treatment, predominantly with mild augmentation. Patients with RLS (n = 20) were recruited at a single site. The cross-titration consisted of decreasing oral dopaminergic agents (ropinirole by 1 mg or pramipexole by 0.25 mg) and increasing rotigotine by 1 mg every two days. Efficacy and adverse events (AEs) were assessed at one, three, six and 12 months after the switch. Patients had moderate-severe RLS symptoms at the baseline (mean international restless legs syndrome (IRLS) score 19.4 ± 5.5); 85% had augmentation and 45% reported afternoon RLS symptoms. The baseline mean pramipexole equivalent dose was 0.6 ± 0.3 mg. At Week 5, 85% (17/20) had successfully switched from their oral dopamine agonist to rotigotine (mean dose 2.5 ± 0.6 mg; change in IRLS score: -6.7 ± 8.4, p = 0.002); 14 patients were CGI-I responders (much or very much improved). Three patients withdrew due to lack of efficacy. Twelve months after cross-titration, 10 patients continued on rotigotine, of whom four required either higher doses of rotigotine or supplemental RLS medication compared with their optimal Week 5 dose; five patients withdrew due to AEs and two due to lack of efficacy. A cross-titration to rotigotine was efficacious after five weeks in 70% of patients dissatisfied with RLS treatment, most of whom had mild augmentation. At one year following the medication switch, 50% had discontinued rotigotine due to lack of continued efficacy or side effects. Copyright © 2016 Elsevier B.V. All rights reserved.

Efficacy and safety of rotigotine in Japanese patients with restless legs syndrome: a phase 3, multicenter, randomized, placebo-controlled, double-blind, parallel-group study.

PubMed

Inoue, Yuichi; Shimizu, Tetsuo; Hirata, Koichi; Uchimura, Naohisa; Ishigooka, Jun; Oka, Yasunori; Ikeda, Junji; Tomida, Takayuki; Hattori, Nobutaka

2013-11-01

We aimed to ascertain the efficacy and safety of transdermal rotigotine (2 and 3mg/24h) in Japanese patients with restless legs syndrome (RLS). In our double-blind placebo-controlled study, 284 Japanese patients with idiopathic RLS were randomly assigned to receive rotigotine 2mg/24h or 3mg/24h, or placebo, for 13 weeks. The primary endpoint was the change in International Restless Legs Syndrome Study Group rating scale (IRLS) total score. The placebo-subtracted decreases in IRLS total score for rotigotine 2 mg/24 h and 3 mg/24 h were -2.8±1.3 and -3.1±1.3, respectively, which were significant (P<0.05). The interaction between baseline Pittsburgh Sleep Quality Index (PSQI) and treatment group for the change in IRLS total score was significant, indicating greater improvements in IRLS total score in patients with severe insomnia. Overall, 80.0%, 86.2%, and 51.6% of patients in the rotigotine 2 mg/24 h, 3 mg/24 h, and placebo groups, respectively, experienced adverse events (AEs) including application site reactions in 42.1%, 50.0%, and 7.4% of patients, respectively. None of the AEs were severe. Our results showed that rotigotine was effective without major safety concerns at doses of up to 3 mg/24 h in Japanese patients with RLS. Copyright © 2013 Elsevier B.V. All rights reserved.

Restless Legs Syndrome, pica, and iron status in blood donors

PubMed Central

Spencer, Bryan R.; Kleinman, Steven; Wright, David J.; Glynn, Simone A.; Rye, David B.; Kiss, Joseph E.; Mast, Alan E.; Cable, Ritchard G.

2014-01-01

BACKGROUND The association of blood donation related iron deficiency with pica or Restless Leg Syndrome (RLS) remains poorly elucidated. This study evaluated the prevalence of RLS and pica in blood donors completing the REDS-II Iron Status Evaluation (RISE) Study. STUDY DESIGN AND METHODS RISE enrolled 2425 blood donors in a prospective cohort study; 1334 donors provided blood samples to characterize iron status and answered a questionnaire inquiring into symptoms of RLS and pica at a final visit after 15–24 months of follow-up. Associations between both conditions and iron status were evaluated. RESULTS There were 9% and 20% of donors reporting symptoms of Probable or Probable/Possible RLS, respectively. Iron depletion and donation intensity were not predictive of RLS. Pica was reported by 65 donors (5.5%), half of whom reported daily cravings. Prevalence of pica increased with degree of iron depletion in women (2% in iron replete females, 13% in those with ferritin < 12ng/mL), but not in men. Probable RLS and pica co-expressed in 8 individuals, but no more frequently than expected by chance. CONCLUSION RLS and pica have been associated with iron deficiency in non-donor populations. This study indicates a potentially high prevalence of RLS in frequent blood donors but shows no association with iron status or donation intensity. Low iron stores were associated with higher prevalence of pica, but only in females. Furthermore, the results are incompatible with RLS and pica sharing a common pathophysiology. PMID:23763445

Practice guideline summary: Treatment of restless legs syndrome in adults

PubMed Central

Winkelman, John W.; Armstrong, Melissa J.; Allen, Richard P.; Chaudhuri, K. Ray; Ondo, William; Trenkwalder, Claudia; Zee, Phyllis C.; Gronseth, Gary S.; Gloss, David; Zesiewicz, Theresa

2016-01-01

Objective: To make evidence-based recommendations regarding restless legs syndrome (RLS) management in adults. Methods: Articles were classified per the 2004 American Academy of Neurology evidence rating scheme. Recommendations were tied to evidence strength. Results and recommendations: In moderate to severe primary RLS, clinicians should consider prescribing medication to reduce RLS symptoms. Strong evidence supports pramipexole, rotigotine, cabergoline, and gabapentin enacarbil use (Level A); moderate evidence supports ropinirole, pregabalin, and IV ferric carboxymaltose use (Level B). Clinicians may consider prescribing levodopa (Level C). Few head-to-head comparisons exist to suggest agents preferentially. Cabergoline is rarely used (cardiac valvulopathy risks). Augmentation risks with dopaminergic agents should be considered. When treating periodic limb movements of sleep, clinicians should consider prescribing ropinirole (Level A) or pramipexole, rotigotine, cabergoline, or pregabalin (Level B). For subjective sleep measures, clinicians should consider prescribing cabergoline or gabapentin enacarbil (Level A), or ropinirole, pramipexole, rotigotine, or pregabalin (Level B). For patients failing other treatments for RLS symptoms, clinicians may consider prescribing prolonged-release oxycodone/naloxone where available (Level C). In patients with RLS with ferritin ≤75 μg/L, clinicians should consider prescribing ferrous sulfate with vitamin C (Level B). When nonpharmacologic approaches are desired, clinicians should consider prescribing pneumatic compression (Level B) and may consider prescribing near-infrared spectroscopy or transcranial magnetic stimulation (Level C). Clinicians may consider prescribing vibrating pads to improve subjective sleep (Level C). In patients on hemodialysis with secondary RLS, clinicians should consider prescribing vitamin C and E supplementation (Level B) and may consider prescribing ropinirole, levodopa, or exercise (Level C

High-Resolution Nerve Ultrasound and Electrophysiological Findings in Restless Legs Syndrome.

PubMed

Pitarokoili, K; Fels, M; Kerasnoudis, A; Toenges, L; Gold, R; Yoon, M-S

2018-05-11

Restless legs syndrome (RLS) is a multifactorial network disorder of a sensorimotor system extending from dopaminergic and glutamatergic cerebral structures to the spinal neurons and peripheral nerves. The role of peripheral nerve damage in the causality and severity progression for RLS patients remains unclear. We performed a clinical and epidemiological study on a cohort of 34 RLS patients focusing on RLS risk factors and disease severity. We investigated the peripheral nerves with nerve conduction studies and with high-resolution nerve ultrasound (HRUS). In 18 of the 34 patients (mean age 67.4 ± 15 years old), a sensorimotor axonal neuropathy was diagnosed. These patients presented with late-onset RLS were treated with membrane stabilizing agents, whereas no neuropathy predisposing comorbidity could be identified for the majority of them. We could show an inverse correlation between the amplitudes of the tibial nerve for the patients with polyneuropathy and the RLS severity index. Neuropathy patients were characterized by an increase of the cross-sectional area (CSA) of the tibial nerve in the popliteal fossa and by increased intranerve and internerve variability values showing an asymmetry of CSA distribution. This pattern resembles previous studies on diabetic neuropathy. Early diagnosis, characterization, and treatment of neuropathy are increasingly relevant for RLS patients as it correlates with disease severity. HRUS revealed a pattern resembling diabetic neuropathy, which implies a similar pathophysiology with metabolic and ischemic origin of RLS-related axonal neuropathy. Copyright © 2018 by the American Society of Neuroimaging.

Accompanying migrainous features in pediatric migraine patients with restless legs syndrome.

PubMed

Sevindik, Melis Sohtaoğlu; Demirci, Seden; Göksan, Baki; Özge, Aynur; Savrun, Feray Karaali; Onur, Hatice; Yıldırım, Veli; Simsek, Ismail; Ozhan, Harika; Uludüz, Derya

2017-09-01

The present study aimed to examine the frequency of restless legs syndrome (RLS) in pediatric patients with migraine and tension-type headache (TTH) and to investigate accompanying migrainous symptoms, sleep characteristics, as well as levels of serum ferritin between the pediatric migraine patients with RLS and those without RLS. We included 65 consecutive patients diagnosed with migraine, 20 patients with TTH, and 97 headache-free children in our study. Demographic, clinical, and laboratory data were noted. The presence of a primary headache was diagnosed using the ICHD-II criteria, and RLS was determined with face-to-face interviews conducted by an experienced neurologist based on the revised International RLS Study Group criteria for pediatrics. The frequency of RLS in pediatric migraine and TTH patients was significantly higher than in the controls (p = 0.0001 and p = 0.025, respectively). The frequencies of allodynia, vertigo/dizziness, and self-reported frequent arousals were significantly higher, and serum ferritin levels were significantly lower in migraine patients with RLS compared to those without RLS (p = 0.05, p = 0.028, p = 0.02, and p = 0.038, respectively). Our study suggests that the frequency of RLS is higher in pediatric migraine and TTH patients compared to controls. Therefore, pediatric headache patients should be questioned about the presence of RLS, as this co-occurrence may lead to more frequent accompanying migrainous symptoms and sleep disturbances.

Clinical pharmacology and efficacy of rotigotine (Neupro® patch) in the treatment of restless leg syndrome.

PubMed

Ferini-Strambi, Luigi; Marelli, Sara; Galbiati, Andrea

2016-08-01

Restless legs syndrome/Willis Ekbom disease (RLS/WED) is a sensorimotor disorder characterized by unpleasant sensations in the legs accompanied by an urge to move them, that typically occurs and tend to worsen in the evening/night or during period of inactivity. Standard medications for RLS/WED are dopamine agonists and calcium channel α-2-δ ligands. The clinical spectrum of RLS/WED is very broad, ranging from individuals suffering from the disease during limited periods up to those severely affected, with daily symptoms. In such cases a long-acting drug like rotigotine should be considered. The clinical pharmacology and efficacy of rotigotine was examined to evaluate the evidence supporting its use in RLS/WED. The rotigotine transdermal patch provides constant delivery of the drug, maintaining a stable plasma concentration over 24 hours by means of a single daily application. Several randomized, double-blind, placebo-controlled trials have demonstrated the efficacy of rotigotine in improving moderate-to-severe RLS/WED symptoms. Rotigotine is generally well tolerated. The most common adverse effects were application-site reactions, dose-dependent, more frequently reported in the first period of treatment. Incidence of augmentation in RLS/WED patients treated with oral dopamine agonists is higher when compared with the use of transdermal rotigotine.

Impact of Short Daily Hemodialysis on Restless Legs Symptoms and Sleep Disturbances

PubMed Central

Schiller, Brigitte; Burkart, John M.; Daoui, Rachid; Kraus, Michael A.; Lee, Yoojin; Miller, Brent W.; Teitelbaum, Isaac; Williams, Amy W.; Finkelstein, Fredric O.

2011-01-01

Summary Background and objectives Restless legs syndrome (RLS) and sleep disturbances are common among in-center hemodialysis patients and are associated with increased morbidity/mortality. Design, setting, participants, & measurements The FREEDOM study is an ongoing prospective cohort study investigating the benefits of home short daily hemodialysis (SDHD) (6 times/week). In this interim report, we examine the long-term effect of SDHD on the prevalence and severity of RLS, as measured by the International Restless Legs Syndrome (IRLS) Study Group rating scale, and sleep disturbances, as measured by the Medical Outcomes Study sleep survey. Results 235 participants were included in this report (intention-to-treat cohort), of which 127 completed the 12-month follow-up (per-protocol cohort). Mean age was 52 years, 55% had an arteriovenous fistula, and 40% suffered from RLS. In the per-protocol analysis, among patients with RLS, the mean IRLS score improved significantly at month 12, after adjustment for use of RLS-related medications (18 versus 11). Among patients with moderate-to-severe RLS (IRLS score ≥15), there was an even greater improvement in the IRLS score (23 versus 13). The intention-to-treat analysis yielded similar results. Over 12 months, there was decline in the percentage of patients reporting RLS (35% versus 26%) and those reporting moderate-to-severe RLS (59% versus 43%). There was a similar and sustained 12-month improvement in several scales of the sleep survey, after adjustment for presence of RLS and use of anxiolytics and hypnotics. Conclusions Home SDHD is associated with long-term improvement in the prevalence and severity of RLS and sleep disturbances. PMID:21415315

Increased Risk of Restless Legs Syndrome in Patients With Migraine

PubMed Central

Yang, Fu-Chi; Lin, Te-Yu; Chen, Hsuan-Ju; Lee, Jiunn-Tay; Lin, Chun-Chieh; Huang, Wen-Yen; Chen, Hsin-Hung; Kao, Chia-Hung

2016-01-01

Abstract Previous studies suggest that an association between restless legs syndrome (RLS) and migraine exists. However, population-based data are unavailable in Asian cohorts. Our study thus aims to evaluate the association between migraine and RLS in a nationwide, population-based cohort in Taiwan and to examine the effects of age, sex, migraine subtype, and comorbidities on RLS development. Data from the Taiwan National Health Insurance Research Database were used. Patients aged 20 years or older with newly diagnosed migraine from 2000 to 2008 were included; 23,641 patients with newly diagnosed migraine and 94,564 subjects without migraine were randomly selected and followed until RLS development, withdrawal from the National Health Insurance, or until the end of 2011. A multivariate Cox proportional hazards regression model was used to explore the risk of RLS in patients with migraine after adjustment for demographic characteristics and comorbidities. Both cohorts were followed for a mean of 7.38 years. After adjustment for covariates, the risk of RLS was 1.42-fold higher (95% confidence interval = 1.13–1.79) in the migraine cohort than in the nonmigraine cohort (7.19 versus 3.42 years per 10,000 person-years). The increased risk was more prominent in males in the migraine cohort (1.87-fold increased risk, 95% confidence interval 1.22–2.85). Neither comorbidity status nor migraine subtype influenced the RLS risk. This population-based study demonstrated that migraine is associated with an increased risk of RLS compared with those without migraine, particularly in male patients with migraine and regardless of the comorbidity status. PMID:26844484

Restless Legs Syndrome in Patients with Hypertension and Diabetes Mellitus.

PubMed

Sabic, Adela; Sinanovic, Osman; Sabic, Dzevad; Galic, Gordan

2016-04-01

The aim of this study was to analyze frequency of restless legs syndrome (RLS) in patients with hypertension and diabetes mellitus. It was analyzed 120 subjects (from Health Center Živinice/Family Medicine Department) through a survey conducted in the period from March to June 2015, of which 30 (8 men/22 women). Subjects were 30 patients with longtime hypertension (HT)(18 men/12 women), 30 patients with diabetes mellitus (DM) type I or II (9 men/21 women), 30 patients with long standing DM type I or II and HT (12 men /18 women), and 30 control subjects (12 men/18 women). RLS were evaluated by questionnaire - International RLS Study Group Criteria. The average age of patients in the group with HT was 58.70 ± 9.07, in the group with DM 48.43 ± 15.37, and in the group of patients with HT and DM 63.90 ± 7.49 years. In the control group mean age was 52.76 ± 14.83 years. Statistical data were analyzed in Excel and SSPS statistical program. RLS was identified in 10 (30%) of those with HT; 7 (21%) in patients with DM, and 10 (30%) in patients with HT+DM. In the control group RLS was verified in 4 (12%) patients. Comparing the results, it was observed significant difference between the HT and the control group (p=0.0012) and HT+ DM and control group (p=0.0012). The frequency of RLS between DM and the control group was not significantly significant (p=0.107). RLS is frequent in patients with hypertension (30%), hypertension+ diabetes mellitus (30%), and patients with DM (21%).

Restless legs syndrome-associated intronic common variant in Meis1 alters enhancer function in the developing telencephalon.

PubMed

Spieler, Derek; Kaffe, Maria; Knauf, Franziska; Bessa, José; Tena, Juan J; Giesert, Florian; Schormair, Barbara; Tilch, Erik; Lee, Heekyoung; Horsch, Marion; Czamara, Darina; Karbalai, Nazanin; von Toerne, Christine; Waldenberger, Melanie; Gieger, Christian; Lichtner, Peter; Claussnitzer, Melina; Naumann, Ronald; Müller-Myhsok, Bertram; Torres, Miguel; Garrett, Lillian; Rozman, Jan; Klingenspor, Martin; Gailus-Durner, Valérie; Fuchs, Helmut; Hrabě de Angelis, Martin; Beckers, Johannes; Hölter, Sabine M; Meitinger, Thomas; Hauck, Stefanie M; Laumen, Helmut; Wurst, Wolfgang; Casares, Fernando; Gómez-Skarmeta, Jose Luis; Winkelmann, Juliane

2014-04-01

Genome-wide association studies (GWAS) identified the MEIS1 locus for Restless Legs Syndrome (RLS), but causal single nucleotide polymorphisms (SNPs) and their functional relevance remain unknown. This locus contains a large number of highly conserved noncoding regions (HCNRs) potentially functioning as cis-regulatory modules. We analyzed these HCNRs for allele-dependent enhancer activity in zebrafish and mice and found that the risk allele of the lead SNP rs12469063 reduces enhancer activity in the Meis1 expression domain of the murine embryonic ganglionic eminences (GE). CREB1 binds this enhancer and rs12469063 affects its binding in vitro. In addition, MEIS1 target genes suggest a role in the specification of neuronal progenitors in the GE, and heterozygous Meis1-deficient mice exhibit hyperactivity, resembling the RLS phenotype. Thus, in vivo and in vitro analysis of a common SNP with small effect size showed allele-dependent function in the prospective basal ganglia representing the first neurodevelopmental region implicated in RLS.

Mapping the changed hubs and corresponding functional connectivity in idiopathic restless legs syndrome.

PubMed

Liu, Chunyan; Wang, Jiaojian; Hou, Yue; Qi, Zhigang; Wang, Li; Zhan, Shuqin; Wang, Rong; Wang, Yuping

2018-05-01

The hubs of the brain network play a key role in integrating and transferring information between different functional modules. However, whether the changed pattern in functional network hubs contributes to the onset of leg discomfort symptoms in restless legs syndrome (RLS) patients remains unclear. Using resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory methods, we investigated whether alterations of hubs can be detected in RLS. First, we constructed the whole-brain voxelwise functional connectivity and calculated a functional connectivity strength (FCS) map in each of 16 drug-naive idiopathic RLS patients and 26 gender- and age-matched healthy control (HC) subjects. Next, a two-sample t test was applied to compare the FCS maps between HC and RLS patients, and to identify significant changes in FCS in RLS patients. To further elucidate the corresponding changes in the functional connectivity patterns of the aberrant hubs in RLS patients, whole-brain resting-state functional connectivity analyses for the hub areas were performed. The hub analysis revealed decreased FCS in the cuneus, fusiform gyrus, paracentral lobe, and precuneus, and increased FCS in the superior frontal gyrus and thalamus in idiopathic drug-naive RLS patients. Subsequent functional connectivity analyses revealed decreased functional connectivity in sensorimotor and visual processing networks and increased functional connectivity in the affective cognitive network and cerebellar-thalamic circuit. Furthermore, the mean FCS value in the superior frontal gyrus was significantly correlated with Hamilton Anxiety Rating Scale scores in RLS patients, and the mean FCS value in the fusiform gyrus was significantly correlated with Hamilton Depression Rating Scale scores. These findings may provide novel insight into the pathophysiology of RLS. Copyright © 2018 Elsevier B.V. All rights reserved.

Effects of rotigotine on daytime symptoms in patients with primary restless legs syndrome: a randomized, placebo-controlled study.

PubMed

Garcia-Borreguero, Diego; Allen, Richard; Hudson, John; Dohin, Elisabeth; Grieger, Frank; Moran, Kimberly; Schollmayer, Erwin; Smit, René; Winkelman, John

2016-01-01

This 12 week double-blind, placebo-controlled study (ClinicalTrials.gov: NCT01569464) was conducted to evaluate the effects of rotigotine transdermal patch on daytime symptoms in patients with idiopathic restless legs syndrome (RLS). Adult patients with moderate-to-severe RLS were randomized to rotigotine (optimal dose: 1-3 mg/24 h) or placebo. A modified four-assessment version (4:00 pm, 6:00 pm, 8:00 pm, and 10:00 pm) of the Multiple Suggested Immobilization Test (m-SIT) was performed at baseline and end of 4 week maintenance (EoM). Primary study outcomes were change from baseline to EoM in International Restless Legs Syndrome Rating Scale (IRLS) and in average of means for the m-SIT Discomfort Scale (m-SIT-DS) (combined average of mean values from each of the individual assessments). Secondary outcomes included average of means of Periodic Limb Movement during Wakefulness Index (PLMWI; PLM/hour) for the combination of m-SIT. A total of 150 patients were randomized and 137 (rotigotine: 92/101 [91.1%]; placebo: 45/49 [91.8%]) completed maintenance. All 150 randomized patients were assessed for efficacy. At EoM, mean change in IRLS was -14.9 ± 9.3 with rotigotine vs. -12.7 ± 7.6 with placebo (ANCOVA, LS mean treatment difference [95% CI]: -0.27 [-2.96, 2.42]; p = 0.8451). Changes in average of means of m-SIT-DS values of each individual SIT were comparable with rotigotine (-2.68 ± 2.31) vs. placebo (-2.62 ± 2.61) (ANCOVA, LS mean treatment difference [95% CI]: 0.07 [-0.61, 0.75]; p = 0.8336) and comparable reductions in PLMWI were observed in both treatment groups (8.34 [-8.50, 25.17]; p = 0.3290). Rotigotine was generally well tolerated. Application site reactions (rotigotine: 20 patients [19.8%]; placebo: 4 [8.2%]) and nausea (16 [15.8%]; 3 [6.1%]) were the most common AEs. Rotigotine was beneficial in improving overall RLS symptom severity (assessed by IRLS) and RLS symptom severity at various times of the day (m

Involvement of the central somatosensory system in restless legs syndrome: A neuroimaging study.

PubMed

Lee, Byeong-Yeul; Kim, Jongmyeong; Connor, James R; Podskalny, Gerald D; Ryu, Yeunchul; Yang, Qing X

2018-05-22

To investigate morphologic changes in the somatosensory cortex and the thickness of the corpus callosum subdivisions that provide interhemispheric connections between the 2 somatosensory cortical areas. Twenty-eight patients with severe restless legs syndrome (RLS) symptoms and 51 age-matched healthy controls were examined with high-resolution MRI at 3.0 tesla. The vertex-wise analysis in conjunction with a novel cortical surface classification method was performed to assess the cortical thickness across the whole-brain structures. In addition, the thickness of the midbody of the corpus callosum that links postcentral gyri in the 2 hemispheres was measured. We demonstrated that a morphologic change occurred in the brain somatosensory system in patients with RLS compared to controls. Patients with RLS exhibited a 7.5% decrease in average cortical thickness in the bilateral postcentral gyrus ( p < 0.0001). Accordingly, there was a substantial decrease in the corpus callosum posterior midbody ( p < 0.008) wherein the callosal fibers are connected to the postcentral gyrus, suggesting altered white matter properties in the somatosensory pathway. Our results provide in vivo evidence of morphologic changes in the primary somatosensory system, which could be responsible for the sensory functional symptoms of RLS. These results provide a better understanding of the pathophysiology underlying the RLS sensory symptoms and could lead to a potential imaging marker for RLS. © 2018 American Academy of Neurology.

Evaluation of restless legs syndrome in fibromyalgia syndrome: an analysis of quality of sleep and life.

PubMed

Civelek, Gul Mete; Ciftkaya, Pinar Oztop; Karatas, Metin

2014-01-01

The aim of this study is to find prevalence and severity of restless legs syndrome (RLS) in patients with fibromyalgia syndrome (FMS) and detect effect of FMS and RLS coexistance on quality of sleep and life. In this study, presence and severity of RLS were detected in patients with FMS and Pitsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Fibromyalgia Impact Questionnaire (FIQ) scores of all patients were measured. One hundred and fifteen female patients with median age 49 (39.0-57.0)[median (25-75{\\%} interquartile range)] were included in the study. In 42.6% of patients RLS coexisting with FMS was found. RLS was classified as moderate in 42.9% of patients and as severe in 49.0% of patients. In patients with FMS ans RLS sleep quality, daytime sleepiness and quality of life were more severely impaired (PSQI scores were 9.0 ± 4.4 vs 7.8 ± 4.3, p=0.003; ESS scores were 5.0(3.0-7.5) vs 3.0(1.0-4.3), p=0.036 and FIQ scores were 68.1 ± 9.8 vs 59.4 ± 16.9, p=0.027) compared to patients with only FMS. Prevalence of RLS was found higher in FMS than normal population and quality of sleep and quality of life were worse in patients with RLS. Presence of RLS should be investigated in every patient with FMS and treatment plans should also cover RLS in case of coexistance with FMS. Prospective cohort studies are needed for better explanation of FMS and RLS coexistance.

Working memory deficit in patients with restless legs syndrome: an event-related potential study.

PubMed

Kim, Sung Min; Choi, Jeong Woo; Lee, Chany; Lee, Byeong Uk; Koo, Yong Seo; Kim, Kyung Hwan; Jung, Ki-Young

2014-07-01

The aim of this study was to investigate whether there is a working memory (WM) deficit in restless legs syndrome (RLS) patients, by studying the Sternberg WM task of event-related potential (ERP). Thirteen drug-naive RLS patients and 13 healthy age-matched controls with no sleep disturbances participated in the present study. P300 ERP was recorded during Sternberg WM task using digits as mnemonic items. P300 amplitudes and reaction times were compared between groups (RLS vs. control) considering brain regions (frontal, central, and parietal) and memory load sizes (two, three, and four) as within-subject factors. Clinical and sleep-related variables were correlated with P300 amplitude. The reaction time in RLS patients was significantly longer than controls over all memory load sizes. The P300 amplitude at parietal regions in RLS patients was significantly lower than in controls regardless of memory load sizes, which was significantly negatively correlated with duration of RLS history in RLS patients. Our study suggests that patients with severe RLS have WM deficits. Furthermore, negative correlation of P300 amplitudes with the duration of RLS illness suggests that cerebral cortical dysfunction in RLS patients results from repeated RLS symptom attacks. Copyright © 2014 Elsevier B.V. All rights reserved.

Excessive Daytime sleepiness in idiopathic restless legs syndrome: characteristics and evolution under dopaminergic treatment.

PubMed

Kallweit, Ulf; Siccoli, Massimiliano M; Poryazova, Rositsa; Werth, Esther; Bassetti, Claudio L

2009-01-01

Whereas insomnia is frequent in restless legs syndrome (RLS), little is known about daytime sleepiness. We studied a series of 27 consecutive patients with idiopathic RLS in order to identify the characteristics and evolution of excessive daytime sleepiness (EDS) under dopaminergic treatment. Patients were assessed by clinical examination, questionnaires and video-polysomnography (PSG). Sleepy patients, as defined by Epworth Sleepiness Scale (ESS) >10, were also assessed by the multiple sleep latency test (MSLT). We excluded RLS patients with other sleep-wake disorders, in particular chronic sleep deprivation. Mean age was 56 years, the mean International RLS Study Group Rating Scale score was 24 at baseline. Ten (37%) of the 27 patients reported EDS. RLS patients with sleepiness had a higher amount of total sleep time (p = 0.029) on PSG and a mean sleep latency of 6.4 min on MSLT. No other differences regarding clinical or polysomnographic parameters were found. RLS severity improved in all patients under dopaminergic treatment (p = 0.001); this was also the case for the ESS score in sleepy patients (p = 0.007). In our series of RLS patients, EDS was common, characterized by longer sleep (PSG) and reduced sleep latencies on MSLT. Under dopaminergic treatment, both RLS severity and ESS improved. Copyright 2009 S. Karger AG, Basel.

Heme Oxygenase-1 and 2 Common Genetic Variants and Risk for Restless Legs Syndrome

PubMed Central

García-Martín, Elena; Jiménez-Jiménez, Félix Javier; Alonso-Navarro, Hortensia; Martínez, Carmen; Zurdo, Martín; Turpín-Fenoll, Laura; Millán-Pascual, Jorge; Adeva-Bartolomé, Teresa; Cubo, Esther; Navacerrada, Francisco; Rojo-Sebastián, Ana; Rubio, Lluisa; Ortega-Cubero, Sara; Pastor, Pau; Calleja, Marisol; Plaza-Nieto, José Francisco; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; García-Albea, Esteban; Agúndez, José A.G.

2015-01-01

Abstract Several neurochemical, neuropathological, neuroimaging, and experimental data, suggest that iron deficiency plays an important role in the pathophysiology of restless legs syndrome (RLS). Heme-oxygenases (HMOX) are an important defensive mechanism against oxidative stress, mainly through the degradation of heme to biliverdin, free iron, and carbon monoxide. We analyzed whether HMOX1 and HMOX2 genes are related with the risk to develop RLS. We analyzed the distribution of genotypes and allelic frequencies of the HMOX1 rs2071746, HMOX1 rs2071747, HMOX2 rs2270363, and HMOX2 rs1051308 SNPs, as well as the presence of Copy number variations (CNVs) of these genes in 205 subjects RLS and 445 healthy controls. The frequencies of rs2071746TT genotype and rs2071746T allelic variant were significantly lower in RLS patients than that in controls, although the other 3 studied SNPs did not differ between RLS patients and controls. None of the studied polymorphisms influenced the disease onset, severity of RLS, family history of RLS, serum ferritin levels, or response to dopaminergic agonist, clonazepam or GABAergic drugs. The present study suggests a weak association between HMOX1 rs2071746 polymorphism and the risk to develop RLS in the Spanish population. PMID:26313808

Heme Oxygenase-1 and 2 Common Genetic Variants and Risk for Restless Legs Syndrome.

PubMed

García-Martín, Elena; Jiménez-Jiménez, Félix Javier; Alonso-Navarro, Hortensia; Martínez, Carmen; Zurdo, Martín; Turpín-Fenoll, Laura; Millán-Pascual, Jorge; Adeva-Bartolomé, Teresa; Cubo, Esther; Navacerrada, Francisco; Rojo-Sebastián, Ana; Rubio, Lluisa; Ortega-Cubero, Sara; Pastor, Pau; Calleja, Marisol; Plaza-Nieto, José Francisco; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; García-Albea, Esteban; Agúndez, José A G

2015-08-01

Several neurochemical, neuropathological, neuroimaging, and experimental data, suggest that iron deficiency plays an important role in the pathophysiology of restless legs syndrome (RLS). Heme-oxygenases (HMOX) are an important defensive mechanism against oxidative stress, mainly through the degradation of heme to biliverdin, free iron, and carbon monoxide. We analyzed whether HMOX1 and HMOX2 genes are related with the risk to develop RLS.We analyzed the distribution of genotypes and allelic frequencies of the HMOX1 rs2071746, HMOX1 rs2071747, HMOX2 rs2270363, and HMOX2 rs1051308 SNPs, as well as the presence of Copy number variations (CNVs) of these genes in 205 subjects RLS and 445 healthy controls.The frequencies of rs2071746TT genotype and rs2071746T allelic variant were significantly lower in RLS patients than that in controls, although the other 3 studied SNPs did not differ between RLS patients and controls. None of the studied polymorphisms influenced the disease onset, severity of RLS, family history of RLS, serum ferritin levels, or response to dopaminergic agonist, clonazepam or GABAergic drugs.The present study suggests a weak association between HMOX1 rs2071746 polymorphism and the risk to develop RLS in the Spanish population.

Pregabalin versus pramipexole: effects on sleep disturbance in restless legs syndrome.

PubMed

Garcia-Borreguero, Diego; Patrick, Jeffrey; DuBrava, Sarah; Becker, Philip M; Lankford, Alan; Chen, Crystal; Miceli, Jeffrey; Knapp, Lloyd; Allen, Richard P

2014-04-01

To compare pregabalin versus placebo and pramipexole for reducing restless legs syndrome (RLS)-related sleep disturbance. Randomized, double-blinded, crossover trial. Twenty-three US sleep centers. Eighty-five individuals with moderate to severe idiopathic RLS and associated sleep disturbance. Participants were randomized across 6 treatment sequences comprising three 4-week periods on pregabalin 300 mg/day (n = 75), pramipexole 0.5 mg/day (n = 76), or placebo (n = 73). Polysomnography was conducted over 2 nights at the end of each period. Primary (wake after sleep onset [WASO], pregabalin vs placebo) and key secondary endpoints were analyzed for statistical significance, with descriptive statistics for other endpoints. Pregabalin improved sleep maintenance, demonstrated by reductions in WASO (-27.1 min vs placebo [P < 0.0001]; -26.9 vs pramipexole) and number of awakenings after sleep onset (-2.7 vs placebo; -7.9 vs pramipexole [P < 0.0001]) by polysomnography, and an increase in subjective total sleep time (30.8 min vs placebo [P < 0.0001]; 26.8 vs pramipexole). Pregabalin also increased slow wave sleep duration (20.9 min vs placebo; 32.1 vs pramipexole [P < 0.0001]). Reduction in periodic limb movement arousal index (PLMAI) with pregabalin was similar to pramipexole and greater than placebo (-3.7 PLMA/h [P < 0.0001]), although reduction in total PLM in sleep was less than for pramipexole. This study demonstrated improvements in objective and subjective measures of sleep maintenance and sleep architecture with pregabalin compared with placebo and pramipexole. Effects of pregabalin on periodic limb movement arousal index were comparable to pramipexole. ClinicalTrials.gov identifier, NCT00991276; http://clinicaltrials.gov/show/NCT00991276.

Restless legs syndrome status as a predictor for lower physical function

PubMed Central

Zhang, Chunbai; Li, Yanping; Malhotra, Atul; Ning, Yi

2014-01-01

Objective: To examine the potential long-term impact of restless legs syndrome (RLS) and other common sleep complaints on subsequent physical function (PF), we conducted a longitudinal analysis of 12,556 men in the Health Professionals Follow-up Study. Methods: We used a set of questions recommended by the International RLS Study Group to assess RLS in 2002. We asked questions regarding other sleep complaints—insomnia, sleep fragmentation, and excessive daytime sleepiness—in 2004. We used the Physical Function (PF-10) survey of the Short Form–36 Health Survey to characterize PF in 1996 and 2008. We examined the 2008 PF-10 scores across categories of baseline RLS (2002), adjusted for age, 1996 PF-10 score, and other potential confounders. Results: The participants with RLS at baseline had significantly lower PF-10 score 6 years later than those without RLS (mean difference = −2.32, p = 0.01), after adjusting for potential confounders. The magnitude of difference in PF-10 score for RLS symptoms ≥15 times/month vs no RLS was more than that of a 5-year increase of age or moderate amount of smoking. Having daily daytime sleepiness and sleep duration ≥9 hours/day were associated with lower mean PF value than not having these symptoms (p < 0.05 for both). Conclusions: RLS and other sleep complaints are associated with lower PF. Our findings need to be replicated by more longitudinal studies including women and populations of other social and cultural backgrounds. It is important to understand whether RLS is an independent risk factor or a marker for other unknown risk factors for disability. PMID:24598708

Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation.

PubMed

Garcia-Borreguero, Diego; Silber, Michael H; Winkelman, John W; Högl, Birgit; Bainbridge, Jacquelyn; Buchfuhrer, Mark; Hadjigeorgiou, Georgios; Inoue, Yuichi; Manconi, Mauro; Oertel, Wolfgang; Ondo, William; Winkelmann, Juliane; Allen, Richard P

2016-05-01

A Task Force was established by the International Restless Legs Syndrome Study Group (IRLSSG) in conjunction with the European Restless Legs Syndrome Study Group (EURLSSG) and the RLS Foundation (RLS-F) to develop evidence-based and consensus-based recommendations for the prevention and treatment of long-term pharmacologic treatment of dopaminergic-induced augmentation in restless legs syndrome/Willis-Ekbom disease (RLS/WED). The Task Force made the following prevention and treatment recommendations: As a means to prevent augmentation, medications such as α2δ ligands may be considered for initial RLS/WED treatment; these drugs are effective and have little risk of augmentation. Alternatively, if dopaminergic drugs are elected as initial treatment, then the daily dose should be as low as possible and not exceed that recommended for RLS/WED treatment. However, the physician should be aware that even low dose dopaminergics can cause augmentation. Patients with low iron stores should be given appropriate iron supplementation. Daily treatment by either medication should start only when symptoms have a significant impact on quality of life in terms of frequency and severity; intermittent treatment might be considered in intermediate cases. Treatment of existing augmentation should be initiated, where possible, with the elimination/correction of extrinsic exacerbating factors (iron levels, antidepressants, antihistamines, etc.). In cases of mild augmentation, dopamine agonist therapy can be continued by dividing or advancing the dose, or increasing the dose if there are breakthrough night-time symptoms. Alternatively, the patient can be switched to an α2δ ligand or rotigotine. For severe augmentation the patient can be switched either to an α2δ ligand or rotigotine, noting that rotigotine may also produce augmentation at higher doses with long-term use. In more severe cases of augmentation an opioid may be considered, bypassing α2δ ligands and rotigotine

Diseases in Patients Coming to a Sleep Center with Symptoms Related to Restless Legs Syndrome

PubMed Central

Kao, Kuo-Chin; Yang, Cheng-Ta; Chuang, Li-Pang; Chou, Yu-Ting; Lai, Szu-Chia; Chen, Rou-Shayn; Chen, Ning-Hung

2013-01-01

Study Objective To explore the profile of patients who visit a sleep center with symptoms that fulfill the four essential criteria for restless legs syndrome (RLS). Design A prospective study. Setting Outpatients from one sleep disorders clinic in Taiwan. Participants 1,200 consecutive patients visit sleep disorders clinic with any sleep complaints. Interventions After completing a history and physical examination, all participants answered the RLS questionnaire. Subjects who fulfilled the four essential criteria for RLS were referred to a special clinic. A work-up including blood tests, polysomnography, and specialized neurological tests etc. was performed to make the final diagnosis. Measurements and Results A total of 1,185 participants were enrolled, and, of these, 131(11.1%) fulfilled the four essential criteria for RLS, and 121 completed the supplemental work-up. Their mean age was 47.6±13.3 and 52.9% were male. Insomnia and snoring were the most common chief complaints. Obstructive sleep apnea syndrome and other diseases were found in 103 patients. Only 18 (14.9%) patients had no comorbid condition and were diagnosed with primary RLS. Conclusions Symptoms of RLS are common in patients with sleep complaints. Even in a sleep clinic, using a questionnaire approach for identification of RLS has a low positive predictive value. Clinicians should pay attention to the limitations of the 4-item questionnaire in diagnosis of RLS and also the importance of a careful differential diagnosis to identify possible secondary causes of RLS. PMID:23977057

Diseases in patients coming to a sleep center with symptoms related to restless legs syndrome.

PubMed

Lin, Shih-Wei; Chen, Yen-Lung; Kao, Kuo-Chin; Yang, Cheng-Ta; Chuang, Li-Pang; Chou, Yu-Ting; Lai, Szu-Chia; Chen, Rou-Shayn; Chen, Ning-Hung

2013-01-01

To explore the profile of patients who visit a sleep center with symptoms that fulfill the four essential criteria for restless legs syndrome (RLS). A prospective study. Outpatients from one sleep disorders clinic in Taiwan. 1,200 consecutive patients visit sleep disorders clinic with any sleep complaints. After completing a history and physical examination, all participants answered the RLS questionnaire. Subjects who fulfilled the four essential criteria for RLS were referred to a special clinic. A work-up including blood tests, polysomnography, and specialized neurological tests etc. was performed to make the final diagnosis. A total of 1,185 participants were enrolled, and, of these, 131(11.1%) fulfilled the four essential criteria for RLS, and 121 completed the supplemental work-up. Their mean age was 47.6±13.3 and 52.9% were male. Insomnia and snoring were the most common chief complaints. Obstructive sleep apnea syndrome and other diseases were found in 103 patients. Only 18 (14.9%) patients had no comorbid condition and were diagnosed with primary RLS. Symptoms of RLS are common in patients with sleep complaints. Even in a sleep clinic, using a questionnaire approach for identification of RLS has a low positive predictive value. Clinicians should pay attention to the limitations of the 4-item questionnaire in diagnosis of RLS and also the importance of a careful differential diagnosis to identify possible secondary causes of RLS.

From bench to bedside: An overview of rotigotine for the treatment of restless legs syndrome.

PubMed

Bogan, Richard K

2014-03-01

Restless legs syndrome (RLS) is a common chronic neurologic disorder. Symptoms are most prevalent during the evening and at night, although daytime symptoms may emerge as the disease progresses. Dopamine agonists are currently considered first-line therapy for moderate to severe idiopathic RLS. Most dopamine agonists have short half-lives and are administered in the evening, shortly before the onset of RLS symptoms. Rotigotine is a non-ergot dopamine receptor agonist that has been specifically developed as a transdermal patch to provide continuous drug delivery over a 24-hour period. This review details the development of rotigotine, from the preclinical studies that established its pharmacokinetic profile to large-scale clinical trials in patients with RLS. Placebo-controlled trials that demonstrated the efficacy and tolerability of rotigotine are discussed, in addition to open-label studies that investigated long-term therapy. Studies were identified by a PubMed search using the key word rotigotine in conjunction with restless legs syndrome and by reviewing reference lists of retrieved publications. All clinical trials of rotigotine in RLS published before September 2013 were included. Preclinical studies have established activity of rotigotine as a dopamine receptor agonist, and pharmacokinetic data have shown that transdermal delivery maintains stable plasma levels over 24 hours. Rotigotine has demonstrated efficacy in improving moderate to severe RLS symptoms in randomized, placebo-controlled trials, based on scores on the International RLS Study Group rating scale, the RLS-6 scale, and the Clinical Global Impression-Severity subscale. Results of an open-label extension study suggest that efficacy may be maintained for up to 5 years. A polysomnographic study demonstrated an improvement in periodic limb movement index with rotigotine, and subjective assessments have suggested beneficial effects in terms of amelioration of sleep disturbances. Premature

Lack of Association between Genetic Risk Loci for Restless Legs Syndrome and Multimorbidity.

PubMed

Szentkirályi, András; Völzke, Henry; Hoffmann, Wolfgang; Winkelmann, Julianne; Berger, Klaus

2016-01-01

Multimorbidity is a risk factor for incident restless legs syndrome (RLS). In this relationship, the potential role of known genetic risk loci for RLS has not been studied. Our aim was to evaluate whether carriers of specific RLS risk alleles have higher comorbidity burden than noncarriers. The Dortmund Health Study (DHS) and the Study of Health in Pomerania (SHIP) are two independent cohort studies in Germany based on age-stratified, random samples drawn from the respective population registers. DHS included 1,312 subjects and SHIP included 4,308 subjects. RLS status was assessed according to the RLS standard minimal criteria. A comorbidity index was calculated by summing the scores of the following conditions: diabetes, hypertension, myocardial infarction, obesity, stroke, cancer, renal disease, anemia, depression, thyroid disease, and migraine. Thirteen single nucleotide polymorphisms (SNP) previously associated with elevated risk of RLS were genotyped. Analyses were carried out on the pooled sample of the two studies. The mean age was 50.4 ± 15.9 y, and the proportion of women was 51.4%. The mean number of comorbid conditions was 1.5 ± 1.3. In multivariable regression, the mean number of comorbidities was not significantly different between carriers of any of the RLS risk alleles and noncarriers either in the total pooled sample or in those having RLS symptoms. Based on these results it is unlikely that known genetic risk factors for RLS would lead to increased multimorbidity. © 2016 Associated Professional Sleep Societies, LLC.

Topography of sensory symptoms in patients with drug-naïve restless legs syndrome.

PubMed

Koo, Yong Seo; Lee, Gwan-Taek; Lee, Seo Young; Cho, Yong Won; Jung, Ki-Young

2013-12-01

We aimed to describe the sensory topography of restless legs syndrome (RLS) sensory symptoms and to identify the relationship between topography and clinical variables. Eighty adult patients with drug-naïve RLS who had symptoms for more than 1year were consecutively recruited. During face-to-face interviews using a structured paper and pencil questionnaire with all participants, we obtained clinical information and also marked the topography of RLS sensory symptoms on a specified body template, all of which were subsequently inputted into our in-house software. The RLS sensory topography patterns were classified according to localization, lateralization, and symmetry. We investigated if these sensory topography patterns differed according to various clinical variables. The lower extremities only (LE) were the most common location (72.5%), and 76.3% of participants exhibited symmetric sensory topography. Late-onset RLS showed more asymmetric sensory distribution compared with early-onset RLS (P=.024). Patients whose sensory symptoms involved the lower extremities in addition to other body parts (LE-PLUS) showed more severe RLS compared with those involving the LE (P=.037). RLS sensory symptoms typically were symmetrically located in the lower extremities. LE-PLUS or an asymmetric distribution more often occurred in patients with more severe RLS symptoms or late-onset RLS. Copyright © 2013 Elsevier B.V. All rights reserved.

Human L-ferritin deficiency is characterized by idiopathic generalized seizures and atypical restless leg syndrome

PubMed Central

Cozzi, Anna; Santambrogio, Paolo; Privitera, Daniela; Broccoli, Vania; Rotundo, Luisa Ida; Garavaglia, Barbara; Benz, Rudolf; Altamura, Sandro; Goede, Jeroen S.; Muckenthaler, Martina U.

2013-01-01

The ubiquitously expressed iron storage protein ferritin plays a central role in maintaining cellular iron homeostasis. Cytosolic ferritins are composed of heavy (H) and light (L) subunits that co-assemble into a hollow spherical shell with an internal cavity where iron is stored. The ferroxidase activity of the ferritin H chain is critical to store iron in its Fe3+ oxidation state, while the L chain shows iron nucleation properties. We describe a unique case of a 23-yr-old female patient affected by a homozygous loss of function mutation in the L-ferritin gene, idiopathic generalized seizures, and atypical restless leg syndrome (RLS). We show that L chain ferritin is undetectable in primary fibroblasts from the patient, and thus ferritin consists only of H chains. Increased iron incorporation into the FtH homopolymer leads to reduced cellular iron availability, diminished levels of cytosolic catalase, SOD1 protein levels, enhanced ROS production and higher levels of oxidized proteins. Importantly, key phenotypic features observed in fibroblasts are also mirrored in reprogrammed neurons from the patient’s fibroblasts. Our results demonstrate for the first time the pathophysiological consequences of L-ferritin deficiency in a human and help to define the concept for a new disease entity hallmarked by idiopathic generalized seizure and atypical RLS. PMID:23940258

Prevalence and Sleep Related Disorders of Restless Leg Syndrome in Hemodialysis Patients

PubMed Central

Chavoshi, Farzaneh; Einollahi, Behzad; Sadeghniat Haghighi, Khosro; Saraei, Maryam; Izadianmehr, Neda

2015-01-01

Background: Despite being frequently described, Restless Leg Syndrome (RLS) in patients, who are on hemodialysis, is a common disease which, has not been well documented in Iran. Objectives: The current study aimed to investigate the prevalence of RLS and its sleep disorders in Iranian patients on hemodialysis. Patients and Methods: In this multicenter cross sectional study, 397 consecutive patients on hemodialysis were evaluated by face-to-face interviews. RLS was diagnosed using the International RLS Study Group (IRLSS) criteria. In addition, three validated sleep disorder questionnaires (Insomnia Severity Index, Epworth sleepiness scale and Pittsburgh sleep quality index) were completed by the patients. Results: One hundred-twenty-six patients with RLS (31.7%; mean age 57.6 ± 15.4 years) participated in the current study. RLS mostly occurs in females (P < 0.001). RLS cases showed poorer quality of sleep (Pittsburgh Sleep Quality Index > 5, P = 0.001), higher scores of Epworth Sleepiness Scale (P < 0.001) and insomnia severity index (P = 0.001). Except thyroid gland dysfunction (P < 0.03, OR ≈ 2.50) and anti-hypertensive medications (P < 0.01, OR ≈ 1.7), there were no significant differences between age, duration of dialysis, etiology of renal insufficiency, intake of nicotine, alcohol or caffeine, and other associated comorbidities between the patients with and without RLS. Conclusions: In the current study, prevalence of RLS was near the weighted-mean prevalence of other studies (mean 30%, range 8%t-52%). This is not just racial variability and may attribute to narrow or wide definition of the disease, plus variations of the prevalence recording time, and sometimes not using the standard criteria or standard interview. PMID:25883911

Thr105Ile (rs11558538) polymorphism in the histamine-1-methyl-transferase (HNMT) gene and risk for restless legs syndrome.

PubMed

Jiménez-Jiménez, Félix Javier; García-Martín, Elena; Alonso-Navarro, Hortensia; Martínez, Carmen; Zurdo, Martín; Turpín-Fenoll, Laura; Millán-Pascual, Jorge; Adeva-Bartolomé, Teresa; Cubo, Esther; Navacerrada, Francisco; Rojo-Sebastián, Ana; Rubio, Lluisa; Ortega-Cubero, Sara; Pastor, Pau; Calleja, Marisol; Plaza-Nieto, José Francisco; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; García-Albea, Esteban; Agúndez, José A G

2017-03-01

A recent meta-analysis suggests an association between the rs11558538 single nucleotide polymorphism in the histamine-N-methyl-transferase (HNMT) gene and the risk for Parkinson's disease. Based on the possible relationship between PD and restless legs syndrome (RLS), we tried to establish whether rs11558538 SNP is associated with the risk for RLS. We studied the genotype and allelic variant frequencies of HNMT rs11558538 SNP 205 RLS patients and 410 healthy controls using a TaqMan assay. The frequencies of the HNMT rs11558538 genotypes allelic variants were similar between RLS patients and controls, and were not influenced by gender, family history of RLS, or RLS severity. RLS patients carrying the genotype rs11558538TT had an earlier age at onset, but this finding was based on three subjects only. These results suggest a lack of major association between HNMT rs11558538 SNP and the risk for RLS.

Identification and treatment of augmentation in patients with restless legs syndrome: practical recommendations.

PubMed

Geyer, James; Bogan, Richard

2017-09-01

Restless legs syndrome (RLS) is a chronic disorder causing clinically significant discomfort to approximately 3% of adults. Although RLS was first identified centuries ago, our understanding of this disorder, its causes, and its treatments is still evolving. In particular, our knowledge of the potential negative effects of RLS treatments, including dopaminergic augmentation, continues to expand. Augmentation, which refers to a paradoxical treatment-related increase in RLS symptoms, has been associated with all three dopamine agonists approved for the treatment of RLS - rotigotine, pramipexole, and ropinirole. This review presents key information on prevention and treatment of dopaminergic augmentation from the recently published consensus-based guidelines issued by the International RLS Study Group task force in conjunction with the European RLS Study Group and the RLS Foundation for first-line treatment of RLS/Willis-Ekbom disease. If dopamine agonists are used to treat RLS, it is recommended that the dosage should be kept as low as possible without exceeding the maximum dose recommended for RLS treatment. As the frequency of augmentation with the rotigotine patch may only be slightly lower than that associated with pramipexole or ropinirole, medications that are effective and have little risk of augmentation, such as alpha-2-delta ligands, may be considered for initial RLS treatment. In addition, we present our clinical experience with treating patients with dopaminergic augmentation by highlighting 2 case studies and practical considerations when treating different patient populations. Applying current RLS augmentation diagnosis and treatment guidelines, as well as collecting detailed histories of worsening RLS symptoms, is critical for patient safety and effective management of RLS augmentation.

Cerebral correlates of muscle tone fluctuations in restless legs syndrome: a pilot study with combined functional magnetic resonance imaging and anterior tibial muscle electromyography.

PubMed

Spiegelhalder, Kai; Feige, Bernd; Paul, Dominik; Riemann, Dieter; van Elst, Ludger Tebartz; Seifritz, Erich; Hennig, Jürgen; Hornyak, Magdolna

2008-01-01

The pathology of restless legs syndrome (RLS) is still not understood. To investigate the pathomechanism of the disorder further we recorded a surface electromyogram (EMG) of the anterior tibial muscle during functional magnetic resonance imaging (fMRI) in patients with idiopathic RLS. Seven subjects with moderate to severe RLS were investigated in the present pilot study. Patients were lying supine in the scanner for over 50 min and were instructed not to move voluntarily. Sensory leg discomfort (SLD) was evaluated on a 10-point Likert scale. For brain image analysis, an algorithm for the calculation of tonic EMG values was developed. We found a negative correlation of tonic EMG and SLD (p <0.01). This finding provides evidence for the clinical experience that RLS-related subjective leg discomfort increases during muscle relaxation at rest. In the fMRI analysis, the tonic EMG was associated with activation in motor and somatosensory pathways and also in some regions that are not primarily related to motor or somatosensory functions. By using a newly developed algorithm for the investigation of muscle tone-related changes in cerebral activity, we identified structures that are potentially involved in RLS pathology. Our method, with some modification, may also be suitable for the investigation of phasic muscle activity that occurs during periodic leg movements.

Restless legs syndrome, sleep impairment, and fatigue in chronic obstructive pulmonary disease.

PubMed

Cavalcante, Antonio George Matos; de Bruin, Pedro Felipe Carvalhedo; de Bruin, Veralice Meireles Sales; Pereira, Eanes Delgado Barros; Cavalcante, Marina Medeiros; Nunes, Deuzilane Muniz; Viana, Cynthia Sampaio

2012-08-01

To investigate the frequency of factors associated with restless legs syndrome (RLS) in patients with chronic obstructive pulmonary disease (COPD). RLS diagnosis was investigated (International RLS Study Group, IRLSSG) and severity was assessed (IRLS rating scale) in 104 consecutive COPD patients (age 69.1±8). Other measures were dyspnea severity (Modified Medical Research Council, MMRC), sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime somnolence (Epworth Sleepiness Scale, ESS), depressive symptoms (Beck Depression Inventory, BDI-II), and fatigue (Fatigue Severity Scale, FSS). Laboratory values included hemoglobin, ferritin, creatinine, and fibrinogen. Thirty-two patients (30.8%) were diagnosed with RLS (65.6% women), which was moderate/severe (IRLS >11) in 26 (81.3%). RLS symptoms started after age 40 in most patients (93.3%). RLS patients had poorer sleep quality (PSQI >5=59.6%; p=0.002), worse fatigue (FSS >27=51%; p=0.005), and more depressive symptoms (BDI-II >10=14.4%; p=0.005). Patients with RLS also presented more severe dyspnea (p=0.009) and lower creatinine levels (p=0.005). Overall, fatigue severity was correlated with older age (p=0.001); level of dyspnea was positively correlated with PSQI and FSS (p<0.005) and negatively correlated with ferritin (p=0.03) and creatinine (p=0.005), and PSQI scores correlated positively with FSS (p<0.005) and negatively with ferritin (p=0.005) and creatinine (p=0.02). Quality of sleep was independently predicted by dyspnea severity and creatinine and fatigue by age and depression. RLS is common in COPD. Patients with RLS have low creatinine, poorer quality of sleep, and more fatigue and depressive symptoms. RLS symptom severity is correlated to lower ferritin and severity of dyspnea. Copyright © 2012 Elsevier B.V. All rights reserved.

Restless Legs Syndrome and Poor Sleep Quality in Obese Children and Adolescents

PubMed

Baran, Rıza Taner; Atar, Müge; Pirgon, Özgür; Filiz, Serkan; Filiz, Meral

2018-06-01

Adult epidemiological studies suggest that the rate of Restless Legs syndrome (RLS) in the general population may range from 5% to 15%. The aim of this study was to investigate the frequency of RLS in a community sample of obese adolescents aged 10-16 years and to assess the association with sleep quality and health-related glucose metabolism markers. The study group comprised 144 obese and overweight children aged 10-16 yearsand the control group consisted of 66 age-matched healthy children. The RLS Questionnaire devised by the International RLS Study and the Pittsburgh Sleep Quality Index (PSQI), where a score >5 indicates poor sleep quality, was used to assess sleep quality. Mean body mass index (BMI) of the overweight/obese and control groups were 30.5±0.5 and 18.7±0.2, respectively. The frequency of RLS was higher in the obese group (21.7%) than the overweight (3.4%) and control (1.5%) (p<0.001) groups. The frequency of a poor PSQI score was significantly higher (p<0.001) in the obese group (37.3%) than the control group (24.2%). The obese with RLS group also had poorer sleep quality scores than the non-RLS obese group. Many symptoms of sleep disruption were more common in obese patients with RLS and RLS was independently correlated with a high PSQI score [odds ratio (OR): 2.25, confidence interval (Cl): 0.96-5.28, p<0.001)] and an increased BMI z-score (OR: 8.87, Cl: 2.04-38.61, p<0.001). RLS is common in obese children and may be associated with altered sleep quality. Obese children with RLS need to be assessed since they may need support to improve their sleep quality.

Restless Legs Syndrome and Poor Sleep Quality in Obese Children and Adolescents

PubMed Central

Baran, Rıza Taner; Atar, Müge; Pirgon, Özgür; Filiz, Serkan; Filiz, Meral

2018-01-01

Objective: Adult epidemiological studies suggest that the rate of Restless Legs syndrome (RLS) in the general population may range from 5% to 15%. The aim of this study was to investigate the frequency of RLS in a community sample of obese adolescents aged 10-16 years and to assess the association with sleep quality and health-related glucose metabolism markers. Methods: The study group comprised 144 obese and overweight children aged 10-16 yearsand the control group consisted of 66 age-matched healthy children. The RLS Questionnaire devised by the International RLS Study and the Pittsburgh Sleep Quality Index (PSQI), where a score >5 indicates poor sleep quality, was used to assess sleep quality. Results: Mean body mass index (BMI) of the overweight/obese and control groups were 30.5±0.5 and 18.7±0.2, respectively. The frequency of RLS was higher in the obese group (21.7%) than the overweight (3.4%) and control (1.5%) (p<0.001) groups. The frequency of a poor PSQI score was significantly higher (p<0.001) in the obese group (37.3%) than the control group (24.2%). The obese with RLS group also had poorer sleep quality scores than the non-RLS obese group. Many symptoms of sleep disruption were more common in obese patients with RLS and RLS was independently correlated with a high PSQI score [odds ratio (OR): 2.25, confidence interval (Cl): 0.96-5.28, p<0.001)] and an increased BMI z-score (OR: 8.87, Cl: 2.04-38.61, p<0.001). Conclusion: RLS is common in obese children and may be associated with altered sleep quality. Obese children with RLS need to be assessed since they may need support to improve their sleep quality. PMID:29175807

Prevalence of restless legs syndrome in Ankara, Turkey: an analysis of diagnostic criteria and awareness.

PubMed

Yilmaz, Nesrin Helvaci; Akbostanci, Muhittin Cenk; Oto, Aycan; Aykac, Ozlem

2013-09-01

The aim of this study was threefold: (1) to investigate the prevalence of restless legs syndrome (RLS), in Ankara, Turkey; (2) to determine the predictive values of diagnostic criteria; and (3) to determine the frequency of physician referrals and the frequency of getting the correct diagnosis. A total of 815 individuals, from randomly selected addresses, above the age of 15, were reached using the questionnaire composed of the four diagnostic criteria. Individuals who responded by answering 'yes' for at least one question were interviewed by neurologists for the diagnosis of RLS. Frequency of physician referrals and frequency of getting the correct diagnosis of RLS were also determined for patients getting the final diagnoses of RLS. Prevalence of RLS in Ankara was 5.52 %; 41.0 % of the individuals diagnosed with RLS had replied 'yes' to either one, two or three questions asked by interviewers. However, only 21.3 % of individuals who replied 'yes' to all four questions received the diagnosis of RLS. Among the patients who had the final diagnosis of RLS, 25.7 % had referred to a physician for the symptoms and 22.2 % got the correct diagnosis. The RLS prevalence in Ankara was somewhere between Western and Far East countries compatible with the geographical location. Diagnostic criteria may not be fully predictive when applied by non-physician pollsters. Physician's probability of correctly diagnosing RLS is still low.

Restless legs syndrome in dialysis patients: a comparison between hemodialysis and continuous ambulatory peritoneal dialysis.

PubMed

Merlino, Giovanni; Lorenzut, Simone; Romano, Giulio; Sommaro, Martina; Fontana, Augusto; Montanaro, Domenico; Valente, Mariarosaria; Gigli, Gian Luigi

2012-12-01

Restless legs syndrome (RLS) is common in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). A few studies so far have investigated RLS prevalence in ESRD patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The aim of this study was to compare the prevalence, characteristics, consequences and predictors of RLS between HD and CAPD patients. We recruited 58 HD and 28 CAPD patients. A neurologist expert in sleep medicine performed RLS diagnosis during a face-to-face interview. The prevalence of RLS was slightly higher in HD than in CAPD patients (19 vs. 10.7%). RLS appeared after the onset of kidney complaint in HD patients; in contrast, in CAPD patients RLS preceded the occurrence of renal disease. Five HD patients reported that RLS symptoms occurred throughout the dialysis session. HD patients with RLS(+) had a higher mean number of HD sessions per week and a longer mean duration of HD session than the RLS(-) ones. Prevalence of females was significantly higher in CAPD patients with RLS(+) than in the RLS(-) ones. RLS frequently affects both HD and CAPD patients. RLS impaired sleep in both groups, but use of dopaminergic agents was uncommon in our sample. Dialysis schedule was associated with RLS in HD patients, while female sex was related to RLS in CAPD patients. Awareness concerning RLS identification and treatment in HD and CAPD patients is recommended.

Transdermal rotigotine for the perioperative management of restless legs syndrome

PubMed Central

2012-01-01

Background Immobilisation, blood loss, sleep deficiency, and (concomitant) medications during perioperative periods might lead to acute exacerbation of symptoms in patients with the restless legs syndrome (RLS). Continuous transdermal delivery of the dopamine agonist rotigotine provides stable plasma levels over 24 h and may provide RLS patients with a feasible treatment option for perioperative situations. To assess the feasibility of use of rotigotine transdermal patch for the perioperative management of moderate to severe RLS, long-term data of an open-label extension of a rotigotine dose-finding study were retrospectively reviewed. Methods The data of all 295 patients who had entered the 5-year study were screened independently by two reviewers for the occurrence of surgical interventions during the study period. The following data were included in this post-hoc analysis: patient age, sex, surgical intervention and outcome, duration of hospital stay, rotigotine maintenance dose at the time of surgery, rotigotine dose adjustment, and continuation/discontinuation of rotigotine treatment. All parameters were analysed descriptively. No pre-specified efficacy assessments (e.g. IRLS scores) were available for the perioperative period. Results During the study period, 61 surgical interventions were reported for 52 patients (median age, 63 years; 67% female); the majority of patients (85%) had one surgical intervention. The mean rotigotine maintenance dose at time of surgery was 3.1 ± 1.1 mg/24 h. For most interventions (95%), rotigotine dosing regimens were maintained during the perioperative period. Administration was temporarily suspended in one patient and permanently discontinued in another two. The majority (96%) of the patients undergoing surgery remained in the study following the perioperative period and 30 of these patients (61%) completed the 5-year study. Conclusions Although the data were obtained from a study which was not designed to assess

Transdermal rotigotine for the perioperative management of restless legs syndrome.

PubMed

Högl, Birgit; Oertel, Wolfgang H; Schollmayer, Erwin; Bauer, Lars

2012-09-25

Immobilisation, blood loss, sleep deficiency, and (concomitant) medications during perioperative periods might lead to acute exacerbation of symptoms in patients with the restless legs syndrome (RLS). Continuous transdermal delivery of the dopamine agonist rotigotine provides stable plasma levels over 24 h and may provide RLS patients with a feasible treatment option for perioperative situations. To assess the feasibility of use of rotigotine transdermal patch for the perioperative management of moderate to severe RLS, long-term data of an open-label extension of a rotigotine dose-finding study were retrospectively reviewed. The data of all 295 patients who had entered the 5-year study were screened independently by two reviewers for the occurrence of surgical interventions during the study period. The following data were included in this post-hoc analysis: patient age, sex, surgical intervention and outcome, duration of hospital stay, rotigotine maintenance dose at the time of surgery, rotigotine dose adjustment, and continuation/discontinuation of rotigotine treatment. All parameters were analysed descriptively. No pre-specified efficacy assessments (e.g. IRLS scores) were available for the perioperative period. During the study period, 61 surgical interventions were reported for 52 patients (median age, 63 years; 67% female); the majority of patients (85%) had one surgical intervention. The mean rotigotine maintenance dose at time of surgery was 3.1 ± 1.1 mg/24 h. For most interventions (95%), rotigotine dosing regimens were maintained during the perioperative period. Administration was temporarily suspended in one patient and permanently discontinued in another two. The majority (96%) of the patients undergoing surgery remained in the study following the perioperative period and 30 of these patients (61%) completed the 5-year study. Although the data were obtained from a study which was not designed to assess rotigotine use in the perioperative setting

Prevalence of Restless Legs Syndrome in Patients with Inflammatory Bowel Disease.

PubMed

Takahara, Ikuko; Takeshima, Fuminao; Ichikawa, Tatsuki; Matsuzaki, Toshihisa; Shibata, Hidetaka; Miuma, Satoshi; Akazawa, Yuko; Miyaaki, Hisamitsu; Taura, Naota; Nakao, Kazuhiko

2017-03-01

There has been increased interest in sleep disorders in patients with inflammatory bowel disease (IBD). Studies in North America and Europe reported that the prevalence of restless legs syndrome (RLS) is much higher in patients with Crohn's disease (CD) than in the general population. The aim of this study was to reveal the prevalence and clinical features of RLS in Japanese patients with IBD and investigate the influence of RLS on sleep quality and quality of life (QOL). The study included 80 outpatients with IBD who visited Nagasaki University Hospital between December 2012 and July 2014. All patients completed the international RLS study group rating scale, a validated measure of the presence of RLS. Sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI), and health-related QOL was assessed using the Japanese version of the 36-item short form healthy profile (SF-36) version 2. The prevalence of RLS in patients with IBD was 20%, including rates of 21.7% in patients with ulcerative colitis (UC) and 17.6% in patients with CD. Among patients with CD, the proportion of women and serum level of CRP were higher in the RLS group than in the non-RLS group. Among those with UC, there were no differences in clinical characteristics between the RLS and non-RLS groups. Patients in the RLS group slept significantly less well than those in the non-RLS group (PSQI > 5; 62.5 vs. 34.4%, P < 0.05). No significant relationships were observed between QOL indices and the presence of RLS (SF-36 physical score, 46.8 vs. 50.1; mental score, 43.8 vs. 45.7; role/social score, 48.1 vs. 49.2). RLS occurs frequently in Japanese patients with UC as well as CD. RLS affects sleep quality but not QOL, and it should be considered one of the causes of sleep disturbance in patients with IBD.

Multimorbidity and the risk of restless legs syndrome in 2 prospective cohort studies.

PubMed

Szentkirályi, András; Völzke, Henry; Hoffmann, Wolfgang; Trenkwalder, Claudia; Berger, Klaus

2014-06-03

Our aim was to evaluate the association between the cumulative effect of comorbidity and the risk of restless legs syndrome (RLS) in 2 population-based German cohort studies. The Dortmund Health Study (DHS) (n = 1,312; median follow-up time: 2.1 years) and the Study of Health in Pomerania (SHIP) (n = 4,308; median follow-up time: 5.0 years) were used for the analyses. RLS was assessed at baseline and follow-up according to the RLS minimal criteria. A comorbidity index was calculated as a sum of the following conditions: diabetes, hypertension, myocardial infarction, obesity, stroke, cancer, renal disease, anemia, depression, thyroid disease, and migraine. The relationship between comorbidity and incident RLS was analyzed with multivariate logistic regression models. An increase in the number of comorbid conditions at baseline predicted prevalent RLS (DHS: trend odds ratio [OR] = 1.24, 95% confidence interval [CI] 0.99-1.56; SHIP: trend OR = 1.34, 95% CI 1.18-1.52) and incident RLS (DHS: trend OR = 1.32, 95% CI 1.04-1.68; SHIP: trend OR = 1.59, 95% CI 1.37-1.85) after adjustment for several covariates. The ORs for incident RLS associated with 3 or more comorbid diseases (DHS: OR = 2.51, 95% CI 1.18-5.34; SHIP: OR = 4.30, 95% CI 2.60-7.11) were higher than the ORs for any single disease. Multimorbidity was a strong risk factor for RLS in these 2 population-based cohort studies. The results support the hypothesis that cumulative disease burden is more important than the presence of a specific single disease in the pathophysiology of RLS. © 2014 American Academy of Neurology.

Adenosine receptors as markers of brain iron deficiency: Implications for Restless Legs Syndrome.

PubMed

Quiroz, César; Gulyani, Seema; Ruiqian, Wan; Bonaventura, Jordi; Cutler, Roy; Pearson, Virginia; Allen, Richard P; Earley, Christopher J; Mattson, Mark P; Ferré, Sergi

2016-12-01

Deficits of sensorimotor integration with periodic limb movements during sleep (PLMS) and hyperarousal and sleep disturbances in Restless Legs Syndrome (RLS) constitute two pathophysiologically distinct but interrelated clinical phenomena, which seem to depend mostly on alterations in dopaminergic and glutamatergic neurotransmission, respectively. Brain iron deficiency is considered as a main pathogenetic mechanism in RLS. Rodents with brain iron deficiency represent a valuable pathophysiological model of RLS, although they do not display motor disturbances. Nevertheless, they develop the main neurochemical dopaminergic changes found in RLS, such as decrease in striatal dopamine D 2 receptor density. On the other hand, brain iron deficient mice exhibit the characteristic pattern of hyperarousal in RLS, providing a tool to find the link between brain iron deficiency and sleep disturbances in RLS. The present study provides evidence for a role of the endogenous sleep-promoting factor adenosine. Three different experimental preparations, long-term (22 weeks) severe or moderate iron-deficient (ID) diets (3- or 7-ppm iron diet) in mice and short-term (3 weeks) severe ID diet (3-ppm iron diet) in rats, demonstrated a significant downregulation (Western blotting in mouse and radioligand binding saturation experiments in rat brain tissue) of adenosine A 1 receptors (A1R) in the cortex and striatum, concomitant to striatal D2R downregulation. On the other hand, the previously reported upregulation of adenosine A 2A receptors (A2AR) was only observed with severe ID in both mice and rats. The results suggest a key role for A1R downregulation in the PLMS and hyperarousal in RLS. Published by Elsevier Ltd.

PERIODIC LIMB MOVEMENTS AND RESTLESS LEGS SYNDROME IN CHILDREN WITH A HISTORY OF PREMATURITY

PubMed Central

Cielo, Christopher M.; DelRosso, Lourdes M.; Tapia, Ignacio E.; Biggs, Sarah N.; Nixon, Gillian M.; Meltzer, Lisa J.; Traylor, Joel; Kim, Ji Young; Marcus, Carole L.

2017-01-01

Introduction Little is known about which children are at increased risk for restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Polysomnographic data from the Caffeine for Apnea of Prematurity-Sleep (CAPS) study showed a high prevalence of elevated periodic limb movement index in a cohort of ex-preterm children, but the clinical importance of this finding, such as association with RLS, is unknown. We hypothesized that ex-preterm children would have a high prevalence of RLS and PLMD. Methods Ex-preterm children enrolled in CAPS, now aged 5-12 years, completed home polysomnography and standardized questionnaires. A diagnosis of RLS or PLMD was established by participants meeting the International Classification of Sleep Disorders, 3rd edition criteria based on questionnaires and polysomnograms. Clinically available serum ferritin levels were assessed. Results 167 participants underwent polysomnography and completed all questionnaires. The overall prevalence of RLS was 14/167 (8.4%). An additional 13 subjects (7.8%) were found to have PLMD. Of the 26 participants who had >5 periodic limb movements/hour, 7 (26.9%) had RLS and 13 (50%) had PLMD. Serum ferritin levels were <50 mcg/L (range 11 to 38.4) for all 8 participants referred for testing. Conclusions Children with a history of prematurity have a high prevalence of RLS, particularly those with elevated periodic limb movements. Iron deficiency likely contributes to RLS and PLMD symptoms in this population. Clinicians evaluating ex-preterm children with sleep disturbances should evaluate for RLS and PLMD. Further studies including serum ferritin evaluation are needed to confirm these findings. PMID:28215268

Restless leg syndrome in different types of demyelinating neuropathies: a single-center pilot study.

PubMed

Luigetti, Marco; Del Grande, Alessandra; Testani, Elisa; Bisogni, Giulia; Losurdo, Anna; Giannantoni, Nadia Mariagrazia; Mazza, Salvatore; Sabatelli, Mario; Della Marca, Giacomo

2013-09-15

to determine the prevalence of restless legs syndrome (RLS) in a cohort of patients with demyelinating neuropathies. Patients were retrospectively recruited from our cohort of different forms of demyelinating neuropathies, including chronic inflammatory demyelinating neuropathy (CIDP), Charcot-Marie-Tooth 1A (CMT1A), and hereditary neuropathy with liability to pressure palsies (HNPP) referred to our Department of Neurology in a 10-year period. The validated 4-item RLS questionnaire was used for diagnosis of RLS. All patients with RLS who fulfilled criteria underwent a suggested immobilization test to confirm the diagnosis. A group of outpatients referred to the sleep disorders unit and data from published literature were used as controls. Prevalence of RLS in demyelinating neuropathy group was higher than prevalence observed in control population (p = 0.0142) or in the literature data (p = 0.0007). In particular, in comparison with both control population and literature data, prevalence of RLS was higher in CIDP group (p = 0.0266 and p = 0.0063, respectively) and in CMT1A group (p = 0.0312 and p = 0.0105, respectively), but not in HNPP (p = 1.000 and p = 0.9320, respectively). our study confirms a high prevalence of RLS in inflammatory neuropathies as CIDP and, among inherited neuropathies, in CMT1A but not in HNPP. Considering that this is only a small cohort from a single-center retrospective experience, the link between RLS and neuropathy remains uncertain, and larger multicenter studies are probably needed to clarify the real meaning of the association between RLS and neuropathy.

Haste makes waste: Decision making in patients with restless legs syndrome with and without augmentation.

PubMed

Heim, Beatrice; Pertl, Marie-Theres; Stefani, Ambra; Delazer, Margarete; Heidbreder, Anna; Zamarian, Laura; Brandauer, Elisabeth; Seppi, Klaus; Högl, Birgit; Poewe, Werner; Djamshidian, Atbin

2017-01-01

To investigate decision making in patients with primary restless legs syndrome (RLS) with and without augmentation treated with dopaminergic medication. A total of 64 non-demented RLS patients treated with dopaminergic medication with and without augmentation were included in this study. We used an information sampling task to assess how much evidence participants gather before making a decision. Performance was compared to the results of 21 healthy controls. All patients with and without augmentation gathered less information than healthy controls before making a decision (p<0.001), but there was no difference between the two patient groups (p = 1.0). Furthermore, both patient groups made more irrational decisions (e.g. decisions against the evidence they had at the time) than healthy controls (p≤0.002). In addition, RLS patients with augmentation made significantly more irrational decisions than RLS patients without augmentation (p = 0.037) and controls (p<0.001). Our results show that RLS patients treated with dopaminergic drugs, regardless of having augmentation or not, jumped to conclusions and decided significantly more often against the evidence they had at the time of their decision. However, those with augmentation performed worse than all other groups and made more often irrational decisions, a phenomenon which is also common in patients with substance abuse or behavioural addictions. Thus, jumping to conclusions and deciding with a higher degree of uncertainty as well as irrational decision making is more common in RLS patients treated with dopaminergic medication particularly in those with augmentation.

Rotigotine transdermal system: developing continuous dopaminergic delivery to treat Parkinson's disease and restless legs syndrome.

PubMed

Benitez, Arturo; Edens, Heather; Fishman, Jesse; Moran, Kimberly; Asgharnejad, Mahnaz

2014-11-01

Rotigotine is a nonergoline dopamine receptor agonist with structural similarity to dopamine. Rotigotine binds to the D1 through D5 dopamine receptors, having several times more affinity than dopamine does to the D2 and D3 receptors. Although rotigotine was demonstrated to restore locomotor activity in animal models of Parkinson's disease (PD), the rapid metabolism of rotigotine limited the development of an orally administered formulation. Rotigotine's high lipid solubility and extended duration of action when applied to the skin in experimental models of PD suggested that rotigotine was a candidate for transdermal application. The constant transdermal delivery of rotigotine over 24 h is hypothesized to approximate continuous agonist-receptor stimulation, which conceptually more closely mimics physiologic striatal dopamine receptor function. Randomized clinical studies have demonstrated rotigotine's efficacy, safety, and tolerability in patients with early- and advanced-stage PD, including improvements in motor symptoms and off-time. Although the etiology is unknown, restless legs syndrome (RLS) is thought to involve dopaminergic dysregulation. Randomized clinical studies also have demonstrated the efficacy of rotigotine in improving the symptoms of moderate-to-severe primary RLS. This review examines rotigotine's developmental history for transdermal administration leading to its approval for the treatment of early- and advanced-stage PD and moderate-to-severe primary RLS. © 2014 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.

Gamma-aminobutyric acid (GABA) receptors genes polymorphisms and risk for restless legs syndrome.

PubMed

Jiménez-Jiménez, Félix Javier; Esguevillas, Gara; Alonso-Navarro, Hortensia; Zurdo, Martín; Turpín-Fenoll, Laura; Millán-Pascual, Jorge; Adeva-Bartolomé, Teresa; Cubo, Esther; Navacerrada, Francisco; Amo, Gemma; Rojo-Sebastián, Ana; Rubio, Lluisa; Díez-Fairén, Mónica; Pastor, Pau; Calleja, Marisol; Plaza-Nieto, José Francisco; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; García-Albea, Esteban; Agúndez, José A G; García-Martín, Elena

2018-05-03

The possible role of gammaaminobutyric acid (GABA) in the pathophysiology of restless legs syndrome (RLS) is suggested by the symptomatic improvement achieved with GABAergic drugs. Thalamic GABA levels have shown positive correlation with periodic limb movements indices and with RLS severity. We tried to investigate the possible association between the most common single nucleotide polymorphisms (SNPs) in the GABA receptors (GABR) genes rho1, 2, and 3 (GABRR1, GABRR2, GABRR3), alpha4 (GABRA4), epsilon (GABRE), and theta (GABRQ) with the risk of developing RLS. We studied the genotype and allelic variant frequencies of the most common SNPs in the GABRR1(rs12200969, rs1186902), GABRR2(rs282129), GABRR3(rs832032), GABRA4(rs2229940), GABRE(rs1139916), and GABRQ(rs3810651) genes in 205 RLS patients and 230 age- and gender-matched healthy controls using specific TaqMan assays. The frequencies of the GABRR3 rs832032TT genotype and the allelic variant GABRR3 rs832032T were significantly higher in RLS patients than in controls (odds ratio [95% confidence intervals] 7.08[1.48-46.44] and 1.66[1.16-2.37], respectively), although only the higher frequency of the rs832032T allele remained as significant after multiple comparison analysis, both in the whole series and in the female gender. The frequencies of the other genotypes of allelic variants did not differ significantly between RLS patients and controls. RLS patients carrying the GABRA4 rs2229940TT genotype showed a significantly younger age at onset of RLS symptoms than those with the other two genotypes. These results suggest association between GABRR3rs832032 polymorphism and the risk for RLS, and a modifier effect of GABRA4 rs2229940 on the age of onset of RLS.

Psychological distress of patients suffering from restless legs syndrome: a cross-sectional study

PubMed Central

2011-01-01

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. PMID:21933380

Restless Legs Symptoms and Pregnancy and Neonatal Outcomes.

PubMed

Oyieng'o, D Onentia; Kirwa, Kipruto; Tong, Iris; Martin, Susan; Antonio Rojas-Suarez, José; Bourjeily, Ghada

2016-02-01

Restless legs syndrome (RLS) is a commonly occurring neurologic disorder that affects up to one third of women during pregnancy. RLS has been associated with increased sympathetic tone in the nonpregnant population. We examined whether a RLS surrogate is associated with a higher prevalence of pregnancy and neonatal outcomes. Data were analyzed from a cross-sectional survey of 1000 women interviewed soon after delivery by using an RLS surrogate question. Women were asked how frequently (0 = none, 1 = rarely [<1 time/week], 2 = sometimes [1-2 times/week], 3 = frequently [3-4 times/week], and 4 = always [5-7 times/week]) they had "experienced jumpy or jerky leg movements" in the last 3 months of pregnancy. Clinical charts were reviewed to obtain relevant demographic and clinical data, including the presence of gestational hypertensive disorders and neonatal outcomes at birth. Subjects who "always" experienced RLS were compared with subjects experiencing symptoms less frequently or not at all with respect to prevalence of gestational hypertensive disorder. The mean ([SD]) age, prepregnancy body mass index (BMI), and BMI at delivery were 29.0 (6.1) years, 26.1 (6.2) kg/m(2), and 32.0 (6.3) kg/m(2), respectively. The overall prevalence of the RLS surrogate (jumpy or jerky leg movements) was 35.5% with the following distribution on a Likert scale: score 1 = 6.4%; score 2 = 10.2%; score 3 = 8.1%; and score 4 = 10.8%. Chronic hypertension was present in 2.1%, pregnancy-induced hypertension in 9.5%, and preeclampsia in 4.5% of respondents. Subjects who reported "always" having sensations of jumpy or jerky legs were more likely to have gestational hypertensive disorders compared with those who reported less frequent occurrence of the symptoms. Adjusted odds ratios were 3.74 (95% CI, 1.31-10.72; P = 0.014) for chronic hypertension; 1.26 (95% CI, 0.65-2.46; P = 0.487) for pregnancy-induced hypertension; and 2.15 (95% CI, 0.97-4.75; P = 0.060) for preeclampsia. There was a

Periodic limb movements and restless legs syndrome in children with a history of prematurity.

PubMed

Cielo, Christopher M; DelRosso, Lourdes M; Tapia, Ignacio E; Biggs, Sarah N; Nixon, Gillian M; Meltzer, Lisa J; Traylor, Joel; Kim, Ji Young; Marcus, Carole L

2017-02-01

Little is known about the pediatric population at an increased risk of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Polysomnographic data from the Caffeine for Apnea of Prematurity-Sleep (CAPS) study showed a high prevalence of elevated periodic limb movement index (PLMI) in a cohort of ex-preterm children, but the clinical importance of this finding, such as association with RLS, is unknown. We hypothesized that ex-preterm children would have a high prevalence of RLS and PLMD. Ex-preterm children enrolled in CAPS, now aged 5-12 years, completed home polysomnography (PSG) and standardized questionnaires. A diagnosis of RLS or PLMD was established by participants meeting the International Classification of Sleep Disorders, 3rd edition, criteria based on questionnaires and polysomnograms. The clinically available serum ferritin levels were assessed. In total, 167 participants underwent polysomnography and completed all questionnaires. The overall prevalence of RLS was 14/167 (8.4%). An additional 13 subjects (7.8%) were found to have PLMD. Of the 26 participants who had PLMI > 5/h, seven (26.9%) had RLS and 13 (50%) had PLMD. The serum ferritin levels were <50 mcg/L (range -38.4) for all eight participants referred for testing. Children with a history of prematurity have a high prevalence of RLS, particularly those with elevated periodic limb movements. Iron deficiency likely contributes to RLS and PLMD symptoms in this population. Clinicians evaluating ex-preterm children with sleep disturbances should evaluate for RLS and PLMD. Further studies including serum ferritin evaluation are required to confirm these findings. Copyright © 2016 Elsevier B.V. All rights reserved.

Allocating provider resources to diagnose and treat restless legs syndrome: a cost-utility analysis.

PubMed

Padula, William V; Phelps, Charles E; Moran, Dane; Earley, Christopher

2017-10-01

Restless legs syndrome (RLS) is a neurological disorder that is frequently misdiagnosed, resulting in delays in proper treatment. The objective of this study was to analyze the cost-utility of training primary care providers (PCP) in early and accurate diagnosis of RLS. We used a Markov model to compare two strategies: one where PCPs received training to diagnose RLS (informed care) and one where PCPs did not receive training (standard care). This analysis was conducted from the US societal and health sector perspectives over one-year, five-year, and lifetime (50-year) horizons. Costs were adjusted to 2016 USD, utilities measured as quality-adjusted life-years (QALYs), and both measures were discounted annually at 3%. Cost, utilities, and probabilities for the model were obtained through a comprehensive review of literature. An incremental cost-effectiveness ratio (ICER) was calculated to interpret our findings at a willingness-to-pay threshold of $100,000/QALY. Univariate and multivariate analyses were conducted to test model uncertainty, in addition to calculating the expected value of perfect information. Providing training to PCPs to correctly diagnose RLS was cost-effective since it cost $2021 more and gained 0.44 QALYs per patient over the course of a lifetime, resulting in an ICER of $4593/QALY. The model was sensitive to the utility for treated and untreated RLS. The probabilistic sensitivity analysis revealed that at $100,000/QALY, informed care had a 65.5% probability of being cost-effective. A program to train PCPs to better diagnose RLS appears to be a cost-effective strategy for improving outcomes for RLS patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Is nocturnal eating in restless legs syndrome linked to a specific psychopathological profile? A pilot study.

PubMed

Marconi, Sara; Scarlatti, Fabiano; Rizzo, Giovanni; Antelmi, Elena; Innamorati, Marco; Pompili, Maurizio; Brugnoli, Roberto; Belvederi Murri, Martino; Amore, Mario; Provini, Federica

2015-11-01

The purpose of the study was to evaluate psychological comorbidity in drug-naive or drug-free primary restless legs syndrome (p-RLS) patients with nocturnal eating disorder (NED), and to analyze the association of comorbid p-RLS and NED with obsessive-compulsive, mood and anxiety symptoms, and personality. Participants comprised 20 consecutive female outpatients with p-RLS, 10 without NED and 10 with NED, and 10 female controls matched for age. Both patients and controls were evaluated by the Hamilton Depression and the Anxiety Rating Scales, the State-Trait Anxiety Inventory, the Maudsley Obsessive Compulsive Inventory and the temperament and character inventory-revised. Compared to controls, p-RLS patients without and with NED had higher trait anxiety and current anxiety and obsessive-compulsive symptoms. p-RLS patients with NED also had significantly higher doubting compared to p-RLS patients without NED. Furthermore, groups differed for harm avoidance (HA), with p-RLS patients with and without NED having higher scores than controls. Untreated p-RLS patients, particularly those with nocturnal eating, report anxiety and obsessive-compulsive symptoms, perceive stressful situations as dangerous and threatening and tend to respond with anxiety to such situations. They have higher tendency to respond intensely to aversive stimuli, inhibiting behavior to avoid punishment, novelty, and frustrative omission of expected rewards. We hypothesize that higher levels of HA, a biologically determined personality trait, might constitute a diathesis predisposing individuals to display obsessive-compulsive symptoms, namely increasingly severe compulsive nocturnal eating.

Rotigotine in the treatment of primary restless legs syndrome: A meta-analysis of randomized placebo-controlled trials.

PubMed

Ding, Jun; Fan, Wei; Chen, Hong-hui; Yan, Peng; Sun, Sheng-gang; Zheng, Jin

2015-04-01

The aim of this study was to summarize the efficacy and tolerability of rotigotine in the treatment of primary restless legs syndrome (RLS). PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for English-language randomized controlled trials (RCTs) that assessed the effectiveness of rotigotine for RLS. The pooled mean change from baseline in International RLS (IRLS) Study Group Rating Scalescore and relative risk (RR) of response based on the Clinical Global Impression-Improvement (CGI-I) scale score were applied to evaluate the outcomes. The pooled proportions of adverse events (AEs) were also estimated. Six RCTs were included. The meta-analysis showed a favorable effectiveness of rotigotine versus placebo on RLS [mean change on IRLS score: mean difference (MD)=-4.80; 95% confidence interval (CI): -5.90 to -3.70; P<0.00001 and RR of response on CGI-I was 2.19; 95% CI: 1.86 to 2.58, P<0.00001]. The most common AEs were application site reactions, nausea, headache and fatigue. In general, rotigotine was well-tolerated in patients with primary RLS. Based on the findings from the meta-analysis, rotigotine was more significantly efficacious in the treatment of RLS than placebo. Nevertheless, long-term studies and more evidence of comparisons of rotigotine with other dopamine agonists are needed.

A prospective study of Willis-Ekbom disease/restless legs syndrome during and after pregnancy.

PubMed

Neyal, Abdurrahman; Senel, Gulcin Benbir; Aslan, Rahime; Nalbantoglu, Mecbure; Acikgoz, Serdar; Yilmaz, Nevin; Tumay, Feray Bolukbasi; Neyal, Munife; Karadeniz, Derya

2015-09-01

Willis-Ekbom disease/restless legs syndrome (WED/RLS) is the most common sleep-related movement disorder in pregnancy. We designed a prospective longitudinal study to investigate the correlates of WED/RLS during and after pregnancy. A total of 138 pregnant women with WED/RLS and a control group of 251 age-matched pregnant women were enrolled prospectively. A questionnaire was administered during a face-to-face interview at first evaluation during pregnancy and three months after delivery. Among all women in the first trimester, 15.6% were diagnosed with WED/RLS, whereas 32.8% of those in the second trimester and 38.8% of those in the third trimester were diagnosed with WED/RLS (p = 0.032). In regression analysis, later gestational age [p < 0.001; odds ratio (OR) 1.054] and previous history of WED/RLS (p = 0.001; OR 2.795) were positively correlated with the presence of WED/RLS, while ferritin levels (p = 0.001; OR 0.956) were negatively correlated with the presence of WED/RLS. Ferritin levels were also negatively correlated with the International RLS Study Group severity index (p = 0.041). Forty-eight patients (34.8%) experienced WED/RLS symptomatology after delivery. The ferritin levels were lower, and the mean number of pregnancies was higher, in women with residual WED/RLS (p = 0.008). Our survey showed that WED/RLS was more common in the second and third trimesters. Emergence of WED/RLS during the second trimester was strongly associated with residual WED/RLS. Lower ferritin levels were associated with both WED/RLS in pregnancy and residual WED/RLS after delivery. A higher number of pregnancies were also associated with a greater likelihood of having residual WED/RLS after delivery. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Restless Legs Syndrome and Depression: Effect Mediation by Disturbed Sleep and Periodic Limb Movements.

PubMed

Koo, Brian B; Blackwell, Terri; Lee, Hochang B; Stone, Katie L; Louis, Elan D; Redline, Susan

2016-11-01

To investigate an association between restless legs syndrome (RLS) and depression and to what extent sleep disturbance, periodic limb movements during sleep (PLMS), and antidepressant medication mediate this relationship. A cross-sectional analysis was conducted of the Osteoporotic Fractures in Older Men Study data in 982 men assessed for RLS (International RLS Study Group scale [IRLSS]) and depression (Geriatric Depression Scale [GDS]), who underwent actigraphy (for sleep latency/efficiency) and polysomnography (for PLMS). Men were split into three groups: no RLS (N = 815), mild RLS (IRLSS ≤ 12, N = 85), moderate-to-severe RLS (IRLSS > 12, N = 82). Depression was defined as GDS score ≥ 6. Logistic and linear regression assessed associations of RLS and depression or number depressive symptoms, respectively. Models were adjusted for age, site, race, education, body mass index, personal habits, benzodiazepine/dopaminergic medication, physical activity, cardiovascular risk factors, and apnea-hypopnea index. Of 982 men, 167 (17.0%) had RLS. Depression was significantly associated with moderate-to-severe RLS after adjustment (versus no RLS: OR [95% CI] 2.85 [1.23, 6.64]). Further adjustment for potential mediators attenuated effect size modestly, most for sleep efficiency (OR: 2.85-2.55). Compared with no RLS, moderate-to-severe RLS was associated with the number of depressive symptoms after adjustment (adjusted means [95% CI]; no RLS: 1.14 [1.05, 1.24] versus IRLSS > 12: 1.69 [1.32, 2.11]). Further adjustment for potential mediators did not alter effect size. For men with PLMS index at least median, number of depressive symptoms significantly increased as RLS category became more severe. Depression is more common as RLS severity worsens. The RLS-depression relationship is modestly explained by sleep disturbance and PLMS. Published by Elsevier Inc.

Patients suffering from restless legs syndrome have low internal locus of control and poor psychological functioning compared to healthy controls.

PubMed

Brand, Serge; Beck, Johannes; Hatzinger, Martin; Holsboer-Trachsler, Edith

2013-01-01

Restless legs syndrome (RLS) is a disturbing sensorimotor disorder negatively influencing both sleep and psychological functioning. The aim of the present study was to assess RLS patients with respect to locus of control, sleep-related personality traits, quality of life, and sleep as compared to healthy controls. Thirty-eight patients (18 females and 20 males; mean age: 56.06 years) diagnosed with RLS and an age- and gender-matched control group (n = 42) were recruited. Participants completed a series of questionnaires related to locus of control, personality traits, quality of life, and sleep. Compared to healthy controls, RLS patients had a lower internal locus of control, unfavourable sleep-related personality traits such as low self-confidence and higher mental arousal, poorer quality of life, and more depressive symptoms. Sleep was also affected. Multiple regression analyses showed that a low internal and a high external locus of control were predicted by RLS. The pattern of results suggests that RLS is associated with a low locus of control, negative personality traits, and poor quality of life as compared to healthy controls. Copyright © 2013 S. Karger AG, Basel.

Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke.

PubMed

Walters, Arthur S; Rye, David B

2009-05-01

Evidence is reviewed documenting an intimate relationship among restless legs syndrome (RLS) / periodic limb movements in sleep (PLMS) and hypertension and cardiovascular and cerebrovascular disease. Sympathetic overactivity is associated with RLS/PLMS, as manifested by increased pulse rate and blood pressure coincident with PLMS. Causality is far from definitive. Mechanisms are explored as to how RLS/PLMS may lead to high blood pressure, heart disease, and stroke: (a) the sympathetic hyperactivity associated with RLS/PLMS may lead to daytime hypertension that in turn leads to heart disease and stroke; (b) in the absence of daytime hypertension, this sympathetic hyperactivity may predispose to heart disease and stroke either directly or indirectly via atherosclerotic plaque formation and rupture; and (c) comorbidities associated with RLS/PLMS, such as renal failure, diabetes, iron deficiency, and insomnia, may predispose to heart disease and stroke. One theoretical cause for sympathetic hyperactivity is insufficient All diencephalospinal dopaminergic neuron inhibition of sympathetic preganglionic neurons residing in the intermediolateral cell columns of the spinal cord. We cannot exclude the possibility that peripheral vascular, cardiovascular, and cerebrovascular disease may also contribute to RLS/PLMS, and mechanisms for these possibilities are also discussed.

Rotigotine in Hemodialysis-Associated Restless Legs Syndrome: A Randomized Controlled Trial.

PubMed

Dauvilliers, Yves; Benes, Heike; Partinen, Markku; Rauta, Virpi; Rifkin, Daniel; Dohin, Elisabeth; Goldammer, Nadine; Schollmayer, Erwin; Schröder, Hanna; Winkelman, John W

2016-09-01

Restless legs syndrome (RLS) has been associated with insomnia, decreased quality of life, and increased morbidity and mortality in end-stage renal disease. This randomized controlled trial investigated effects of rotigotine in patients with RLS and end-stage renal disease. Double-blind placebo-controlled study. Adults with moderate to severe RLS (International RLS Study Group Rating Scale [IRLS] ≥ 15) and Periodic Limb Movement Index (PLMI) ≥ 15 who were receiving thrice-weekly hemodialysis enrolled from sites in the United States and Europe. Following randomization and titration (≤21 + 3 days) to optimal-dose rotigotine (1-3mg/24 h) or placebo, patients entered a 2-week maintenance period. Polysomnography was performed at baseline and the end of maintenance. Primary efficacy outcome: reduction in PLMI, assessed by ratio of PLMI at end of maintenance to baseline. Secondary/other outcomes (P values exploratory) included mean changes from baseline in PLMI, IRLS, and Clinical Global Impression item 1 (CGI-1 [severity of illness]) score. 30 patients were randomly assigned (rotigotine, 20; placebo, 10); 25 (15; 10) completed the study with evaluable data. Mean (SD) PLMI ratio (end of maintenance to baseline) was 0.7±0.4 for rotigotine and 1.3±0.7 for placebo (analysis of covariance treatment ratio, 0.44; 95% CI, 0.22 to 0.88; P=0.02). Numerical improvements were observed with rotigotine versus placebo in IRLS and CGI-1 (least squares mean treatment differences of -6.08 [95% CI, -12.18 to 0.02; P=0.05] and -0.81 [95% CI, -1.94 to 0.33; P=0.2]). 10 of 15 rotigotine and 2 of 10 placebo patients were CGI-1 responders (≥50% improvement). Hemodialysis did not affect unconjugated rotigotine concentrations. The most common adverse events (≥2 patients) were nausea (rotigotine, 4 [20%]; placebo, 0); vomiting (3 [15%]; 0); diarrhea (1 [5%]; 2 [20%]); headache (2 [10%]; 0); dyspnea (2 [10%]; 0); and hypertension (2 [10%]; 0). Small sample size and short

Efficacy of Pramipexole for the Treatment of Primary Restless Leg Syndrome: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

PubMed

Liu, Guang Jian; Wu, Lang; Lin Wang, Song; Xu, Li Li; Ying Chang, Li; Fu Wang, Yun

2016-01-01

The objective of this meta-analysis was to systematically evaluate the efficacy of pramipexole for the treatment of primary moderate-to-severe restless leg syndrome (RLS). Databases of PubMed, OVID, ScienceDirect, SpringerLink, Thomson Reuters Web of Science, the Cochrane Library, the Wiley Online Library, ArticleFirst, CALIS, Study, CNKI, and WanFang were searched to identify randomized controlled trials (RCTs) investigating pramipexole for the treatment of primary moderate-to-severe RLS. A meta-analysis was then conducted to pool results. Twelve RCTs involving 3286 participants were included in this study. The mean (SD) treatment duration was 11.12 (5.72) weeks/person. The meta-analysis found that the post-treatment change in the International Restless Leg Syndrome Study Group Rating Scale (IRLS) score of the pramipexole group was significantly superior to that of the placebo group (weighted mean difference [WMD] = -4.64; 95% CI, -5.95 to -3.33; n = 8). More patients in the pramipexole group reported at least a 50% reduction in the IRLS score after treatment (risk ratio [RR] = 1.57; 95% CI, 1.43 to 1.73; n = 8). In terms of the scores for the Clinical Global Impression of Improvement scale (RR = 1.48; 95% CI, 1.31 to 1.66; n = 11) and the Patient Global Impression scale (RR = 1.54; 95% CI, 1.31 to 1.81; n = 9), treatment outcomes of the pramipexole group were significantly superior to those of the placebo group. In terms of the change in quality of life (WMD = 5.39; 95% CI, 2.28 to 8.50; n = 4), the change in daytime tiredness (WMD = -0.61; 95% CI, -1.21 to -0.01; n = 4), the change in the number of periodic limb movements per hour of sleep (WMD = -35.95; 95% CI, -56.42 to -15.48; n = 3), and the change in the quality of sleep (WMD = 3.60; 95% CI, 1.69 to 5.50; n = 6), the treatment outcomes of the pramipexole group were significantly superior to those of the placebo group. This meta-analysis study indicated that pramipexole could effectively improve the symptoms

Rotigotine's effect on PLM-associated blood pressure elevations in restless legs syndrome

PubMed Central

Cassel, Werner; Benes, Heike; Kesper, Karl; Rye, David; Sica, Domenic; Winkelman, John W.; Bauer, Lars; Grieger, Frank; Joeres, Lars; Moran, Kimberly; Schollmayer, Erwin; Whitesides, John; Carney, Hannah C.; Walters, Arthur S.; Oertel, Wolfgang; Trenkwalder, Claudia

2016-01-01

Objective: This double-blind, placebo-controlled, interventional trial was conducted to investigate the effects of rotigotine patch on periodic limb movement (PLM)–associated nocturnal systolic blood pressure (SBP) elevations. Methods: Patients with moderate to severe restless legs syndrome (RLS) were randomized to rotigotine (optimal dose [1–3 mg/24 h]) or placebo. Continuous beat-to-beat blood pressure (BP) assessments were performed during polysomnography at baseline and at the end of 4-week maintenance. Primary outcome was change in number of PLM-associated SBP elevations (defined as slope of linear regression ≥2.5 mm Hg/beat-to-beat interval over 5 consecutive heartbeats [≥10 mm Hg]). Additional outcomes were total SBP elevations, PLM-associated and total diastolic BP (DBP) elevations, periodic limb movements index (PLMI), and PLM in sleep arousal index (PLMSAI). Results: Of 81 randomized patients, 66 (37 rotigotine, 29 placebo) were included in efficacy assessments. PLM-associated SBP elevations were significantly reduced with rotigotine vs placebo (least squares mean treatment difference [95% confidence interval (CI)] −160.34 [−213.23 to −107.45]; p < 0.0001). Rotigotine-treated patients also had greater reduction vs placebo in total SBP elevations (−161.13 [−264.47 to −57.79]; p = 0.0028), PLM-associated elevations (−88.45 [−126.12 to −50.78]; p < 0.0001), and total DBP elevations (−93.81 [−168.45 to −19.16]; p = 0.0146), PLMI (−32.77 [−44.73 to −20.80]; p < 0.0001), and PLMSAI (−7.10 [−11.93 to −2.26]; p = 0.0047). Adverse events included nausea (rotigotine 23%; placebo 8%), headache (18% each), nasopharyngitis (18%; 8%), and fatigue (13%; 15%). Conclusions: Further investigation is required to determine whether reductions in nocturnal BP elevations observed with rotigotine might modify cardiovascular risk. Classification of evidence: This study provides Class I evidence that for patients with moderate to severe

Gabapentin enacarbil, pregabalin and rotigotine are equally effective in restless legs syndrome: a comparative meta-analysis.

PubMed

Iftikhar, I H; Alghothani, L; Trotti, L M

2017-12-01

To synthesize evidence from available randomized controlled trials (RCT) to compare the efficacies of dopaminergic drugs (pramipexole, ropinirole and rotigotine) and α-2-δ ligands (gabapentin enacarbil and pregabalin) for the treatment of restless legs syndrome (RLS). We searched PubMed for all eligible RCTs. Network meta-analysis using frequentist methodology with random effect models was performed for mean changes in scores on the International RLS Study Group Rating Scale (IRLS) and for responder rates on Clinical Global Impressions-Improvement (CGI-I); analyzed as odds ratio (OR). Network meta-analysis of mean changes in IRLS data from 35 studies with 7333 participants showed that all treatments, in specific gabapentin enacarbil, followed by pregabalin and rotigotine were superior to placebo [mean reduction in IRLS scores: -5.31 (-6.74 to -3.87), -5.20 (-6.91 to -3.49), 5.17 (3.73-6.61), respectively] but there were no significant differences between active treatments. Network meta-analysis of 5137 participants from 24 studies showed that gabapentin enacarbil and rotigotine were associated with the highest CGI-I response rates [ORs: 5.68; (95% CI, 4.14-7.21); and 4.68 (2.87-6.49), compared to placebo, respectively]. No significant inter-treatment differences exist, except for that between gabapentin enacarbil and ropinirole. Based on IRLS scores and CGI-I response rates, while gabapentin enacarbil, pregabalin and rotigotine stand out as the most efficacious of all examined drugs, it is noteworthy that no significant inter-treatment differences exist, except for that between gabapentin enacarbil and ropiniriole (for CGI-I response rates). © 2017 EAN.

Regular intake of non-opioid analgesics is associated with an increased risk of restless legs syndrome in patients maintained on antidepressants.

PubMed

Leutgeb, U; Martus, P

2002-08-30

To evaluate prevalence and risk factors of restless legs syndrome (RLS) in secondary-care patients maintained on tricyclic and serotonin reuptake inhibiting antidepressants. A total of 243 subjects with affective and anxiety disorders were interviewed for symptoms of RLS before and after at least 6 months of antidepressant pharmacotherapy within a naturalistic study. Logistic regression analysis was applied to adjust for the effects of age, gender, comorbidities, and the most frequent co-medications. The overall prevalence of RLS was 27%. In the RLS-affected patients, regular use or overuse of non-opioid analgesics frequently combined with caffeine was the major risk factor which significantly correlated with psychiatric and medical comorbidity. In a subsample of 172 patients who had seldom taken analgesics the prevalence of RLS was 9%, which corresponds with its prevalence in the general population. Neither antidepressants nor neuroleptics but non-opioid analgesics appear to be a major risk factor of RLS. Their regular use should be considered in studies of RLS-patients on psychotropic or other drugs. In this sample of secondary-care patients, ICD-10 classified depression or anxiety per se did not appear to be a risk factor of RLS.

Unfavorable polysomnographic sleep patterns predict poor sleep and poor psychological functioning 3 years later in patients with restless legs syndrome.

PubMed

Brand, Serge; Beck, Johannes; Hatzinger, Martin; Savic, Mirjana; Holsboer-Trachsler, Edith

2011-01-01

Amongst the variety of disorders affecting sleep, restless legs syndrome (RLS) merits particular attention. Little is known about long-term outcomes for sleep or psychological functioning following a diagnosis of RLS. The aim of the present study was thus to evaluate sleep and psychological functioning at a 3-year follow-up and based on polysomnographic measurements. Thirty-eight patients (18 female and 20 male patients; mean age: 56.06, SD = 12.07) with RLS and sleep electroencephalographic recordings were followed-up 33 months later. Participants completed a series of self-rating questionnaires related to sleep and psychological functioning. Additionally, they completed a sleep log for 7 consecutive days. Age, male gender, increased light sleep (S1, S2) and sleep onset latency, along with low sleep efficiency, predicted psychological functioning and sleep 33 months later. Specifically, sleep fragmentation predicted poor psychological functioning, and both sleep fragmentation and light sleep predicted poor sleep. In patients with RLS, irrespective of medication or duration of treatment, poor objective sleep patterns at diagnosis predicted both poor psychological functioning and poor sleep about 3 years after diagnosis. The pattern of results suggests the need for more thorough medical and psychotherapeutic treatment and monitoring of patients with RLS. © 2010 S. Karger AG, Basel.

Distal muscle activity alterations during the stance phase of gait in restless leg syndrome (RLS) patients.

PubMed

Dafkin, Chloe; Green, Andrew; Olivier, Benita; McKinon, Warrick; Kerr, Samantha

2018-05-01

To assess if there is a circadian variation in electromyographical (EMG) muscle activity during gait in restless legs syndrome (RLS) patients and healthy control participants. Gait assessment was done in 14 RLS patients and 13 healthy control participants in the evening (PM) and the morning (AM). Muscle activity was recorded bilaterally from the tibialis anterior (TA), lateral gastrocnemius (GL), rectus femoris (RF) and biceps femoris (BF) muscles. A circadian variation during the stance phase in only TA (PM > AM, p < 0.005) and BF (PM < AM, p = 0.008) activity was observed in control participants. Conversely no circadian variation was seen in any muscles in the RLS patients. RLS patients had an increased TA and GL activity (RLS > Controls, p < 0.05) during early stance and decreased GL activity (RLS < Controls, p < 0.01) during terminal stance in comparison to control participants in the evening. No other significant differences were noted between RLS patients and control participants. Activation of GL during the swing phase was noted in 79% of RLS patients and in 23% of control participants in the morning compared to 71% and 38% in the evening, respectively. EMG muscle activity shows no circadian variation in RLS patients. Evening differences in gait muscle activation patterns between RLS patients and control participants are evident. These results extend our knowledge about alterations in spinal processing during gait in RLS. A possible explanation for these findings is central pattern generator sensitization caused by increased sensitivity in cutaneous afferents in RLS patients. Copyright © 2018 Elsevier B.V. All rights reserved.

Management of augmentation of restless legs syndrome with rotigotine: a 1-year observational study.

PubMed

Trenkwalder, Claudia; Canelo, Monica; Lang, Michael; Schroeder, Hanna; Kelling, Daniela; Berkels, Reinhard; Schollmayer, Erwin; Heidbrede, Tanja; Benes, Heike

2017-02-01

The aim of this study is to assess the effect of switching to rotigotine transdermal patch on severity of restless legs syndrome (RLS) in patients who experienced acute augmentation with previous oral dopaminergics. In this 13-month observational study, adults with moderate-to-severe RLS and augmentation were switched to rotigotine per the physician's independent decision. Assessments included Clinical Global Impression severity score (CGI-1); (primary), treatment regimen for switching (secondary), RLS-6, International RLS Study Group Rating Scale (IRLS), and augmentation severity rating scale (ASRS). A total of 99 patients received rotigotine, of whom 46 completed observational period, and 43 were assessed for effectiveness. A total of 5 patients switched to rotigotine after a >1-day drug holiday, 23 switched overnight, 9 had an overlapping switch, and 6 received ongoing oral dopaminergics with rotigotine for ≥28 days. Of the 99 patients, 57 took concomitant RLS medications (excluding switching medications) on at least 1 day. At the final visit, median change in CGI-1 (Hodges-Lehman estimate [95% CI]) was -2.0 (-2.5, -1.50); 37 of the 43 patients improved by ≥1 CGI-1 category, and 16 of 43 were responders (≥50% improvement). RLS-6 and IRLS scores also improved. Patients had median ASRS of 0 at the final visit indicating "no worsening/occurrence of augmentation." ASRS item 1 showed a shift in mean time of symptom onset (24-h clock) from 12:38 (baseline) to 18:25 (final visit). Most common reasons for withdrawal of rotigotine were adverse events (26 patients) and lack of efficacy (14 patients). Switching from oral therapies to rotigotine was effective in improving RLS symptoms in 37 of the 43 patients (from the original population of 99 patients) who remained in the study over 13 months. ClinicalTrials.govNCT01386944. Copyright © 2015 Elsevier B.V. All rights reserved.

Alterations in Pain Responses in Treated and Untreated Patients with Restless Legs Syndrome: Associations with Sleep Disruption

PubMed Central

Edwards, Robert R; Quartana, Phillip J.; Allen, Richard P; Greenbaum, Seth; Earley, Christopher J; Smith, Michael T

2011-01-01

Objective There has been recent interest in characterizing potential abnormalities of pain processing in patients with sleep disorders such as Restless Legs Syndrome (RLS). The aim of this study was to evaluate psychophysical responses to noxious heat and pressure stimuli in both treated and untreated RLS patients, compared to matched controls. Methods This study is a cross-sectional group comparison of RLS patients with matched controls. A total of 31 patients (15 treated, 16 untreated) with a confirmed diagnosis of RLS were compared to 18 controls with no history of RLS or related sleep disorders. Results RLS patients (both treated and untreated) demonstrated reduced pain thresholds and reported greater clinical pain relative to controls. Moreover, RLS patients demonstrated enhanced temporal summation of heat pain (p< .05), which may reflect aberrant central nervous system facilitation of pain transmission. Both treated and untreated RLS patients reported disrupted sleep relative to controls, and mediation analyses suggested that the reduced pain thresholds in RLS were attributable to sleep disturbance. However, the effect of RLS on the magnitude of temporal summation of heat pain was independent of sleep disturbance. Conclusions These findings suggest that central nervous system pain processing may be amplified in RLS, perhaps partially as a consequence of sleep disruption. RLS patients, even those whose symptoms are managed pharmacologically, may be at elevated long-term risk for the development or maintenance of persistent pain conditions. Further studies in larger samples could help to improve the prospects for pain management in RLS patients. PMID:21570347

Rotigotine improves restless legs syndrome: a 6-month randomized, double-blind, placebo-controlled trial in the United States.

PubMed

Hening, Wayne A; Allen, Richard P; Ondo, William G; Walters, Arthur S; Winkelman, John W; Becker, Philip; Bogan, Richard; Fry, June M; Kudrow, David B; Lesh, Kurt W; Fichtner, Andreas; Schollmayer, Erwin

2010-08-15

This randomized, double-blinded, placebo-controlled trial (NCT00135993) assessed efficacy and safety of the dopamine agonist rotigotine in the treatment of idiopathic restless legs syndrome (RLS) over a 6-month maintenance period. A total of 505 eligible participants with moderate to severe RLS (IRLS sum score >or= 15) were randomly assigned to five groups to receive either placebo or rotigotine (0.5, 1, 2, or 3 mg/24 hr) delivered by once-daily transdermal patch (fixed-dose regimen). The two co-primary efficacy parameters decreased from baseline to end of maintenance in IRLS sum score and in clinical global impressions (CGI-1) score. On both primary measures, 2 and 3 mg/24 hr rotigotine was superior to placebo (P < 0.001). Adjusted treatment differences to placebo for the IRLS sum score were -4.5 (95% CI: -6.9, -2.2) for 2 mg/24 hr rotigotine, -5.2 (95% CI: -7.5, -2.9) for 3 mg/24 hr rotigotine, and for CGI item 1 -0.65 (95% CI: -1.0, -0.3) and -0.9 (95% CI: -1.3, -0.5) for the 2 and 3 mg/24 hr doses, respectively. Skin reactions (27%) and known dopaminergic side effects such as nausea (18.1%) and headache (11.6%) were mostly mild or moderate in rotigotine subjects. Rotigotine transdermal patches releasing 2 to 3 mg/24 hr significantly reduced the severity of RLS symptoms. Treatment efficacy was maintained throughout the 6-month double-blind period.

The Effect of Massage With Lavender Oil on Restless Leg Syndrome in Hemodialysis Patients: A Randomized Controlled Trial.

PubMed

Hashemi, Sayyed Hossein; Hajbagheri, Ali; Aghajani, Mohammad

2015-12-01

Restless leg syndrome (RLS) is a common problem in patients with chronic renal failure. It can reduce the quality of life and sleep disturbances. This disorder is usually treated pharmacologically. Recently, complementary medicine methods have been suggested because of chemical drugs adverse effects. There is not enough evidence about the effect of aromatherapy on RLS. The aim of this study was to determine the effects of massage with lavender oil on RLS symptoms in hemodialysis patients. This randomized clinical trial study included 70 hemodialysis patients with RLS that were randomly assigned into two groups in 2014. The experimental group received effleurage massage using lavender oil and control group received routine care for three weeks. Data was collected with RLS questionnaire and analyzed using independent and paired t-test and Chi-square test. The mean RLS scores were not significantly different in the two groups at the start of study (22.41 ± 7.67 vs. 22.90 ± 4.38, P = 0.76). At the end of study, the mean RLS score significantly decreased in the intervention group, while this score remained relatively un-changed in the control group (12.41 ± 5.49 vs. 23.23 ± 4.52, P < 0.0001). Lavender oil massage was effective to improve RLS in hemodialysis patients. It has no adverse effects, is practical and cost-effective. It is suggested to be used along with routine treatment of RLS in hemodialysis patients.

Restless legs syndrome augmentation among Japanese patients receiving pramipexole therapy: Rate and risk factors in a retrospective study

PubMed Central

Takahashi, Masayoshi; Nishida, Shingo; Nakamura, Masaki; Kobayashi, Mina; Matsui, Kentaro; Ito, Eiki; Usui, Akira; Inoue, Yuichi

2017-01-01

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. PMID:28264052

Restless legs syndrome after high-risk TIA and minor stroke: association with reduced quality of life.

PubMed

Boulos, Mark I; Wan, Anthony; Black, Sandra E; Lim, Andrew S; Swartz, Richard H; Murray, Brian J

2017-09-01

Restless legs syndrome (RLS) is a movement disorder that is associated with poor quality of life and depressive symptoms in the general population. Emerging evidence suggests that RLS is closely associated with cerebrovascular disease. We assessed the effect of RLS on quality of life after stroke and transient ischemic attack (TIA). In this single-center prospective study, we recruited patients within 14 days of high-risk TIA or minor stroke. Patients were diagnosed with RLS using a questionnaire based on the 2003 International RLS Study Group criteria, and diagnoses were confirmed by a sleep neurologist. Follow-up assessments were conducted within 2-6 months of recruitment. The outcome of quality of life was measured using the Stroke-specific Quality of Life (SS-QoL). Of the 94 patients recruited into the study, 23 (24.4%) were diagnosed with RLS: 11 were newly diagnosed with RLS and 12 had RLS preceding the index stroke/TIA. There were no significant differences in baseline characteristics between those with or without RLS. Median SS-QoL in patients with RLS was lower at baseline (p = 0.008) and at follow-up (p = 0.002). RLS patients had more depressive symptoms at follow-up (p = 0.007). Ordinal logistic regression demonstrated that RLS was negatively associated with quality of life at baseline (OR = 0.28; p = 0.010) and at follow-up (OR = 0.14; p = 0.029), independent of functional outcome and depressive symptoms. RLS is common after stroke or TIA and negatively affects the quality of life. Screening for RLS after cerebrovascular events may be warranted, and future research should assess whether treatment of RLS can improve post-stroke quality of life. Copyright © 2017 Elsevier B.V. All rights reserved.

The Effect of Massage With Lavender Oil on Restless Leg Syndrome in Hemodialysis Patients: A Randomized Controlled Trial

PubMed Central

Hashemi, Sayyed Hossein; Hajbagheri, Ali; Aghajani, Mohammad

2015-01-01

Background: Restless leg syndrome (RLS) is a common problem in patients with chronic renal failure. It can reduce the quality of life and sleep disturbances. This disorder is usually treated pharmacologically. Recently, complementary medicine methods have been suggested because of chemical drugs adverse effects. There is not enough evidence about the effect of aromatherapy on RLS. Objectives: The aim of this study was to determine the effects of massage with lavender oil on RLS symptoms in hemodialysis patients. Patients and Methods: This randomized clinical trial study included 70 hemodialysis patients with RLS that were randomly assigned into two groups in 2014. The experimental group received effleurage massage using lavender oil and control group received routine care for three weeks. Data was collected with RLS questionnaire and analyzed using independent and paired t-test and Chi-square test. Results: The mean RLS scores were not significantly different in the two groups at the start of study (22.41 ± 7.67 vs. 22.90 ± 4.38, P = 0.76). At the end of study, the mean RLS score significantly decreased in the intervention group, while this score remained relatively un-changed in the control group (12.41 ± 5.49 vs. 23.23 ± 4.52, P < 0.0001). Conclusions: Lavender oil massage was effective to improve RLS in hemodialysis patients. It has no adverse effects, is practical and cost-effective. It is suggested to be used along with routine treatment of RLS in hemodialysis patients. PMID:26835466

Pharmacokinetics of rotigotine transdermal system in adolescents with idiopathic restless legs syndrome (Willis-Ekbom disease).

PubMed

Elshoff, Jan-Peer; Hudson, John; Picchietti, Daniel L; Ridel, Keith; Walters, Arthur S; Doggett, Kimberly; Moran, Kimberly; Oortgiesen, Marga; Ramirez, Francisco; Schollmayer, Erwin

2017-04-01

To investigate the pharmacokinetics (PK) of rotigotine transdermal system in adolescents with moderate-to-severe idiopathic restless legs syndrome (RLS). This multicenter, open-label, dose-escalation study enrolled patients ≥13 to <18 years of age. Rotigotine transdermal patches were applied daily and up-titrated weekly: 0.5, 1, 2, 3 mg/24 h. Blood samples were collected on the final day of each dose step. Primary PK variables were the apparent total body clearance (CL/f; L/h) and volume of distribution at steady state (V SS /f; L) of unconjugated rotigotine for each dose step, calculated for the PK per-protocol set (PKPPS). Other PK, safety, and efficacy variables (International RLS Study Group Rating Scale [IRLS]; Clinical Global Impressions Item 1 [CGI-1]) were assessed. Of 24 patients who received rotigotine, 23 completed all dose steps and 17 formed the PKPPS. Least-squares mean (95% confidence interval) CL/f and V SS /f values were broadly similar across all dose steps (CL/f: 0.5 mg/24 h: 676.86 [408.50-1121.51]; 1 mg/24 h: 671.72 [459.11-982.80]; 2 mg/24 h: 937.56 [658.50-1334.89]; 3 mg/24 h: 1088.77 [723.47-1638.53]; V SS /f: 5403.16 [2850.67-10,241.17]; 6220.79 [3842.05-10,072.28]; 7114.01 [4547.88-11,128.07]; 6037.92 [3598.36-10,131.41]). Among 23 patients with efficacy data, mean IRLS and CGI-1 scores improved at each dosage level. Adverse events reported by ≥3 patients were nausea (seven) and application site reactions (four). Key PK properties of rotigotine in adolescent patients with moderate-to-severe idiopathic RLS were comparable to those previously observed in adults. Rotigotine improved RLS symptoms and was well tolerated. ClinicalTrials.gov: NCT01495793. Copyright © 2016 Elsevier B.V. All rights reserved.

Quantifying Leg Movement Activity During Sleep.

PubMed

Ferri, Raffaele; Fulda, Stephany

2016-12-01

Currently, 2 sets of similar rules for recording and scoring leg movement (LM) exist, including periodic LM during sleep (PLMS) and periodic LM during wakefulness. The former were published in 2006 by a task force of the International Restless Legs Syndrome Study Group, and the second in 2007 by the American Academy of Sleep Medicine. This article reviews the basic recording methods, scoring rules, and computer-based programs for PLMS. Less frequent LM activities, such as alternating leg muscle activation, hypnagogic foot tremor, high-frequency LMs, and excessive fragmentary myoclonus are briefly described. Copyright © 2016 Elsevier Inc. All rights reserved.

New insights into restless genital syndrome: static mechanical hyperesthesia and neuropathy of the nervus dorsalis clitoridis.

PubMed

Waldinger, Marcel D; Venema, Pieter L; van Gils, Ad P G; Schweitzer, Dave H

2009-10-01

Systematic study of dysesthetic and paresthetic regions contributing to persistent genital arousal in women with restless genital syndrome (ReGS) is needed for its clinical management. To investigate distinct localizations of ReGS. Twenty-three women, fulfilling all five criteria of persistent genital arousal disorder were included into the study. In-depth interviews, routine and hormonal investigations, electroencephalographs, and magnetic resonance imaging (MRI) of brain and pelvis were performed in all women. The localizations of genital sensations were investigated by physical examination of the ramus inferior of the pubic bone (RIPB) and by sensory testing of the skin of the genital area with a cotton swab (genital tactile mapping test or GTM test). Sensitivity of RIPB, GTM test. Of 23 women included in the study, 18(78%), 16(69%), and 12(52%) reported restless legs syndrome, overactive bladder syndrome, and urethra hypersensitivity. Intolerance of tight clothes and underwear (allodynia or hyperpathia) was reported by 19 (83%) women. All women were diagnosed with ReGS. Sitting aggravated ReGS in 20(87%) women. In all women, MRI showed pelvic varices of different degree in the vagina (91%), labia minora and/or majora (35%), and uterus (30%). Finger touch investigation of the dorsal nerve of the clitoris (DNC) along the RIPB provoked ReGS in all women. Sensory testing showed unilateral and bilateral static mechanical Hyperesthesia on various trigger points in the dermatome of the pudendal nerve, particularly in the part innervated by DNC, including pelvic bone. In three women, sensory testing induced an uninhibited orgasm during physical examination. ReGS is highly associated with pelvic varices and with sensory neuropathy of the pudendal nerve and DNC, whose symptoms are suggestive for small fiber neuropathy (SFN). Physical examination for static mechanical Hyperesthesia is a diagnostic test for ReGS and is recommended for all individuals with complaints of

When gender matters: restless legs syndrome. Report of the "RLS and woman" workshop endorsed by the European RLS Study Group.

PubMed

Manconi, Mauro; Ulfberg, Jan; Berger, Klaus; Ghorayeb, Imad; Wesström, Jan; Fulda, Stephany; Allen, Richard P; Pollmächer, Thomas

2012-08-01

Sleep is an essential human behavior that shows prominent gender differences. Disturbed sleep, in particular, is much more prevalent in females than males. Restless legs syndrome (RLS) as one cause of disturbed sleep was observed to be somewhat more common among women than men in Ekbom's 1945 seminal series of clinical cases with the disease. He, however, reported this gender difference mainly for those with more severe symptoms. Since then numerous studies have reported that women are affected by RLS about twice as often as males for mild as well as moderate to severe RLS. The present review focuses on RLS in females from the perspectives of both epidemiology and pathophysiology. RLS will generally become worse or might appear for the first time during pregnancy. Parity increases the risk of RLS later in life suggesting that pregnancy is a specific behavioral risk factor for developing RLS. Some evidence suggests that dysfunction in iron metabolism and high estrogen levels might contribute to RLS during pregnancy. But, menopause does not lower the incidence of RLS nor does hormone replacement therapy lead to an increase, suggesting a quite complex uncertain role of hormones in the pathophysiology of RLS. Therefore, further, preferably longitudinal studies are needed to unravel the factors causing RLS in women. These studies should include genetic, clinical and polysomnographic variables, as well as hormonal measures and variables assessing iron metabolism. Copyright © 2011 Elsevier Ltd. All rights reserved.

Molecular genetic studies of DMT1 on 12q in French-Canadian restless legs syndrome patients and families.

PubMed

Xiong, Lan; Dion, Patrick; Montplaisir, Jacques; Levchenko, Anastasia; Thibodeau, Pascale; Karemera, Liliane; Rivière, Jean-Baptiste; St-Onge, Judith; Gaspar, Claudia; Dubé, Marie-Pierre; Desautels, Alex; Turecki, Gustavo; Rouleau, Guy A

2007-10-05

Converging evidence from clinical observations, brain imaging and pathological findings strongly indicate impaired brain iron regulation in restless legs syndrome (RLS). Animal models with mutation in (DMT1) divalent metal transporter 1 gene, an important brain iron transporter, demonstrate a similar iron deficiency profile as found in RLS brain. The human DMT1 gene, mapped to chromosome 12q near the RLS1 locus, qualifies as an excellent functional and possible positional candidate for RLS. DMT1 protein levels were assessed in lymphoblastoid cell lines from RLS patients and controls. Linkage analyses were carried out with markers flanking and within the DMT1 gene. Selected patient samples from RLS families with compatible linkage to the RLS1 locus on 12q were fully sequenced in both the coding regions and the long stretches of UTR sequences. Finally, selected sequence variants were further studied in case/control and family-based association tests. A clinical association of anemia and RLS was further confirmed in this study. There was no detectable difference in DMT1 protein levels between RLS patient lymphoblastoid cell lines and normal controls. Non-parametric linkage analyses failed to identify any significant linkage signals within the DMT1 gene region. Sequencing of selected patients did not detect any sequence variant(s) compatible with DMT1 harboring RLS causative mutation(s). Further studies did not find any association between ten SNPs, spanning the whole DMT1 gene region, and RLS affection status. Finally, two DMT1 intronic SNPs showed positive association with RLS in patients with a history of anemia, when compared to RLS patients without anemia. (c) 2007 Wiley-Liss, Inc.

Prevalence, severity, and impact on quality of life of restless leg syndrome in patients with liver cirrhosis in India.

PubMed

Goel, Amit; Jat, Shankar Lal; Sasi, Avani; Paliwal, Vimal Kumar; Aggarwal, Rakesh

2016-05-01

Restless leg syndrome (RLS) has recently been shown to be increased in patients with liver cirrhosis (LC). We prospectively studied the prevalence and severity of RLS, and the effect of its presence on the quality of life (QoL) in Indian patients with LC. Adult patients with stable LC (n = 121; 98 male; median age 47 [range 18-68] years; Child-Pugh class A/B/C 59/39/23), were prospectively enrolled along with a group of healthy, adult controls (n = 121; 84 male; median age 42 [19-70] years). Patients with recent (<4 weeks) worsening were excluded. The subjects underwent an initial screening for RLS, followed by a re-evaluation to confirm the diagnosis, using the International RLS Diagnostic Criteria, and assessment of its severity. All participants underwent QoL assessment. RLS was commoner in LC patients (8/121; 6.6 %) than in controls (1/121; p < 0.05; odds ratio = 8.5 [1.1-69.0]). Presence of RLS showed no association with specific gender (male 7/98, female 1/23), Child-Pugh class (A 5/59, B 1/39 and C 2/23) or cause of liver disease (alcohol 3/32, hepatitis B 1/18, hepatitis C 3/28, and cryptogenic 1/25). RLS severity was moderate (5), severe (2), or very severe (1). Though QoL scores were lower in patients with LC than in controls, those in patients with and without RLS were similar. RLS was commoner in patients with LC than in controls, but did not correlate with liver disease severity and did not adversely influence QoL in LC.

Uremic restless legs syndrome (RLS) and sleep quality in patients with end-stage renal disease on hemodialysis: potential role of homocysteine and parathyroid hormone.

PubMed

Gade, Katrin; Blaschke, Sabine; Rodenbeck, Andrea; Becker, Andreas; Anderson-Schmidt, Heike; Cohrs, Stefan

2013-01-01

The aetiology of uremic restless legs syndrome (RLS) remains unclear. Our research investigated whether an elevated plasma concentration of the excitatory amino acid homocysteine might be associated with RLS occurrence in patients with chronic renal insufficiency on hemodialysis. Total plasma homocysteine as well as creatinine, urea, folate, parathyroid hormone, hemoglobin, iron, ferritin, phosphate, calcium, magnesium, and albumin levels were compared between 26 RLS-affected (RLSpos) and 26 non-affected (RLSneg) patients on chronic hemodialysis. We further compared subjective sleep quality between RLSpos and RLSneg patients using the Pittsburgh-Sleep-Quality-Index and investigated possible relationships between laboratory parameters and sleep quality. Taking individual albumin concentrations into account, a significant positive correlation between total plasma homocysteine and RLS occurrence was observed (r= 0.246; p=0.045). Sleep quality was significantly more reduced in RLSpos compared to RLSneg patients and RLS severity correlated positively with impairment of sleep quality. Bad sleep quality in all patients was associated with higher concentrations of parathyroid hormone. Our results suggest a possible aetiological role of homocysteine in uremic RLS. They confirm that uremic RLS is an important factor causing sleep impairment in patients on hemodialysis. Higher parathyroid hormone levels might also be associated with bad sleep quality in these patients. © 2013 S. Karger AG, Basel.

Treatment of moderate to severe restless legs syndrome: 2-year safety and efficacy of rotigotine transdermal patch

PubMed Central

2010-01-01

Background Rotigotine is a unique dopamine agonist with activity across D1 through D5 receptors as well as select adrenergic and serotonergic sites. This study reports the 2-year follow-up safety and efficacy data of an ongoing open-label multicenter extension study (NCT00498186) of transdermal rotigotine in patients with moderate to severe restless legs syndrome (RLS). Methods Patients received a once-daily patch application of an individually optimized dose of rotigotine between 0.5 mg/24 h to 4 mg/24 h. Safety assessments included adverse events (AEs) and efficacy was measured by the International RLS Study Group Severity Rating Scale (IRLS), RLS-6 scales and Clinical Global Impression (CGI). Quality of life (QoL) was measured by QoL-RLS. Results Of 310 patients who completed a 6-week placebo-controlled trial (SP709), 295 (mean age 58 ± 10 years, 66% females) were included in the open-label trial SP710. 64.7% (190/295 patients) completed the 2-year follow-up; 29 patients discontinued during the second year. Mean daily rotigotine dose after 2 years was 2.93 ± 1.14 mg/24 h with a 2.9% dose increase from year 1. Rotigotine was generally well tolerated. The rate of typical dopaminergic side effects, nausea and fatigue, was low (0.9% and 2.3%, respectively) during the second year; application site reactions were frequent but lower than in year 1 (16.4% vs. 34.5%). The IRLS total score improved from baseline of SP709 (27.8 ± 5.9) by 17.2 ± 9.2 in year 2 completers. Similar improvements were observed in RLS-6 scales, CGI scores and QoL-RLS. The responder rate in the CGI change item 2 ("much" and "very much" improved) was 95% after year 2. Conclusions Transdermal rotigotine is an efficacious and well-tolerated long-term treatment option for patients with moderate to severe RLS with a high retention rate during 2 years of therapy. Trial registration NCT00498186 PMID:20920156

Effectiveness and tolerability of rotigotine transdermal patch for the treatment of restless legs syndrome in a routine clinical practice setting in Germany.

PubMed

Stiasny-Kolster, Karin; Berg, Daniela; Hofmann, Werner E; Berkels, Reinhard; Grieger, Frank; Lauterbach, Thomas; Schollmayer, Erwin; Bachmann, Cornelius G

2013-06-01

We aimed to assess effectiveness and tolerability of rotigotine in patients with moderate to severe idiopathic restless legs syndrome (RLS) under daily practice conditions in Germany. In this 3-month noninterventional study, effectiveness was assessed using RLS-6 (primary variables were symptom severity when falling asleep [item 2] and during the night [item 3]). Data were collected at baseline and at the end of treatment. Safety assessments included adverse events (AEs). Six hundred and eighty-four patients were treated with rotigotine and 418 (61%) completed the study. The full analysis set (FAS) comprised 564 patients (106 de novo; 458 pretreated [454 had complete rotigotine dosing data]). Mean rotigotine dose of longest duration was 2.4±1.4 mg/24 h. Rotigotine improved all RLS-6 items (mean change from baseline [item 2], -2.4±3.6; [item 3], -2.7±3.4), with the most pronounced improvement observed in daytime symptoms while at rest (item 4, -2.9±3.2). AEs were typical of dopaminergic treatment and transdermal administration. De novo patients generally started rotigotine on 1 mg/24 h (85% [90/106]) and pretreated patients on 1 (50% [227/454]) or 2 mg/24 h (40% [183/454]). Most patients who were pretreated with levodopa (57%), pramipexole (84%), or ropinirole (78%) monotherapy discontinued these medications on initiation of rotigotine. Rotigotine was effective and well-tolerated when used in routine clinical practice. Copyright © 2013 Elsevier B.V. All rights reserved.

Associations of Incident Cardiovascular Events With Restless Legs Syndrome and Periodic Leg Movements of Sleep in Older Men, for the Outcomes of Sleep Disorders in Older Men Study (MrOS Sleep Study).

PubMed

Winkelman, John W; Blackwell, Terri; Stone, Katie; Ancoli-Israel, Sonia; Redline, Susan

2017-04-01

Both restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS) may be associated with incident cardiovascular disease (CVD). However, the individual contributions of these factors to adverse CVD outcomes are unknown. During the MrOS Sleep Study, 2823 men (mean age = 76.3 years) participated in a comprehensive sleep assessment from 2000 to 2002. RLS was identified by self-report of a physician diagnosis of RLS. A periodic limb movement of sleep index (PLMI) was derived from unattended in-home polysomnography. Incident cardiovascular events were centrally adjudicated during 8.7 ± 2.6 years of follow-up. The primary outcome was all-cause CVD; secondary outcomes included incident myocardial infarction (MI) and cerebrovascular disease. Cox proportional hazards regression models were adjusted for multiple covariates, including PLMI, to examine if there were independent associations of RLS and PLMI to the outcomes. Physician-diagnosed RLS was reported by 2.2% and a PLMI ≥ 15 was found in 59.6% of men. RLS was not associated with the composite CVD outcome. RLS was significantly associated with incident MI (Hazard ratio [HR] = 2.02, 95% CI, 1.04-3.91) even after adjustment for multiple covariates. Results were only modestly attenuated when PLMI was added to the model. PLMI also was found to predict incident MI (per SD increase in PLMI, HR = 1.14, 95% CI, 1.00-1.30, p = .05), and was materially unchanged after addition of RLS. The independent risk that RLS confers for MI suggests a role for non-PLMS factors such as sleep disturbance, shared genetic factors, or PLM-independent sympathetic hyperactivity. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Quantitative sensory test for primary restless legs syndrome/Willis-Ekbom disease using the current perception threshold test.

PubMed

Cho, Yong Won; Kang, Min-Sung; Kim, Keun Tae; Do, So Young; Lim, Jung-Geun; Lee, So Young; Motamedi, Gholam K

2017-02-01

Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is a sensorimotor neurological disorder, and it is especially aggravated at night. The purpose of this study was to investigate the diurnal sensory dysfunction in primary RLS/WED using the current perception threshold (CPT) test, compared to healthy controls. Thirty primary RLS/WED subjects and 30 healthy controls were enrolled. The severity of RLS/WED and sleep problems were evaluated in all subjects. Peripheral polyneuropathy was excluded through neurological examination and nerve conduction study. We used the Neurometer ® system for the CPT test and applied three different parameters (2000 Hz, 250 Hz, and 5 Hz), to stimulate both big toes. The CPT test was performed twice, once during the asymptomatic daytime period and again in the evening, when the patients were symptomatic. The mean ages of the RLS/WED group and controls were 50.5 ± 11.7 (22; 73.3% female), and 46.3 ± 11.4 (24; 80.0% female), respectively. The mean international RLS/WED study group severity scale score was 28.6 ± 4.25. There was no significant difference in the current perception thresholds between the RLS/WED patients and controls in daytime. However, the RLS/WED patients had lower mean CPT measurements for all three stimulation protocols in the evening (2000 Hz: 393.2 ± 93.7 vs 430.8 ± 79.6, 250 Hz: 172.0 ± 48.4 vs 198.5 ± 38.2, and 5 Hz: 98.0 ± 34.1 vs 124.6 ± 31.3), while the healthy controls showed no difference. RLS patients showed a lower CPT in the evening. The diurnal variation of hyperalgesia in RLS/WED patients indicates a central (circadian) sensory processing disturbance rather than a peripheral disturbance. Copyright © 2016 Elsevier B.V. All rights reserved.

A mixed treatment comparison of gabapentin enacarbil, pramipexole, ropinirole and rotigotine in moderate-to-severe restless legs syndrome.

PubMed

Sun, Ying; van Valkenhoef, Gert; Morel, Thomas

2014-11-01

A mixed treatment comparison (MTC) was performed to investigate the relative efficacy and safety of licensed pharmaceuticals for moderate-to-severe restless legs syndrome (RLS). RLS trials published over the past 10 years were identified via systematic literature searches of MEDLINE, Embase, Cochrane CENTRAL, and manufacturers' websites. MTC was performed with WinBUGS software using a Bayesian approach. Identified primary outcomes: change in International RLS Study Group Rating Scale (IRLS) at week 12 and end of maintenance (EoM). IRLS and Clinical Global Impression - Improvement Scale (CGI-I) responders, RLS-6 items and adverse events (AEs). Twenty-eight clinical trials were identified. Fifteen were included in the primary analysis. Indirect comparisons were established among gabapentin enacarbil, pramipexole, ropinirole, rotigotine and placebo. Overall, the four active treatments showed similar efficacies as assessed by changes in IRLS scores, IRLS responders, CGI-I responders, and RLS-6 scores. The sole exception was change in IRLS at week 12, for which rotigotine was likely more efficacious than ropinirole (mean difference: -2.52 [95% CrI: -4.74, -0.40]). Indirect comparisons on safety endpoints indicated ropinirole was associated with a higher risk of nausea than the other agents, and was more likely to result in discontinuations due to lack of efficacy than pramipexole. Nausea was likely more frequent with pramipexole than gabapentin enacarbil, and rotigotine was more likely to result in discontinuation due to AEs than ropinirole and pramipexole. This MTC confirmed the superiority of gabapentin enacarbil, pramipexole, ropinirole, and rotigotine above placebo in alleviating RLS symptoms. Compared to ropinirole, rotigotine showed some additional benefit in terms of change in IRLS at Week 12. Choice of RLS drugs requires careful evaluation of effectiveness and safety profiles in clinical practice. Due to lack of head-to-head trials, inconsistency could not be

The urge to move and breathe - the impact of obstructive sleep apnea syndrome treatment in patients with previously diagnosed, clinically significant restless legs syndrome.

PubMed

Silva, Cristiana; Peralta, Ana Rita; Bentes, Carla

2017-10-01

The association between restless legs syndrome (RLS) and obstructive sleep apnea syndrome (OSAS) has seldom been reported. There is one study reporting improvement of RLS symptoms severity in patients naive of treatment after initiation of continuous positive airway pressure (CPAP) for OSAS. The aim of this study was to evaluate the impact of the OSAS treatment in patients with previously diagnosed, clinically significant RLS in a usual clinical setting. This was a retrospective study of RLS patients from a sleep clinic with a concomitant or subsequent diagnosis of OSAS. All patients who started treatment for OSAS and had a follow-up of ≥3 months were selected. Exclusion criteria included noncompliance, absence of sufficient information on clinical records, and RLS improvement following treatment of secondary causes. The primary outcome variable was clinical status of RLS symptoms following OSA treatment. Other variables included demographics, RLS treatment and outcome, OSA diagnosis, treatment, compliance, outcome, and PSG characteristics. From a database of 97 RLS patients, 56 patients had both OSA and RLS. Of these patients, 28 met the criteria for the study. In all, 17 patients (60.9%) were female, with a mean age 60 years. A total of 16 patients (57.1%) were diagnosed with idiopathic RLS. OSAS was diagnosed, on average, 21 months after the RLS diagnosis. A total of 19 (70.4%) patients were overweight or obese, 26 (92.9%) reported snoring, and 10 (35.7%) witnessed apneas. A total of 16 patients (57.1%) had excessive daytime sleepiness and 23 (84.1%) had insomnia. The mean apnea-hypopnea index was 19. Patients were mostly treated with dopamine agonists (19 patients, 67.9%) for the RLS, and nine patients were treated with more than two drugs for RLS. A total of 20 patients (71.4%) had improvement of symptoms of RLS after therapy for OSAS, of whom nine stopped drug therapy and eight reduced the dose. In patients with clinically significant RLS, treatment of

Test-to-test variability in motor activity during the suggested immobilization test in restless legs patients.

PubMed

Haba-Rubio, José; Sforza, Emilia

2006-10-01

To evaluate the test-to-test variability of the suggested immobilization test (SIT) in patients with restless legs syndrome (RLS). Twenty patients with primary RLS (12 men and eight women; age: 53.3+/-11.3 years) were selected for the study. We compared the results of two SITs performed on two consecutive evenings prior to polysomnographic recordings. Overall, the periodic leg movement index during the SIT (SIT PLM) and the SIT PLM index associated with sensory manifestations (SIT PLM+) were not significantly different between tests. The number of PLM sequences per SIT, the mean PLM duration and the PLM interval did not significantly change between the two consecutive tests. The pattern of temporal evolution of motor activity across the SIT was very reproducible, SIT PLM showing a clear tendency to a progressive increase across the test, with the SIT PLM+ index decreasing in the second half of the test. Despite good reproducibility, there were marked intra-individual differences. Considering the proposed cut-off value of 12 for the SIT PLM index to confirm RLS, 11 patients were positive at the first test and four additional patients became positive at the second test. SIT PLM index changes did not correlate with age, severity of disease and polysomnographic measures. Quantitative analysis of motor activity during two consecutive SITs in RLS patients showed a significant inter-test intra-individual variability unrelated to demographic, clinical or polysomnographic parameters. SIT PLM index variability suggests that a single test would not be sensitive enough for diagnostic purposes in unclear cases and that new criteria need to be applied to increase its specificity and sensitivity.

Assessing health-related quality of life in patients with restless legs syndrome in Korea: comparison with other chronic medical diseases.

PubMed

Cho, Yong Won; Kim, Do Hyung; Allen, Richard P; Earley, Christopher J

2012-10-01

There have been few quality of life (QoL) studies of patients with restless legs syndrome (RLS) in Asian countries. We studied the QoL of patients with RLS and compared it to normal controls and patients with hypertension, type 2 diabetes, or osteoarthritis in Korea. A total of 215 RLS patients (141 female; mean age 51.7 ± 13.5) were enrolled. All patients completed the questionnaires, including all the Korean versions of SF-36, RLS QoL, the International RLS Severity scale (IRLS), the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory-2 (BDI-2). These results were compared with the scores from normal controls (N=214) and from patients with hypertension (196), uncomplicated type 2 diabetes (185), or osteoarthritis of the knee (177). The SF-36 QoL in patients with RLS was lower than that of the normal controls, and even lower than patients with hypertension or diabetes, but higher than those with osteoarthritis. The SF-36 Qol of RLS patients showed a significantly negative correlation with the severity of RLS symptoms(r=-0.430, p<0.001) and the severity of depression (r=-0.565, p<0.001), but was not significantly related to gender, age, or age-of-symptom onset (early or late-onset). Step-wise multiple regression identified three factors related to SF-36 QoL: depression (46.5% of RLS had responses on BDI-2 indicating depression) (β=-.899, p<0.001), RLS symptom severity (K-IRLS) (β=-.718, p<0.001), and gender (female) (β=-6.128, p=0.007). These findings show that RLS has a considerable impact on the QoL of Koreans, which is comparable with studies of western countries. The QoL impairment relates to the degree of depression with RLS for Koreans. Copyright © 2012 Elsevier B.V. All rights reserved.

Chronic pulmonary disease is associated with pain spreading and restless legs syndrome in middle-aged women-a population-based study.

PubMed

Ding, Zou; Stehlik, Romana; Hedner, Jan; Ulfberg, Jan; Grote, Ludger

2018-06-04

Recent studies suggest an increased prevalence of chronic pain conditions and restless legs syndrome (RLS) in patients with chronic pulmonary disease (CPD). We analyzed the prevalence and risk factors for pain and RLS in a population-based sample of females with comorbid CPD. Questionnaire-based data from 2745 women aged 18-64 years were analyzed regarding comorbid CPD status (severe bronchitis, emphysema, asthma). Pain status was assessed according to symptoms reflecting severity (Visual Analogue Scale, VAS rating 0-10) and duration and spreading (limited spread or widespread) of pain. A diagnosis of RLS was defined by four validated diagnostic criteria. Anthropometrics and co-morbidities were assessed as covariates in univariate and multivariate analyses. Widespread pain was overrepresented in women with CPD (44.6 vs. 24.6%, p < 0.001). The odds ratio for widespread pain in women with CPD was 1.6 (95% confidence interval (CI) 1.2-2.2, p < 0.001) in the fully adjusted model. Severe pain (VAS rating ≥ 7) was more prevalent in females with known CPD (28.8 vs. 15.4%, p < 0.001, odd ratio 1.4 (95% CI 1.0-1.9, p = 0.029)). The prevalence of RLS was 37.4 and 23.8% in subjects with or without CPD, respectively (p < 0.001). In multivariate analysis, CPD was associated with a 30% risk increase for RLS (odds ratio 1.3 (95% CI 1.0-1.7, p = 0.04)). This population-based study identified CPD as an independent risk factor for severe and widespread pain as well as for RLS. Further research addressing pathophysiological mechanisms linking CPD and chronic pain conditions/RLS is warranted.

Transcranial direct current stimulation on primary sensorimotor area has no effect in patients with drug-naïve restless legs syndrome: a proof-of-concept clinical trial.

PubMed

Koo, Yong Seo; Kim, Sung Min; Lee, Chany; Lee, Byeong Uk; Moon, Ye Ji; Cho, Yong Won; Im, Chang-Hwan; Choi, Jeong Woo; Kim, Kyung Hwan; Jung, Ki-Young

2015-02-01

To evaluate the efficacy of transcranial direct current stimulation (tDCS) in people with drug-naïve restless legs syndrome (RLS). A two-week, double-blind, randomized, sham-controlled trial was performed. Thirty-three females with RLS were recruited. Participants received five sessions of tDCS using cathodal, anodal or sham stimulation. They were assessed at baseline (T0), three days (T1) and 13 days (T2) after the end of tDCS. Primary outcomes included the International RLS Group Rating Scale (IRLS) and the Clinical Global Impressions-Improvement (CGI-I). Secondary outcomes included the Patient Global Impression scale, the Pittsburgh Sleep Quality Index, the Medical Outcome Study sleep subscales, and the Beck Depression Inventory. Objective neurophysiological changes were assessed using event-related desynchronization/synchronization (ERD/ERS) of electroencephalography. The changes in the IRLS scores, as well as the responder rate in the CGI-I scale, did not differ significantly among the groups. There was also no significant difference in any of the secondary outcome measures and ERD/ERS among the groups. Transcranial direct current stimulation with electrodes on the sensorimotor areas showed no significant effect in people with drug-naïve RLS. Copyright © 2014 Elsevier B.V. All rights reserved.

‘You never told me I would turn into a gambler’: a first person account of dopamine agonist – induced gambling addiction in a patient with restless legs syndrome

PubMed Central

Jones, Henrietta Bowden; George, Sanju

2011-01-01

Dopaminergic agents are commonly used and effective treatments for restless legs syndrome (RLS), a disabling sensorimotor disorder. Less known are some of the potentially disabling side effects of these treatments, particularly iatrogenic gambling addiction, as is described here. Here the authors present a 62-year-old man, with a 20–year history of RLS, who developed gambling addiction while on dopaminergic treatment. He was not forewarned of this side effect, nor was he ever screened for gambling behaviours prior to or during treatment. Eight months after discontinuation of dopaminergic treatment and after 10 sessions of cognitive–behavioural therapy for gambling addiction, his gambling behaviours have partially resolved. To our knowledge, this is the first ever first person account of this condition. To prevent the devastating consequences of gambling addiction or to minimise its impact by early intervention, the authors call for clinicians involved in treatment of RLS to follow these simple measures: screen patients for gambling behaviours prior to the onset and during dopaminergic treatment; forewarn patients of this potential side effect; and if patients screen positive, refer them to specialist gambling treatment services, in addition to making necessary changes to their medication regime. PMID:22678941

Reported bruxism and restless legs syndrome in media personnel with or without irregular shift work.

PubMed

Ahlberg, Kristiina; Ahlberg, Jari; Könönen, Mauno; Partinen, Markku; Hublin, Christer; Savolainen, Aslak

2005-04-01

A standardized questionnaire was mailed to all employees of the Finnish Broadcasting Company with irregular shift work (n = 750) and to an equal number of randomly selected controls in the same company with regular 8-h daytime work. The questionnaire covered demographic items, employment details, general health experience, physical status, psychosocial status, stress, work satisfaction and performance, tobacco use, bruxism, and restless legs symptoms (RLS). The aim was to investigate among a multiprofessional media personnel the associations between reported bruxism and RLS, while simultaneously controlling the effects of gender, age, tobacco use, shift work, and dissatisfaction with current workshift schedule. The overall response rate was 58.3% (53.7% men). The response rate in the irregular shift work group was 82.3% (56.6% men) and in the regular daytime work group 34.3% (46.7% men). In the bivariate analyses, RLS was more prevalent in workers at either end of the studied age range (p < 0.05). Self-reported frequent bruxism was significantly associated with younger age (p < 0.05). Females reported RLS (11.4%) slightly more often than males (7.7%) (NS). In logistic regression, frequent bruxism (p < 0.05) and older age (p < 0.05) were significantly positively associated with RLS. Dissatisfaction with one's current workshift schedule (p < 0.05) and RLS (p < 0.05) were significantly positively associated with frequent bruxism, while age (p < 0.05) was significantly negatively associated. In conclusion, perceived bruxism may be a sign of a stressful situation or dissatisfaction, while RLS as a more stable trait may in itself negatively affect sleep quality and further enhance the problem.

Restless Legs Syndrome in a Community Sample of Korean Adults: Prevalence, Impact on Quality of Life, and Association with DSM-IV Psychiatric Disorders

PubMed Central

Cho, Seong-Jin; Hong, Jin Pyo; Hahm, Bong-Jin; Jeon, Hong Jin; Chang, Sung Man; Cho, Maeng Je; Lee, Hochang B.

2009-01-01

Study Objectives: Conflicting reports on prevalence of RLS exist in Asian countries due to differences in sampling strategies and assessment instruments. We assessed the prevalence, correlates, quality of life, and psychiatric comorbidity of RLS in South Korea. Design/setting: Cross-sectional nationwide survey. Participants: Nationally representative sample of 6,509 Korean adults aged 18–64. Measurement & Results: Face-to-face interviews based on the Korean translation of the four features of RLS defined by the International RLS Study Group (IRLSSG), the Korean version of Composite International Diagnostic Interview (K-CIDI), and EuroQol (EQ-5D) were conducted for all participants. The weighted prevalence of RLS in South Korea was 0.9% (men, 0.6%; women, 1.3%). Subjects with RLS had a lower quality of life according to EQ-5D than those without RLS. Adjusted odds ratio for lifetime diagnosis of DSM-IV major depressive disorder (2.57, 95% confidence interval [1.33, 4.96]), panic disorder (18.9 [4.72, 75.9]) and posttraumatic stress disorder (3.76 [1.32, 10.7]) suggest strong association between RLS and DSM-IV depression and anxiety disorders. Conclusions: Prevalence of RLS estimated based on the IRLSSG diagnostic criteria is substantially lower in South Korea than in Western countries. Differences in culture and risk factors that affect the expression of RLS may vary across the countries. Citation: Cho SJ; Hong JP; Hahm BJ; Jeon HJ; Chang SM; Cho MJ; Lee HB. Restless legs syndrome in a community sample of korean adults: prevalence, impact on quality of life, and association with DSM-IV psychiatric disorders. SLEEP 2009;32(8):1069-1076. PMID:19725258

Clinical and electrophysiological impact of repetitive low-frequency transcranial magnetic stimulation on the sensory–motor network in patients with restless legs syndrome

PubMed Central

Cantone, Mariagiovanna; Aricò, Debora; Lanuzza, Bartolo; Cosentino, Filomena Irene Ilaria; Paci, Domenico; Papotto, Maurizio; Pennisi, Manuela; Bella, Rita; Pennisi, Giovanni; Paulus, Walter; Ferri, Raffaele

2018-01-01

Background: Based on the hyperexcitability and disinhibition observed in patients with restless legs syndrome (RLS) following transcranial magnetic stimulation (TMS), we conducted a study with low-frequency repetitive TMS (rTMS) over the primary motor (M1) and somatosensory cortical areas (S1) in patients with RLS. Methods: A total of 13 right-handed patients and 10 age-matched controls were studied using clinical scales and TMS. Measurements included resting motor threshold (rMT), motor-evoked potentials (MEPs), cortical silent period (CSP), and central motor conduction time (CMCT). A single evening session of rTMS (1 Hz, 20 trains, 50 stimuli each) was administered over the left M1, left S1, and sham stimulation over M1 in a random order. Clinical and TMS measures were repeated after each stimulation modality. Results: Baseline CSP was shorter in patients than in controls and remained shorter in patients for both motor and somatosensory stimulation. The patients reported a subjective improvement of both initiating and maintaining sleep the night after the rTMS over S1. Patients exhibited a decrease in rMT after rTMS of S1 only, although the effect was smaller than in controls. MEP latency and CMCT changed only in controls after stimulation. Sham stimulation was without effect on the observed variables. Conclusions: rTMS on S1-M1 connectivity alleviated the sensory–motor complaints of RLS patients. The TMS indexes of excitation and inhibition indicate an intracortical and corticospinal imbalance, mainly involving gamma-aminobutyric acid (GABA)ergic and glutamatergic circuitries, as well as an impairment of the short-term mechanisms of cortical plasticity. The rTMS-induced activation of the dorsal striatum with the consequent increase of dopamine release may have contributed to the clinical and neurophysiological outcome. PMID:29511386

Restless Legs Syndrome

MedlinePlus

... most cases of RLS can be treated with non-drug therapies and if necessary, medications. top What ... drug pramipexole, suggesting this class of drug offers equivalent benefits. Dopaminergic agents . These drugs, which increase dopamine ...

Restless Legs Syndrome

MedlinePlus

... caused by an imbalance of the brain chemical dopamine, which sends messages to control muscle movement. Heredity ... deficiency, often with anemia. When kidneys don't function properly, iron stores in your blood can decrease. ...

Restless legs syndrome

MedlinePlus

... often in people with: Chronic kidney disease Diabetes Iron, magnesium, or folic acid deficiency Parkinson disease Peripheral neuropathy Pregnancy Multiple sclerosis RLS may also occur in people who: Use ...

The Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults—An Update for 2012: Practice Parameters with an Evidence-Based Systematic Review and Meta-Analyses

PubMed Central

Aurora, R. Nisha; Kristo, David A.; Bista, Sabin R.; Rowley, James A.; Zak, Rochelle S.; Casey, Kenneth R.; Lamm, Carin I.; Tracy, Sharon L.; Rosenberg, Richard S.

2012-01-01

A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendation include levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline (which has additional caveats for use). Therapies with an OPTION level of recommendation include carbamazepine, gabapentin, pregabalin, clonidine, and for patients with low ferritin levels, iron supplementation. The committee recommends a STANDARD AGAINST the use of pergolide because of the risks of heart valve damage. Therapies for RLS secondary to ESRD, neuropathy, and superficial venous insufficiency are discussed. Lastly, therapies for PLMD are reviewed. However, it should be mentioned that because PLMD therapy typically mimics RLS therapy, the primary focus of this review is therapy for idiopathic RLS. Citation: Aurora RN; Kristo DA; Bista SR; Rowley JA: Zak RS; Casey KR; Lamm CI; Tracy SL; Rosenberg RS. The treatment of restless legs syndrome and periodic limb movement disorder in adults—an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses. SLEEP 2012;35(8):1039-1062. PMID:22851801

Restless Legs Syndrome/Willis-Ekbom Disease Is Prevalent in Working Nurses, but Seems Not to Be Associated with Shift Work Schedules.

PubMed

Waage, Siri; Pallesen, Ståle; Moen, Bente Elisabeth; Bjorvatn, Bjørn

2018-01-01

Insomnia and excessive sleepiness are among the most commonly reported sleep problems related to shift work. Sleep-related movement disorders have, however, received far less attention in relation to such work schedules. The objective of this study was to investigate the association between different shift work schedules and the prevalence of Restless legs syndrome/Willis-Ekbom disease (RLS/WED) in a large sample of Norwegian nurses. Our hypothesis was that shift working nurses would report higher prevalence of RLS/WED compared to day workers. A total of 1,788 nurses with different work schedules (day work, two-shift rotation, night work, three shift rotation) participated in a cohort study, started in 2008/2009. Four questions about RLS/WED based on the diagnostic criteria were included in wave 4 (2012). RLS/WED prevalence rates across different shift schedules were explored by the Pearson chi-square test. Logistic regression analysis was used to assess the association between RLS/WED and work schedules and shift work disorder (SWD) with adjustment for sex, age, marital status, smoking, and caffeine use. In total, 90.0% of the nurses were females, mean age 36.5 years (SD = 8.6, range 25-67). The overall prevalence of RLS/WED was 26.8%. We found no significant differences between the prevalence of RLS/WED across the different shift schedules, ranging from 23.3% (day work) to 29.4% (night work). There was a significant difference ( p  < 0.001) in the prevalence of RLS/WED between nurses having SWD (33.5%) compared to nurses not having SWD (23.8%). SWD remained significantly associated with RLS/WED in the adjusted logistic regression analysis (1.56, CI: 1.24-1.97). This study did not support the hypothesis. RLS/WED was associated with SWD, which might indicate that nurses vulnerable to shift work also are sensitive to other complaints related to a misalignment of the biological clock.

An update on pharmacological, pharmacokinetic properties and drug-drug interactions of rotigotine transdermal system in Parkinson's disease and restless legs syndrome.

PubMed

Elshoff, Jan-Peer; Cawello, Willi; Andreas, Jens-Otto; Mathy, Francois-Xavier; Braun, Marina

2015-04-01

This narrative review reports on the pharmacological and pharmacokinetic properties of rotigotine, a non-ergolinic D₃/D₂/D₁ dopamine receptor agonist approved for the treatment of early- and advanced-stage Parkinson's disease (PD) and moderate to severe restless legs syndrome (RLS). Rotigotine is formulated as a transdermal patch providing continuous drug delivery over 24 h, with a plasma concentration profile similar to that of administration via continuous intravenous infusion. Absolute bioavailability after 24 h transdermal delivery is 37 % of the applied rotigotine dose. Following a single administration of rotigotine transdermal system (24-h patch-on period), most of the absorbed drug is eliminated in urine and feces as sulphated and glucuronidated conjugates within 24 h of patch removal. The drug shows a high apparent volume of distribution (>2500 L) and a total body clearance of 300-600 L/h. Rotigotine transdermal system provides dose-proportional pharmacokinetics up to supratherapeutic dose rates of 24 mg/24 h, with steady-state plasma drug concentrations attained within 1-2 days of daily dosing. The pharmacokinetics of rotigotine transdermal patch are similar in healthy subjects, patients with early- or advanced-stage PD, and patients with RLS when comparing dose-normalized area under the plasma concentration-time curve (AUC) and maximum plasma drug concentration (Cmax), as well as half-life and other pharmacokinetic parameters. Also, it is not influenced in a relevant manner by age, sex, ethnicity, advanced renal insufficiency, or moderate hepatic impairment. No clinically relevant drug-drug interactions were observed following co-administration of rotigotine with levodopa/carbidopa, domperidone, or the CYP450 inhibitors cimetidine or omeprazole. Also, pharmacodynamics and pharmacokinetics of an oral hormonal contraceptive were not influenced by rotigotine co-administration. Rotigotine was generally well tolerated, with an adverse event profile

A prospective study of the cumulative incidence and course of restless legs syndrome in de novo patients with Parkinson's disease during chronic dopaminergic therapy.

PubMed

Marchesi, Elena; Negrotti, Anna; Angelini, Monica; Goldoni, Matteo; Abrignani, Giorgia; Calzetti, Stefano

2016-03-01

The authors report the cumulative incidence of Restless Legs Syndrome (RLS) over a 3 years follow-up period in 92 de novo Parkinson's disease patients under chronic dopaminergic therapy and the clinical course of the sensory-motor disorder over 12 months as from its onset. The overall cumulative incidence of RLS was found by 15.3%, i.e. 14 incident cases, and by 11.9%, i.e. 11 incident cases, after the exclusion of possible "secondary" forms of the disorder. These figures are higher than those reported in general population in Germany (Study of Health in Pomerania), confirming our previous findings of incidence rate of the disorder. At the end of the 3 years follow-up period the prevalence of "current" RLS was significantly higher than that previously found in drug naïve Parkinson's disease patients and in controls, supporting the view that RLS emerging in the course of chronic dopaminergic therapy is the main determinant of the co-morbid association with Parkinson's disease. During the 12 months period of observation the RLS showed a frequency of occurrence of 6.08 episodes per month on average and a remittent clinical course was prevailing in the 11 incident cases, with a significant frequency decrease in the second as compared to the first 6 months, i.e. 3.26 versus 8.9 episodes per month, and none of the patients developed augmentation in the same period. It is hypothesized that the remittent course could be due to long-term adaptation (downregulation) of the hypersensitive post-synaptic dopamine receptors in the spinal cord to a continuous dopaminergic stimulation, possibly coupled with compensatory up-regulation of pre-synaptic dopamine re-uptake mechanism, in the patients in which the hypothalamic A11 area, site of origin of the dopamine-mediated diencephalo-spinal pathway, is involved in the neurodegenerative process.

Incidence of Augmentation in Primary Restless Legs Syndrome Patients May Not Be That High: Evidence From A Systematic Review and Meta-Analysis

PubMed Central

Liu, Guang Jian; Wu, Lang; Wang, Song Lin; Ding, Li; Xu, Li Li; Wang, Yun Fu; Chang, Li Ying

2016-01-01

Abstract Augmentation is a common complication of primary restless legs syndrome (RLS) during treatment; however, its incidence rate remains unclear. The aim of this study is investigate the rate of augmentation during RLS treatment. We searched 6 databases, including PubMed, OVID, Embase, Wiley citations, Web of Science research platform (including SciELO Citation Index, Medline, KCI Korean Journal Database, the Web of Science™ Core Collection), and the Cochrane library, and screened the reference lists of the included trials and recently published reviews. Randomized controlled trials and observational studies that reported augmentation events during RLS treatment. Primary RLS patients older than 18 years. No restrictions regarding intervention types were applied. Three investigators independently extracted and pooled the data to analyze the augmentation rate of the total sample and of patient subgroups with different interventions, treatment durations and drug regimens and different geographic origins. Fixed-effects or random-effects model was used for pooled analysis. A total of 60 studies involving 11,543 participants suggested an overall augmentation rate of 5.6% (95% confidence intervals (CI), 4.0–7.7). The augmentation incidence was 6.1% (95% CI, 4.1–9.1) for long-term treatment and 3.3% (95% CI, 1.4–7.3) for short-term treatment. In addition, 27.1% (95% CI, 12.3–49.5) of the levodopa-treated patients, 6.0% (95% CI, 4.1–8.8) of the patients treated with dopamine agonists, and 0.9% (95% CI, 0.2–3.3) of the patients taking pregabalin or gabapentin developed augmentation. Augmentation occurred in 7.2% (95% CI, 5.0–10.3) of the patients taking immediate-release drugs and in 1.7% (95% CI, 0.6–5.0) of the patients taking transdermal application. The main limitations are that the augmentation rates were not evaluated according to drug dosage, gender, and age and symptom severity. Approximately 5 to 6 in 100 RLS patients developed augmentation

Effects of rotigotine on clinical symptoms, quality of life and sleep hygiene adequacy in haemodialysis-associated restless legs syndrome.

PubMed

Esteve, Vicent; Carneiro, Jose; Salazar, Gabriel; Pou, Mónica; Tapia, Irati; Fulquet, Miquel; Duarte, Verónica; Saurina, Anna; Moreno, Fátima; Ramírez de Arellano, Manel

Restless legs syndrome (RLS) is a neurological disorder characterised by bothersome symptoms associated with impaired quality of life and sleep hygiene. Rotigotine is a novel therapeutic alternative, although few studies have been published in patients on haemodialysis (HD) with RLS treated with rotigotine. 1.- To establish the prevalence of RLS in our HD unit. 2.- To evaluate the efficacy and safety profile of rotigotine and its effect on symptoms, quality of life and sleep hygiene in our HD population with RLS. A single-centre, 12-week prospective study. Two stages (6 weeks): stage 1 (no treatment) and stage 2 (rotigotine). We analysed: 1.- Demographic data, biochemistry data, HD suitability parameters and RLS medical treatment data. 2.- Lower extremity symptoms questionnaire (QS). 3.- RLS severity symptoms scale (SRLSS). 4.- RLS Quality of life: John Hopkins RLS-QoL (JH-QoL). 5.- Sleep hygiene: SCOPA Scale. We included 66 HD patients, 14 with RLS; 44.4% male, 70.2±9.9 years and 111.1±160.8 months on HD. And 22.9% RLS. Exclusively in stage 2, a significant improvement for QS (10±2.4 vs. 5.7±1.0), SRLSS (21±4 vs. 5.7±4.6), JH-QoL (22.1±4.4 vs. 4.3±4.0) and SCOPA (16±5.3 vs. 6.7±1.9) were observed. A 77.7 and 11.1%, showed partial (> 20%) and complete (> 80%) remission, respectively, while 55.5% achieved «zero» symptoms. Only one patient had gastrointestinal intolerance and none experienced augmentation effect. No changes in biochemical data, suitability for dialysis or medical treatment were found. The inter-group analysis showed a significant improvement in relation to QS, SRLSS, JH-QoL and SCOPA in stage 2. RLS showed a considerable prevalence in our HD unit. Rotigotine improved clinical symptoms, quality of life and sleep hygiene in RLS patients on HD and was found to be a safe drug with minimal side effects and total therapeutic compliance. Nevertheless, future studies should be performed to confirm the benefits of rotigotine in RLS patients on

Short communication: measures of weight distribution and frequency of steps as indicators of restless behavior.

PubMed

Chapinal, N; de Passillé, A M; Rushen, J; Tucker, C B

2011-02-01

Restless behavior, as measured by the steps taken or weight shifting between legs, may be a useful tool to assess the comfort of dairy cattle. These behaviors increase when cows stand on uncomfortable surfaces or are lame. The objective of this study was to compare 2 measures of restless behavior, stepping behavior and changes in weight distribution, on 2 standing surfaces: concrete and rubber. Twelve cows stood on a weighing platform with 1 scale/hoof for 1h. The platform was covered with either concrete or rubber, presented in a crossover design. Restlessness, as measured by both the frequency of steps and weight shifting (measured as the standard deviation of weight applied over time to the legs), increased over 1h of forced standing on either concrete or rubber. A positive relationship was found between the frequency of steps and the standard deviation of weight over 1h for both treatments and pairs of legs (r ≥ 0.66). No differences existed in the standard deviation of weight applied to the front (27.6 ± 1.6 kg) or rear legs (33.5 ± 1.4 kg) or the frequency of steps (10.2 ± 1.6 and 20.8 ± 3.2 steps/10 min for the front and rear pair, respectively) between rubber and concrete. Measures of restlessness are promising tools for assessing specific types of discomfort, such as those associated with lameness, but additional tools are needed to assess comfort of non-concrete standing surfaces. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

World Association of Sleep Medicine (WASM) 2016 standards for recording and scoring leg movements in polysomnograms developed by a joint task force from the International and the European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG).

PubMed

Ferri, R; Fulda, S; Allen, R P; Zucconi, M; Bruni, O; Chokroverty, S; Ferini-Strambi, L; Frauscher, B; Garcia-Borreguero, D; Hirshkowitz, M; Högl, B; Inoue, Y; Jahangir, A; Manconi, M; Marcus, C L; Picchietti, D L; Plazzi, G; Winkelman, J W; Zak, R S

2016-10-01

This report presents the results of the work by a joint task force of the International and European Restless Legs Syndrome Study Groups and World Association of Sleep Medicine that revised and updated the current standards for recording and scoring leg movements (LM) in polysomnographic recordings (PSG). First, the background of the decisions made and the explanations of the new rules are reported and then specific standard rules are presented for recording, detecting, scoring and reporting LM activity in PSG. Each standard rule has been classified with a level of evidence. At the end of the paper, Appendix 1 provides algorithms to aid implementation of these new standards in software tools. There are two main changes introduced by these new rules: 1) Candidate LM (CLM), are any monolateral LM 0.5-10 s long or bilateral LM 0.5-15 s long; 2) periodic LM (PLM) are now defined by runs of at least four consecutive CLM with an intermovement interval ≥10 and ≤ 90 s without any CLM preceded by an interval <10 s interrupting the PLM series. There are also new options defining CLM associated with respiratory events. The PLM rate may now first be determined for all CLM not excluding any related to respiration (providing a consistent number across studies regardless of the rules used to define association with respiration) and, subsequently, the PLM rate should also be calculated without considering the respiratory related events. Finally, special considerations for pediatric studies are provided. The expert visual scoringof LM has only been altered by the new standards to require accepting all LM > 0.5 s regardless of duration, otherwise the technician scores the LM as for the old standards. There is a new criterion for the morphology of LM that applies only to computerized LM detection to better match expert visual detection. Available automatic scoring programs will incorporate all the new rules so that the new standards should reduce technician burden for

Restless Legs Syndrome Foundation

MedlinePlus

... toward a cure! Become a Member Donate Your tax-deductible gift will help fund vital research leading ... a registered 501(c)(3) non-profit corporation (Tax ID #56-1784846). Donations are tax-deductible as ...

Restless legs syndrome in patients with sequelae of poliomyelitis.

PubMed

Kumru, Hatice; Portell, Enric; Barrio, Manuela; Santamaria, Joan

2014-10-01

No studies have examined the association between RLS and the sequelae of poliomyelitis (PM). We studied the frequency and severity of RLS in a group of consecutive patients with the sequelae of poliomyelitis (PM) and the effect of treatment with dopaminergic drugs. A diagnosis of RLS was made according to the criteria of the International RLS Study Group, and severity was assessed by the RLS rating scale. Information on sex, age, age at onset, site affected by PM, disease duration of PM, and history of post-polio syndrome (pPS) was obtained in a cohort of 52 PM patients. The mean age was 55.9 ± 6.5 years; 39 patients had post-polio syndrome (75%). RLS was diagnosed in 21 (40.4%) patients. Sixteen of the 21 patients (76.2%) with RLS had pPS, which was similar to the non-RLS group (74.2% patients with pPS). RLS symptoms were very severe in 5 patients, severe in 13, moderate in 2 and mild in 1. Nineteen of the 21 patients with RLS had symptoms predominantly in the more affected lower limb (90% of patients). Sixteen patients received dopaminergic agonist treatment with a significant reduction in their scores on the RLS severity scale from 28.3 ± 4.7 to 6.9 ± 7.3 (p < 0.001). RLS occurs frequently in patients with PM, both in those with and without pPS, and responds well to treatment with dopaminergic drugs. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Acute leg compartment syndrome after exertion].

PubMed

Misović, Sidor; Kronja, Goran; Ignjatović, Dragan; Tomić, Aleksandar

2005-03-01

A case of a 22-year old soldier, with a history of pain in the leg during heavy exercise, which desisted at rest, was presented. One day before admission, the patient had felt an extreme exertion-induced pain in his right leg which had not lessenned at rest. At the same time, the patient noticed persistent severe leg edema. On physical examination, the intracompartmental pressure was 62 mmHg (> 30 mmHg). The patient was urgently operated on, and fasciotomy according to Mubarak was used. At second surgery, the debridement of the muscles of the posterior group of the leg, and the evacuation of hemathoma from the anterior and lateral group of the right leg muscles were perfomed. Postoperative recovery was uneventful. Fasciotomy wounds were closed within 14 days of the surgery. The complete physical treatment was done. Follow-up examinations 1, 3, and 6 months afterwards were satisfactory. The soldier completed his compulsory military service without any sequelae. Laboratory results were normal. Overlooked, unrecognized or surgically untreated compartment syndrome can cause severe damage, including even the loss of the extremity.

An under-diagnosed geriatric syndrome: sleep disorders among older adults.

PubMed

Tufan, Asli; Ilhan, Birkan; Bahat, Gulistan; Karan, Mehmet Akif

2017-06-01

Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered 'yes' to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment.

Leg orientation as a clinical sign for pusher syndrome

PubMed Central

Johannsen, Leif; Broetz, Doris; Karnath, Hans-Otto

2006-01-01

Background Effective control of (upright) body posture requires a proper representation of body orientation. Stroke patients with pusher syndrome were shown to suffer from severely disturbed perception of own body orientation. They experience their body as oriented 'upright' when actually tilted by nearly 20° to the ipsilesional side. Thus, it can be expected that postural control mechanisms are impaired accordingly in these patients. Our aim was to investigate pusher patients' spontaneous postural responses of the non-paretic leg and of the head during passive body tilt. Methods A sideways tilting motion was applied to the trunk of the subject in the roll plane. Stroke patients with pusher syndrome were compared to stroke patients not showing pushing behaviour, patients with acute unilateral vestibular loss, and non brain damaged subjects. Results Compared to all groups without pushing behaviour, the non-paretic leg of the pusher patients showed a constant ipsiversive tilt across the whole tilt range for an amount which was observed in the non-pusher subjects when they were tilted for about 15° into the ipsiversive direction. Conclusion The observation that patients with acute unilateral vestibular loss showed no alterations of leg posture indicates that disturbed vestibular afferences alone are not responsible for the disordered leg responses seen in pusher patients. Our results may suggest that in pusher patients a representation of body orientation is disturbed that drives both conscious perception of body orientation and spontaneous postural adjustment of the non-paretic leg in the roll plane. The investigation of the pusher patients' leg-to-trunk orientation thus could serve as an additional bedside tool to detect pusher syndrome in acute stroke patients. PMID:16928280

What Is Restless Legs Syndrome?

MedlinePlus

... creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Sometimes, these feelings also occur in the ... creeping, crawling, pulling, itching, tingling, burning, aching, or electric shocks. Severe RLS may cause painful feelings. However, ...

Shin-splints: common exercise-related syndromes affecting the lower leg.

PubMed

Williamson, B L; Arthur, C H C

2014-01-01

Lower leg pain is a common complaint of athletically active individuals, often limiting physical activities. As such, the group of lower leg conditions related to athletic pursuits and physical exercise confer considerable operational implications for the military. Whilst acute injuries to the lower limb are commonly encountered and are clearly of significance, this article focuses instead on chronic conditions related to physical activity. These include insults to bone such as stress fractures and medial tibial stress syndrome, and those related to the soft tissues such as chronic exertional compartment syndrome. In this article we will examine the presentation and management of these conditions.

Characterization of Burning Mouth Syndrome in Patients with Parkinson's Disease.

PubMed

Bonenfant, David; Rompré, Pierre H; Rei, Nathalie; Jodoin, Nicolas; Soland, Valerie Lynn; Rey, Veronica; Brefel-Courbon, Christine; Ory-Magne, Fabienne; Rascol, Olivier; Blanchet, Pierre J

2016-01-01

To determine the prevalence and characteristics of burning mouth syndrome (BMS) in a Parkinson's disease (PD) population through a self-administered, custom-made survey. A total of 218 surveys were collected during regular outpatient visits at two Movement Disorders Clinics in Montreal (Canada) and Toulouse (France) to gather information about pain experience, PD-related symptoms, and oral and general health. A neurologist confirmed the diagnosis of PD, drug treatment, Hoehn-Yahr stage, and Schwab & England Activity of Daily Living score. Data between groups were compared using the independent samples Mann-Whitney U test and two-sided exact Fisher test. Data from 203 surveys were analyzed. BMS was reported by eight subjects (seven females and one male), resulting in a prevalence of 4.0% (95% confidence interval [CI] = 2.1-7.8). Five participants with chronic nonburning oral pain were excluded. PD severity and levodopa equivalent daily dose did not differ between non-BMS and BMS participants. Mean poor oral health index was higher in BMS compared to non-BMS subjects (49.0 vs 32.2 points, P < .05). BMS manifested after PD onset in seven patients, did not occur on a daily basis in four, and always coexisted with restless legs syndrome. This survey yielded a low prevalence of BMS in PD patients, indicating no strong link between the two conditions. An augmenting effect such as that resulting from drug treatment in restless legs syndrome or sensory neuropathy cannot be excluded.

Genetics Home Reference: restless legs syndrome

MedlinePlus

... P, Ripke S, Trenkwalder C, Zimprich A, Stiasny-Kolster K, Oertel W, Bachmann CG, Paulus W, Högl B, ... W, Peglau I, Vodicka P, Vávrová J, Sonka K, Nevsimalova S, Montplaisir J, Turecki G, Rouleau G, Gieger ...

Restless Legs Syndrome -- Causes and Symptoms

MedlinePlus

... return to Overview & Facts | continue to Self-Tests & Diagnosis » Copyright © 2018 American Academy of Sleep Medicine 2510 North Frontage Road, Darien, IL 60561 Telephone: (630) 737-9700 Fax: ( ...

Rotigotine transdermal system: a short review

PubMed Central

Bunten, Sabine; Happe, Svenja

2006-01-01

Rotigotine (Neupro®) is a new non-ergolinic dopamine agonist transdermal patch that can be applied once daily. To date, it is approved for the treatment of early Parkinson’s disease as monotherapy and has been shown to be effective in the treatment of advanced-stage Parkinson’s disease and restless legs syndrome in several clinical trials. This review gives an overview of physical, chemical, and pharmaceutical characteristics, pharmacokinetics, biotransformation and elimination, drug interactions, and adverse events of rotigotine. Further, the rationale for the treatment of Parkinson’s disease and restless legs syndrome with rotigotine is discussed. PMID:19412491

Neuroleptic-induced "painful legs and moving toes" syndrome: successful treatment with clonazepam and baclofen.

PubMed

Sandyk, R

1990-12-01

The syndrome of "painful legs and moving toes" is characterised by spontaneous causalgic pain in the lower extremities associated with peculiar involuntary movements of the toes and feet. It has been observed after a variety of lesions affecting the posterior nerve roots, the spinal ganglia and the peripheral nerves. The pathophysiology of the syndrome is unknown. I report a patient who developed the syndrome during treatment for schizophrenia with the antipsychotic agent molindone hydrochloride. The patient's response to the combination of clonazepam and baclofen suggests that the pathophysiology of the "painful legs and moving toes" may be linked to impairment of spinal serotonergic and GABA functions.

Fibromyalgia

MedlinePlus

... following: Anxiety. Depression. Irritable bowel syndrome. Restless legs syndrome. Increased sensitivity to odors, bright lights, loud noises, or medicines. Headaches, migraines, or jaw pain. Dry eyes or mouth. Dizziness and problems with balance. Problems ...

Leg Movement Activity During Sleep in Adults With Attention-Deficit/Hyperactivity Disorder.

PubMed

Garbazza, Corrado; Sauter, Cornelia; Paul, Juliane; Kollek, Jenny; Dujardin, Catharine; Hackethal, Sandra; Dorn, Hans; Peter, Anita; Hansen, Marie-Luise; Manconi, Mauro; Ferri, Raffaele; Danker-Hopfe, Heidi

2018-01-01

Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls. Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of "periodicity," i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires. Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients. Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.

Survey of management of acute, traumatic compartment syndrome of the leg in Australia.

PubMed

Wall, Christopher J; Richardson, Martin D; Lowe, Adrian J; Brand, Caroline; Lynch, Joan; de Steiger, Richard N

2007-09-01

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency and is associated with significant morbidity if not diagnosed promptly and treated effectively. Despite the urgency of effective management to minimize the risk of adverse outcomes, there is currently little consensus in the published reports as to what constitutes best practice in the management of acute limb compartment syndrome. A structured survey was sent to all currently practising orthopaedic surgeons and accredited orthopaedic registrars in Australia to assess their current practice in the management of acute, traumatic compartment syndrome of the leg. Questions were related to key decision nodes in the management process, as identified in a literature review. These included identification of patients at high risk, diagnosis of the condition in alert and unconscious patients, optimal timeframe and technique for carrying out a fasciotomy and management of fasciotomy wounds. A total of 264 valid responses were received, a response rate of 29% of all eligible respondents. The results indicated considerable variation in management of acute compartment syndrome of the leg, in particular in the utilization of compartment pressure measurement and the appropriate pressure threshold for fasciotomy. Of the 78% of respondents who regularly measured compartment pressure, 33% used an absolute pressure threshold, 28% used a differential pressure threshold and 39% took both into consideration. There is variation in the management of acute, traumatic compartment syndrome of the leg in Australia. The development of evidence-based clinical practice guidelines may be beneficial.

Le syndrome des jambes sans repos: fréquence et facteurs de risque chez l'hémodialysé

PubMed Central

Soumeila, Illiassou; Keita, Salia; Elhassani, Anis; Sidibé, Mohamed; Alaoui, Khadija; Kabbali, Nadia; Arrayhani, Mohamed; Sqalli, Tarik

2015-01-01

Le syndrome des jambes sans repos (SJSR) ou syndrome d'impatience musculaire est un trouble moteur caractérisé par des sensations désagréables dans les jambes. Les causes sont mal connues et sa fréquence est estimée entre 25% et 75% chez les hémodialysés. Il s'agit d'une étude transversale monocentrique menée au centre d'hémodialyse du CHU Hassan II de Fès (hôpital Al Ghassani) entre décembre 2012 et janvier 2013. Nous avons défini le syndrome de jambes sans repos selon la définition de l'international restless legs study group de 2003 reposant sur 4 critères essentiels au diagnostic. L'international restless legs syndrome scale (IRLES) a été coté par un même néphrologue pour mesurer la sévérité du syndrome des jambes sans repos. 84 hémodialysés ont répondu au questionnaire avec 41,7% de cas de SJSR dont 6,6% de formes graves. Nous avons retrouvé une association entre le SJSR et la carence martiale p(0,018), la néphropathie initiale p(0,041), l'HTA p(0,026) et le sexe féminin p(0,024). Dans notre série, il ressort que la carence martiale et l'HTA sont les principaux facteurs de risque modifiables de ce syndrome chez nos patients. Les facteurs traditionnels comme le tabagisme, l’âge supérieur à 50 ans et la dialyse inadéquate ne sont pas associés à ce trouble dans notre série. PMID:26015849

Restless Legs Syndrome -- Self-Tests and Diagnosis

MedlinePlus

... Overview & Facts Symptoms & Causes Diagnosis & Self Tests Treatment Sleep Apnea Overview & Facts Symptoms & Risk Factors Self-Tests Diagnosis ... for a Sleep Study Testing Process & Results Home Sleep Apnea Testing Overview Testing Process & Results CPAP Overview Benefits ...

Athletes' leg pains.

PubMed Central

Orava, S.; Puranen, J.

1979-01-01

The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. PMID:486888

Boredom: Under-aroused and restless.

PubMed

Danckert, James; Hammerschmidt, Tina; Marty-Dugas, Jeremy; Smilek, Daniel

2018-05-01

Boredom is a common experience associated with a range of negative outcomes. Debate remains as to whether boredom should be considered a high or low arousal state. We employed passages of text to induce either boredom or interest and probed self-reported levels of boredom, arousal, and restlessness. Results replicated known associations between mind-wandering and state boredom (i.e., mind-wandering was highest for the boredom mood induction). Reports of sleepiness (a proxy for arousal level) were highest for the boring induction. While restlessness was not different for the boring and interesting inductions when they were performed first, restlessness was significantly higher for the boredom induction when it was experienced last. We discuss these results within the context of the debate regarding boredom and arousal. Copyright © 2018 Elsevier Inc. All rights reserved.

Is restlessness best understood as a process? Reflecting on four boys’ restlessness during music therapy in kindergarten

PubMed Central

Helle-Valle, Anna; Binder, Per-Einar; Anderssen, Norman; Stige, Brynjulf

2017-01-01

ABSTRACT ADHD can be considered an internationally recognized framework for understanding children’s restlessness. In this context, children’s restlessness is understood as a symptom of neurodevelopmental disorder. However, there are other possible understandings of children’s restlessness. In this article, we explore four boys’ collaborative and creative process as it is described and understood by three adults. The process is framed by a community music therapy project in a Norwegian kindergarten, and we describe four interrelated phases of this process: Exploring musical vitality and cooperation, Consolidating positions, Performing together, and Discovering ripple effects. We discuss these results in relation to seven qualities central to a community music therapy approach: participation, resource orientation, ecology, performance, activism, reflexivity and ethics. We argue that in contrast to a diagnostic approach that entails a focus on individual problems, a community music therapy approach can shed light on adult and systemic contributions to children’s restlessness. PMID:28532331

Painful legs and moving toes syndrome: a 76-patient case series.

PubMed

Hassan, Anhar; Mateen, Farrah J; Coon, Elizabeth A; Ahlskog, J Eric

2012-08-01

To better characterize the clinical features, electrophysiologic features, and treatment outcomes of painful legs and moving toes (PLMT) syndrome. Large case series. Neurology outpatient clinic at a tertiary referral center, 1983-2011. All cases of PLMT seen at our institution during an 18-year period were identified using our medical record linkage system. Key demographic, clinical, imaging, and electrophysiologic features of PLMT. Treatment outcomes and long-term follow-up are also reported. Of 76 cases identified (including 50 women [66%]), the mean age at onset was 58 years (range, 24-86 years) and at neurologic evaluation was 63 years (range, 26-88 years). Pure lower limb involvement was most common (69 patients [91%]), and 44 cases (58%) were bilateral. The most frequently diagnosed causes were peripheral neuropathy (21 cases [28%]), previous trauma (8 [11%]), and radiculopathy (7 [9%]); 32 cases (42%) were cryptogenic. Electromyography consistently showed irregular 50-millisecond to 1-second bursts of normal motor unit potential firing at 2 to 200 Hz accompanying the movements. Pain occurred first in nearly all cases and was more distressing to patients than the movements. Both components were difficult to treat, with no consistent benefit from a variety of drugs and therapeutic modalities. The syndrome persisted in most patients (83%) during the mean follow-up of 4.6 years, suggesting low likelihood of spontaneous resolution. Painful legs and moving toes syndrome is a debilitating clinical syndrome, not because of the movements but rather because of the pain, which often is refractory to treatment. Segmental lower limb involvement is most common, and neurophysiologic findings support a pathophysiologic process localizing to a central generator at the spinal cord or brainstem level.

Sleep Disturbances in U.S. Soldiers after Deployment to Afghanistan or Iraq

DTIC Science & Technology

2010-11-11

and “The type of sleep disturbances (e.g., insomnia, sleep apnea , restless leg syndrome , others, or I do not know).” Endorsement to the first...leg syndrome ’ (n = 9), and ‘ sleep apnea ’ (n = 5). Psychological factors such as PTSD, depression, and PSS also showed either a high rate or score...sleepers. The most frequent type of sleep disturbances was ‘insomnia’ (n = 42), followed by ‘others’ and ‘don’t know’ (n = 21), ‘ sleep apnea ’ (n = 15), and

Chronic Lower Leg Pain in Athletes

PubMed Central

Brewer, Rachel Biber; Gregory, Andrew J. M.

2012-01-01

Context: Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse. Evidence Acquisition: PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment. Results: Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary. Conclusion: Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians. PMID:23016078

Thermally-assisted Magma Emplacement Explains Restless Calderas

NASA Astrophysics Data System (ADS)

Amoruso, A.; Crescentini, L.; D'Antonio, M.; Acocella, V.

2017-12-01

Many calderas show repeated unrest over centuries. Though probably induced by magma, this unique behaviour is not understood and its dynamics remains elusive. To better understand these restless calderas, we interpret deformation data and build thermal models of Campi Flegrei, Italy, which is the best-known, yet most dangerous calderas, lying to the west of Naples and restless since the 1950s at least.Our elaboration of the geodetic data indicates that the inflation and deflation of magmatic sources at the same location explain most deformation, at least since the build-up of the last 1538 AD eruption. However, such a repeated magma emplacement requires a persistently hot crust.Our thermal models show that the repeated emplacement was assisted by the thermal anomaly created by magma that was intruded at shallow depth 3 ka before the last eruption and, in turn, contributed to maintain the thermal anomaly itself. This may explain the persistence of the magmatic sources promoting the restless behaviour of the Campi Flegrei caldera; moreover, it explains the crystallization, re-melting and mixing among compositionally distinct magmas recorded in young volcanic rocks.Available information at other calderas highlights similarities to Campi Flegrei, in the pattern and cause of unrest. All monitored restless calderas have either geodetically (Yellowstone, Aira Iwo-Jima, Askja, Fernandina and, partly, Long Valley) or geophysically (Rabaul, Okmok) detected sill-like intrusions inducing repeated unrest. Some calderas (Yellowstone, Long Valley) also show stable deformation pattern, where inflation insists on and mimics the resurgence uplift. The common existence of sill-like sources, also responsible for stable deformation patterns, in restless calderas suggests close similarities to Campi Flegrei. This suggests a wider applicability of our model of thermally-assisted sill emplacement, to be tested by future studies to better understand not only the dynamics of restless

Women's health issues with fibromyalgia syndrome.

PubMed

Shaver, Joan L F; Wilbur, Joellen; Robinson, F Patrick; Wang, Edward; Buntin, Mary S

2006-11-01

Fibromyalgia syndrome (FMS) involves multiple sensory, somatic, and cognitive symptoms that are bound to affect or be affected by physical and mental health status and behavioral components of daily life. From a telephone survey of 442 women with and 205 women without FMS as volunteers, data were compared on (1) general health status, (2) reproductive and sleep-related diagnoses, and (3) lifestyle health behaviors. All multiple or logistics regression analyses for group differences were controlled for age, body mass index (BMI), race, employment status, marital status, having a college degree, low household income, and having ever been diagnosed with depression, with a Bonferroni p value correction for multiple indicators. Accordingly, FMS negatively impacted both perceived physical and mental health status, although relatively more so for physical (p < 0.017). Women with FMS were more likely to have had reproductive health or sleep-related diagnoses, including premenstrual syndrome, dysmenorrhea, breast cysts, bladder cystitis, sleep apnea, restless leg syndrome, and abnormal leg movements (p < 0.0125). They were calculated to use less than half as many calories per week as control women (689 +/- 1293 vs. 1499 +/- 1584 kcal/week, p < 0.05) and had more sleep pattern difficulties (p < 0.0125), more negative changes in sexual function (greater odds for 5 of 10 indicators at p < 0.005), and lower alcohol use (odds ratio = 0.39, p < 0.05). Patients with FMS deserve careful assessment for reproductive conditions and sleep-related functional disorders. Besides more research into mechanisms underlying symptoms, intervention testing specifically to alleviate sleep problems, low physical activity levels, and sexual dysfunction should be paramount.

Do we understand children's restlessness? Constructing ecologically valid understandings through reflexive cooperation

PubMed Central

Binder, Per-Einar; Stige, Brynjulf

2015-01-01

Attention-deficit/hyperactivity disorder (ADHD) is the most widely used children's mental health diagnosis today, but the validity of the diagnosis is controversial, for instance, because it might conceal relational and ecological dimensions of restlessness. We invited parents and professionals from one local community in western Norway to participate in cooperative group discussions on how to conceptualize and understand children's restlessness. We carried out a thematic and reflexive analysis of the cooperative group discussions on ADHD and children's restlessness, and present findings related to three ecological levels inspired by Bronfenbrenner's ecological systems model. At the level of the individual, restlessness was discussed as individual trait, as the expectation to be seen and heard, and as a result of traumatization. At the level of dyad, group or family, restlessness was discussed as a relational phenomenon and as parents' problems. At the level of community, restlessness was discussed as lack of cooperation and lack of structures or resources. Our findings show how contextualized and cooperative reflexivity can contribute to more valid understandings of children's restlessness, and how cooperative inquiry can stimulate reflections about solidarity and sustainability in relation to adult's actions. PMID:26701898

Restless legs syndrome: differential diagnosis and management with rotigotine

PubMed Central

Merlino, Giovanni; Serafini, Anna; Robiony, Francesca; Valente, Mariarosaria; Gigli, Gian Luigi

2009-01-01

RLS is a common sleep disorder with distinctive clinical features. The prevalence of RLS in Caucasians and North Americans ranges from 5% to 10%. However, only some of these subjects (almost the 3% of the general population) report being affected by a frequent and severe form of the sleep disorder. RLS is diagnosed clinically by means of four internationally recognized criteria that summarize the main characteristics of the sleep disorder. Besides the essential criteria, supportive and associated features of RLS have been established by experts in order to help physicians treat patients with doubtful symptoms. Several clinical conditions may mimic this sleep disorder. In order to increase the sensibility and specificity of RLS diagnosis, doctors should perform a meticulous patient history and then an accurate physical and neurological examination. Dopamine agonists are recognized as the preferred first-line treatment for RLS. Rotigotine is a non-ergoline dopamine agonist with selectivity for D1, D2 and D3 receptors. The drug is administered via transdermal patches which release rotigotine for 24 hours. Four clinical trials demonstrated that this compound is able to improve RLS symptomatology with few and moderate adverse events. Head to head trials are required to compare the efficacy and tolerability of rotigotine with other dopamine agonists administered via oral intake. Rotigotine has been approved by the FDA and EMEA for Parkinson’s disease. For the treatment of moderate to severe idiopathic RLS, rotigotine has been recommended for approval by the EMEA and is under review by the FDA. PMID:19557102

Common Leg Injuries of Long-Distance Runners

PubMed Central

Gallo, Robert A.; Plakke, Michael; Silvis, Matthew L.

2012-01-01

Context Long-distance running (greater than 3000 m) is often recommended to maintain a healthy lifestyle. Running injury rates increase significantly when weekly mileage extends beyond 40 miles cumulatively. With the development of running analysis and other diagnostic tests, injuries to the leg secondary to bone, musculotendinous, and vascular causes can be diagnosed and successfully managed. Evidence Acquisition Searches used the terms running, injuries, lower extremity, leg, medial tibial stress syndrome, compartment syndrome, stress fractures, popliteal artery entrapment, gastrocnemius soleus tears, and Achilles tendinopathy. Sources included Medline, Google Scholar, and Ovid from 1970 through January 2012. Results Tibial stress fractures and medial tibial stress syndrome can sometimes be prevented and/or treated by correcting biomechanical abnormalities. Exertional compartment syndrome and popliteal artery entrapment syndrome are caused by anatomic abnormalities and are difficult to treat without surgical correction. Conclusion Leg pain due to bone, musculotendinous, and vascular causes is common among long-distance runners. Knowledge of the underlying biomechanical and/or anatomic abnormality is necessary to successfully treat these conditions. PMID:24179587

Thermally-assisted Magma Emplacement Explains Restless Calderas.

PubMed

Amoruso, Antonella; Crescentini, Luca; D'Antonio, Massimo; Acocella, Valerio

2017-08-11

Many calderas show repeated unrest over centuries. Though probably induced by magma, this unique behaviour is not understood and its dynamics remains elusive. To better understand these restless calderas, we interpret deformation data and build thermal models of Campi Flegrei caldera, Italy. Campi Flegrei experienced at least 4 major unrest episodes in the last decades. Our results indicate that the inflation and deflation of magmatic sources at the same location explain most deformation, at least since the build-up of the last 1538 AD eruption. However, such a repeated magma emplacement requires a persistently hot crust. Our thermal models show that this repeated emplacement was assisted by the thermal anomaly created by magma that was intruded at shallow depth ~3 ka before the last eruption. This may explain the persistence of the magmatic sources promoting the restless behaviour of the Campi Flegrei caldera; moreover, it explains the crystallization, re-melting and mixing among compositionally distinct magmas recorded in young volcanic rocks. Our model of thermally-assisted unrest may have a wider applicability, possibly explaining also the dynamics of other restless calderas.

Rotigotine transdermal patch and sleep in Parkinson's disease: where are we now?

PubMed

Rosa-Grilo, Miguel; Qamar, Mubasher A; Taddei, Raquel N; Pagonabarraga, Javier; Kulisevsky, Jaime; Sauerbier, Anna; Chaudhuri, K Ray

2017-01-01

A wide range of sleep dysfunction complicates Parkinson's disease during its course from prodromal to palliative stage. It is now increasingly acknowledged that sleep disturbances are thus integral to the disease and pose a significant burden impacting on quality of life of patients. Sleep fragmentation, restless legs syndrome, nocturia, and nocturnal pain are regarded as one of the main components of night-time sleep dysfunction with possible secondary impact on cognition and well-being. The role of dopaminergic therapies, particularly using a continuous drug delivery strategy in managing some of these sleep issues, have been reported but the overall concept remains unclear. This review provides an overview of several aspects of night-time sleep dysfunction in Parkinson's disease and describes all available published open-label and blinded studies that investigated the use of rotigotine transdermal patch targeting sleep. Blinded studies have suggested beneficial effects of rotigotine transdermal patch on maintenance insomnia and restless legs syndrome in Parkinson's disease patients. Open-label studies support these observations and also suggest beneficial effects on nocturia and nocturnal pain.

Burning mouth syndrome: Clinical description, pathophysiological approach, and a new therapeutic option.

PubMed

Cárcamo Fonfría, A; Gómez-Vicente, L; Pedraza, M I; Cuadrado-Pérez, M L; Guerrero Peral, A L; Porta-Etessam, J

2017-05-01

Burning mouth syndrome is defined as scorching sensation in the mouth in the absence of any local lesions or systemic disease that would explain that complaint. The condition responds poorly to commonly used treatments and it may become very disabling. We prospectively analysed the clinical and demographic characteristics and response to treatment in 6 cases of burning mouth syndrome, diagnosed at 2 tertiary hospital headache units. Six female patients between the ages of 34 and 82 years reported symptoms compatible with burning mouth syndrome. In 5 of them, burning worsened at the end of the day; 4 reported symptom relief with tongue movements. Neurological examinations and laboratory findings were normal in all patients and their dental examinations revealed no buccal lesions. Each patient had previously received conventional treatments without amelioration. Pramipexol was initiated in doses between 0.36mg and 1.05mg per day, resulting in clear improvement of symptoms in all cases, a situation which continues after a 4-year follow up period. Burning mouth syndrome is a condition of unknown aetiology that shares certain clinical patterns and treatment responses with restless leg syndrome. Dopamine agonists should be regarded as first line treatment for this entity. Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS)

MedlinePlus

... Professional Version Sleep Disorders Overview of Sleep Snoring Insomnia and Excessive Daytime Sleepiness (EDS) Circadian Rhythm Sleep ... pressure when a person stands (orthostatic hypotension), and insomnia. Benzodiazepines: These drugs (such as clonazepam ) cause drowsiness, ...

Weinberg's syndrome: a disorder of attention and behavior problems needing further research.

PubMed

Brumback, R A

2000-07-01

A subset of inattentive children have an underlying problem in sustaining wakefulness ("vigilance"). This disorder of vigilance, termed Weinberg's syndrome, is characterized by difficulty in maintaining wakefulness and alertness as evidenced by (among other symptoms) motor restlessness (fidgeting and moving about, yawning and stretching, talkativeness) and complaints of tiredness. During tasks requiring concentration (continuous mental activity) such as reading, children with Weinberg's syndrome will daydream, lose interest, complain of boredom, and become increasingly restless. Napping, while infrequent, usually is not refreshing. A distinct personality described by family members and friends as kind, affectionate, compassionate, or "angelic" also seems to characterize this condition. Weinberg's syndrome has a familial pattern suggesting autosomal-dominant inheritance. Additional neurophysiologic, pharmacotherapeutic, epidemiologic, and genetic studies will be necessary for a full understanding of Weinberg's syndrome.

Problem Behaviors Associated with 15q- Angelman Syndrome.

ERIC Educational Resources Information Center

Clarke, David J.; Marston, Geoff

2000-01-01

Seventy-three caregivers of persons with Angelman syndrome completed the Aberrant Behavior checklist and Reiss Screen for Maladaptive Behavior. Responses indicate that 15q- Angelman syndrome is associated with problems such as lack of speech, over activity, restlessness, and eating and sleeping problems. Inappropriate laughter was only reported…

Weak social networks and restless sleep interrelate through depressed mood among elderly.

PubMed

Cheng, Grand H-L; Malhotra, Rahul; Chan, Angelique; Østbye, Truls; Lo, June C

2018-06-04

Sleep disturbance is common in late life. While social interaction is a basic human concern, few studies have explored the linkage between interpersonal relationships and sleep disturbance. The present study examines the reciprocal associations between weak social networks outside the household and sleep disturbance in elderly, as well as the underlying mechanisms. We utilized data from a nationally representative longitudinal survey of community-dwelling elderly in Singapore (n = 1417; ≥ 60 years). Participants were assessed three times over 6 years (2009, 2011, 2015). Measures included strength of social networks outside the household, restless sleep (sleep disturbance), and the mediating variables of depressed mood, chronic diseases, and cognitive impairment. A cross-lagged mediation analysis was conducted. Bootstrapping results showed that weaker social networks were related to more restless sleep via more depressed mood. Also, restless sleep was negatively associated with social networks through depressed mood. The other mediators examined were not significant. Weak social networks and restless sleep reciprocally influence each other through depressed mood. Recognition of this interplay can inform efforts in improving elderly's sleep quality, social networks, and psychological well-being.

A polysomnographic and clinical study of sleep disorders in patients with Behçet and neuro-Behçet syndrome.

PubMed

Uygunoğlu, Uğur; Benbir, Gulcin; Saip, Sabahattin; Kaynak, Hakan; Siva, Aksel

2014-01-01

Brainstem is the most common site of involvement in neuro-Behçet syndrome (NBS). On the other hand, the critical importance of this anatomical region in the regulation of sleep has been disregarded in the literature. We aimed to investigate the microstructure of sleep in patients with Behçet syndrome (BS) and NBS. Patients were allocated to 2 groups: (1) BS without any neurological involvement and (2) NBS with brainstem lesions only. A control group was also enrolled in this study. The comparison of polysomnographic parameters between all patients (BS and NBS) with the control group showed that sleep onset was longer (p = 0.006), the duration of superficial NREM sleep stage (N2) was significantly longer (p = 0.018), and the respiratory disturbance index was significantly higher (p = 0.034) in patients. Sleep apnea and restless legs syndrome are more commonly observed in BS and NBS. Our findings emphasize the importance of questioning the quality of sleep and its disorders in patients with BS in order to better handle the common somatic complaints in these patients, such as fatigue or daytime sleepiness . © 2014 S. Karger AG, Basel.

Periodic limb movements and insomnia, a common but under-recognized association

PubMed Central

Varadharajulu, Saravanan; Chandrasekaran, Baskaran

2015-01-01

Periodic limb movements unlike restless leg syndrome is under diagnosed and unrecognized in medical arena. While robust Western trials have elucidated the association between periodic limb movements and sleep disturbances, it is not well received and recognized in India even in well sophisticated tertiary care hospital. We report a chronic insomnia patient who had sleep disturbances for past 30 years due to periodic limb movements alone. This was diagnosed through polysomnography. This case emphasizes monitoring leg movements during sleep study. This report may open new horizons in improving monitoring in sleep study in clinical setting. PMID:26124530

The prevalence of fibromyalgia in other chronic pain conditions.

PubMed

Yunus, Muhammad B

2012-01-01

Central sensitivity syndromes (CSS) include fibromyalgia syndrome (FMS), irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS). CSS are mutually associated. In this paper, prevalence of FMS among other members of CSS has been described. An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example, rheumatoid arthritis, systemic lupus, ankylosing spondylitis, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild.

[Dopamine agonists--clinical applications beyond Parkinson's disease].

PubMed

Kuran, Włodzimierz

2007-01-01

Contemporary experience and results of clinical trials concerning dopamine agonist application in the treatment of many different diseases (apart from Parkinson's disease) are presented in the paper. A basic clinical recommendation for agonists is restless legs syndrome. In this syndrome almost all agonists give a considerable subjective and objective improvement. Treatment of atypical parkinsonism (MSA, PSP, CBD) in the majority of patients is ineffective. The author also presents promising results of treatment with agonists in such diverse diseases as hyperkinetic syndromes, cocaine dependence, drug-resistant depression and erectile dysfunction (apomorphine). Dopamine partial agonists (e.g. aripiprazol) are recommended in the modern treatment of schizophrenia.

Intramuscular deoxygenation during exercise in patients who have chronic anterior compartment syndrome of the leg

NASA Technical Reports Server (NTRS)

Mohler, L. R.; Styf, J. R.; Pedowitz, R. A.; Hargens, A. R.; Gershuni, D. H.

1997-01-01

Currently, the definitive diagnosis of chronic compartment syndrome is based on invasive measurements of intracompartmental pressure. We measured the intramuscular pressure and the relative oxygenation in the anterior compartment of the leg in eighteen patients who were suspected of having chronic compartment syndrome as well as in ten control subjects before, during, and after exercise. Chronic compartment syndrome was considered to be present if the intramuscular pressure was at least fifteen millimeters of mercury (2.00 kilopascals) before exercise, at least thirty millimeters of mercury (4.00 kilopascals) one minute after exercise, or at least twenty millimeters of mercury (2.67 kilopascals) five minutes after exercise. Changes in relative oxygenation were measured with use of the non-invasive method of near-infrared spectroscopy. In all patients and subjects, there was rapid relative deoxygenation after the initiation of exercise, the level of oxygenation remained relatively stable during continued exercise, and there was reoxygenation to a level that exceeded the pre-exercise resting level after the cessation of exercise. During exercise, maximum relative deoxygenation in the patients who had chronic compartment syndrome (mean relative deoxygenation [and standard error], -290 +/- 39 millivolts) was significantly greater than that in the patients who did not have chronic compartment syndrome (-190 +/- 10 millivolts) and that in the control subjects (-179 +/- 14 millivolts) (p < 0.05 for both comparisons). In addition, the interval between the cessation of exercise and the recovery of the pre-exercise resting level of oxygenation was significantly longer for the patients who had chronic compartment syndrome (184 +/- 54 seconds) than for the patients who did not have chronic compartment syndrome (39 +/- 19 seconds) and the control subjects (33 +/- 10 seconds) (p < 0.05 for both comparisons).

The Prevalence of Fibromyalgia in Other Chronic Pain Conditions

PubMed Central

Yunus, Muhammad B.

2012-01-01

Central sensitivity syndromes (CSS) include fibromyalgia syndrome (FMS), irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS). CSS are mutually associated. In this paper, prevalence of FMS among other members of CSS has been described. An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example, rheumatoid arthritis, systemic lupus, ankylosing spondylitis, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild. PMID:22191024

Can't Curb the Urge to Move? Living with Restless Legs Syndrome

MedlinePlus

... active is usually a good thing. But the motivation to move goes to unwelcome extremes for people ... the dopamine A brain chemical that regulates movement, motivation and other functions. system, and patients often have ...

Chronic deep posterior compartment syndrome of the leg in athletes: postoperative results of fasciotomy.

PubMed

van Zoest, W J F; Hoogeveen, A R; Scheltinga, M R M; Sala, H A; van Mourik, J B A; Brink, P R G

2008-05-01

The present study evaluates the efficacy of two treatment regimens in individuals possibly suffering from chronic exercise induced compartment syndrome (CECS) of the deep posterior compartment of the leg. We hypothesised that the current method of fasciotomy of the deep posterior compartment of the leg is a procedure with a limited success rate. Dynamic intra-compartmental pressure measurements were applied to 46 patients that had symptomatology of a posterior CECS. Only those patients that met predefined pressure criteria, the "high-pressure group" (27 patients), were offered surgical treatment in the form of fasciotomy. The other 19 patients, "low-pressure group", received conservative treatment, consisting of inlays and physiotherapy. In addition, these patients were examined more closely in order to exclude different pathology. Efficacy of both approaches was evaluated by a questionnaire after a mean three-year follow-up. Fifty-two percent of the high-pressure group judged their operation successful, whereas 48 % did not. The majority of the low-pressure group (84 %) was free of symptoms, after conservative treatment as well as following treatment of other pathology. The present study shows that the success rate of patients surgically treated for posterior CECS is relatively low (52 %). The established cut-off points for the compartment pressure to deselect patients for an operation are justified based on the long-term success rate of the low-pressure group.

Sleep-related movement disorders.

PubMed

Merlino, Giovanni; Gigli, Gian Luigi

2012-06-01

Several movement disorders may occur during nocturnal rest disrupting sleep. A part of these complaints is characterized by relatively simple, non-purposeful and usually stereotyped movements. The last version of the International Classification of Sleep Disorders includes these clinical conditions (i.e. restless legs syndrome, periodic limb movement disorder, sleep-related leg cramps, sleep-related bruxism and sleep-related rhythmic movement disorder) under the category entitled sleep-related movement disorders. Moreover, apparently physiological movements (e.g. alternating leg muscle activation and excessive hypnic fragmentary myoclonus) can show a high frequency and severity impairing sleep quality. Clinical and, in specific cases, neurophysiological assessments are required to detect the presence of nocturnal movement complaints. Patients reporting poor sleep due to these abnormal movements should undergo non-pharmacological or pharmacological treatments.

Sleep patterns and sleep disturbances across pregnancy.

PubMed

Mindell, Jodi A; Cook, Rae Ann; Nikolovski, Janeta

2015-04-01

This study sought to characterize sleep patterns and sleep problems in a large sample of women across all months of pregnancy. A total of 2427 women completed an Internet-based survey that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, vitality scale of the Short Form 36 Health Survey (SF-36), Insomnia Severity Index (ISI), Berlin questionnaire, International Restless Legs Syndrome (IRLS) question set, and a short version of the Pregnancy Symptoms Inventory (PSI). Across all months of pregnancy, women experienced poor sleep quality (76%), insufficient nighttime sleep (38%), and significant daytime sleepiness (49%). All women reported frequent nighttime awakenings (100%), and most women took daytime naps (78%). Symptoms of insomnia (57%), sleep-disordered breathing (19%), and restless legs syndrome (24%) were commonly endorsed, with no difference across the month of pregnancy for insomnia, sleep-disorder breathing, daytime sleepiness, or fatigue. In addition, high rates of pregnancy-related symptoms were found to disturb sleep, especially frequent urination (83%) and difficulty finding a comfortable sleep position (79%). Women experience significant sleep disruption, inadequate sleep, and high rates of symptoms of sleep disorder throughout pregnancy. These results suggest that all women should be screened and treated for sleep disturbances throughout pregnancy, especially given the impact of inadequate sleep and sleep disorders on fetal, pregnancy, and postpartum outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

Sleep disorders in patients with multiple sclerosis.

PubMed

Čarnická, Zuzana; Kollár, Branislav; Šiarnik, Pavel; Krížová, Lucia; Klobučníková, Katarína; Turčáni, Peter

2015-04-15

Poor sleep is a frequent symptom in patients with multiple sclerosis (MS). The objective of the study was to assess the relationship between nocturnal polysomnographic (PSG) findings and quality of sleep, fatigue, and increased daytime sleepiness among patients with MS. Clinical characteristics were collected. Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and International Restless Legs Syndrome Rating Scale were used to assess quality of sleep, fatigue, excessive daytime sleepiness, and the presence of restless legs syndrome (RLS). All patients underwent nocturnal diagnostic PSG examination. Fifty patients with MS were enrolled into the study. Age was the only independent variable significantly determining apnea-hypopnea index and desaturation index (DI) (beta = 0.369, p = 0.010, beta 0.301, p = 0.040). PSQI and ESS score were significantly higher in a population with RLS (p = 0.004, p = 0.011). FSS significantly correlated with DI (r = 0.400, p = 0.048). Presence of RLS was the only independent variable significantly determining PSQI and ESS (p = 0.005, p = 0.025). DI and presence of RLS were independent variables determining FSS (p = 0.015, p = 0.024). Presence of RLS seems to be the main factor determining poor sleep, fatigue, and daytime somnolence. Sleep disordered breathing and its severity influences only fatigue in patients with MS. © 2015 American Academy of Sleep Medicine.

Dopamine agonist withdrawal syndrome: implications for patient care.

PubMed

Nirenberg, Melissa J

2013-08-01

Dopamine agonists are effective treatments for a variety of indications, including Parkinson's disease and restless legs syndrome, but may have serious side effects, such as orthostatic hypotension, hallucinations, and impulse control disorders (including pathological gambling, compulsive eating, compulsive shopping/buying, and hypersexuality). The most effective way to alleviate these side effects is to taper or discontinue dopamine agonist therapy. A subset of patients who taper a dopamine agonist, however, develop dopamine agonist withdrawal syndrome (DAWS), which has been defined as a severe, stereotyped cluster of physical and psychological symptoms that correlate with dopamine agonist withdrawal in a dose-dependent manner, cause clinically significant distress or social/occupational dysfunction, are refractory to levodopa and other dopaminergic medications, and cannot be accounted for by other clinical factors. The symptoms of DAWS include anxiety, panic attacks, dysphoria, depression, agitation, irritability, suicidal ideation, fatigue, orthostatic hypotension, nausea, vomiting, diaphoresis, generalized pain, and drug cravings. The severity and prognosis of DAWS is highly variable. While some patients have transient symptoms and make a full recovery, others have a protracted withdrawal syndrome lasting for months to years, and therefore may be unwilling or unable to discontinue DA therapy. Impulse control disorders appear to be a major risk factor for DAWS, and are present in virtually all affected patients. Thus, patients who are unable to discontinue dopamine agonist therapy may experience chronic impulse control disorders. At the current time, there are no known effective treatments for DAWS. For this reason, providers are urged to use dopamine agonists judiciously, warn patients about the risks of DAWS prior to the initiation of dopamine agonist therapy, and follow patients closely for withdrawal symptoms during dopamine agonist taper.

Modeling Human Performance in Restless Bandits with Particle Filters

ERIC Educational Resources Information Center

Yi, Sheng Kung M.; Steyvers, Mark; Lee, Michael

2009-01-01

Bandit problems provide an interesting and widely-used setting for the study of sequential decision-making. In their most basic form, bandit problems require people to choose repeatedly between a small number of alternatives, each of which has an unknown rate of providing reward. We investigate restless bandit problems, where the distributions of…

Bright light therapy and melatonin in motor restless behaviour in dementia: a placebo-controlled study.

PubMed

Haffmans, P M; Sival, R C; Lucius, S A; Cats, Q; van Gelder, L

2001-01-01

The purpose of this study was to evaluate the effects of bright light therapy combined with melatonin on motor restless behaviour in dementia. Double-blind, placebo-controlled, cross-over trial consisting of four periods. One week wash-out was followed by a 2-week period of light therapy in combination with placebo or melatonin. The second wash-out period of 1 week was followed by 2 weeks of treatment (cross-over). Twenty-four bed medium-stay psychogeriatric ward at a Dutch psychiatric teaching hospital. Ten patients, who met the criteria for dementia (DSM-IV) and motor restless behaviour (subscale 10 of the GIP), were included. Informed consent was obtained by proxy. All subjects were exposed during 2x5 consecutive days for 30 minutes to 10,000 lux bright light and randomly administered 2.5 mg melatonin or placebo at 22.00 h. Clinical Global Impression (CGI), Dutch version of the geriatric behavioural observation scale (GIP), Social Dysfunction and Aggression Scale (SDAS) were assessed after each wash-out and treatment period. Outcome criteria were CGI, assessing motor restless behaviour, the SDAS, measuring extrovert aggression and the GIP, assessing social, psychomotor and emotional behaviour. Six demented inpatients completed the trial. Positive effects were found for the treatment combined with placebo. Patients were less restless and more co-operative. The condition with melatonin showed no additional positive effects, additionally, patients became more aggressive and showed the same or more disturbed behaviour. Bright light therapy has a positive effect on motor restless behaviour. Light therapy in combination with melatonin has no positive effects. The results might be explained by a possible overshoot of chronobiological synchronisation or the timing of the melatonin intake. Copyright 2001 John Wiley & Sons, Ltd.

Periodic limb movements of sleep: empirical and theoretical evidence supporting objective at-home monitoring

PubMed Central

Moro, Marilyn; Goparaju, Balaji; Castillo, Jelina; Alameddine, Yvonne; Bianchi, Matt T

2016-01-01

Introduction Periodic limb movements of sleep (PLMS) may increase cardiovascular and cerebrovascular morbidity. However, most people with PLMS are either asymptomatic or have nonspecific symptoms. Therefore, predicting elevated PLMS in the absence of restless legs syndrome remains an important clinical challenge. Methods We undertook a retrospective analysis of demographic data, subjective symptoms, and objective polysomnography (PSG) findings in a clinical cohort with or without obstructive sleep apnea (OSA) from our laboratory (n=443 with OSA, n=209 without OSA). Correlation analysis and regression modeling were performed to determine predictors of periodic limb movement index (PLMI). Markov decision analysis with TreeAge software compared strategies to detect PLMS: in-laboratory PSG, at-home testing, and a clinical prediction tool based on the regression analysis. Results Elevated PLMI values (>15 per hour) were observed in >25% of patients. PLMI values in No-OSA patients correlated with age, sex, self-reported nocturnal leg jerks, restless legs syndrome symptoms, and hypertension. In OSA patients, PLMI correlated only with age and self-reported psychiatric medications. Regression models indicated only a modest predictive value of demographics, symptoms, and clinical history. Decision modeling suggests that at-home testing is favored as the pretest probability of PLMS increases, given plausible assumptions regarding PLMS morbidity, costs, and assumed benefits of pharmacological therapy. Conclusion Although elevated PLMI values were commonly observed, routinely acquired clinical information had only weak predictive utility. As the clinical importance of elevated PLMI continues to evolve, it is likely that objective measures such as PSG or at-home PLMS monitors will prove increasingly important for clinical and research endeavors. PMID:27540316

Radiating leg pain and positive straight leg raising in spondylolysis in children.

PubMed

Halperin, N; Copeliovitch, L; Schachner, E

1983-09-01

Three children presented with low back pain radiating to the leg and with spasm of the hamstring and paravertebral muscles. Since the pain could not be ascribed to trauma, it was necessary to exclude the presence of infection or tumors. All the signs--localization of the pain, tenderness on one side of the back, X-ray film findings of unilateral or bilateral spondylolysis, and localized positive bone scan--pointed to spondylolysis as the cause of pain. All three children exhibited symptoms resembling those found in the facet syndrome described by Mooney and Robertson.

Emerging therapeutics in sleep.

PubMed

Saper, Clifford B; Scammell, Thomas E

2013-09-01

The development of new therapeutics for sleep disorders is increasingly dependent upon understanding the basic brain circuitry that underlies sleep-wake regulation, and how it may be pharmacologically manipulated. In this review, we consider the pathophysiological basis of major sleep disorders that often are seen by neurologists, including excessive daytime sleepiness, insomnia, narcolepsy, rapid eye movement sleep behavior disorder, and restless legs syndrome, as well as circadian disorders, and we review the current and potential future therapeutic approaches. Copyright © 2013 American Neurological Association.

Sleep disorders during pregnancy.

PubMed

Pien, Grace W; Schwab, Richard J

2004-11-01

This paper reviews the topic of sleep disorders in pregnant women. We describe changes in sleep architecture and sleep pattern during pregnancy, discuss the impact of the physical and biochemical changes of pregnancy on sleep in pregnant women and examine whether maternal-fetal outcomes may be adversely affected in women with disordered sleep. The literature on common sleep disorders affecting pregnant women, including insomnia, sleep-disordered breathing and restless legs syndrome, is reviewed and recommendations are made for the management of these disorders during pregnancy.

Compartment syndrome and shin splints of the lower leg.

PubMed

Gerow, G; Matthews, B; Jahn, W; Gerow, R

1993-05-01

The objective of this article is to review and categorize the current knowledge on compartment syndromes (CS) and shin splints (SS), with specific importance relegated to the diagnosis, differential diagnosis and management of these conditions. The bibliographic data sources reviewed are limited to the English language and human content and are from medical and scientific journals, as well as chiropractic and medical texts. A mini-Medline version of Index Medicus was utilized. Terms for indexing included compartment syndromes, shin splints and stress fractures. The bibliographies of the journals selected were then evaluated and, where appropriate, the specific journal or text references regarding diagnosis and management were then reviewed. This information was then included in this article, where useful, to further clarify or reference statements made. Differential diagnosis of the acute CS from chronic CS and SS requires clinical methods and imaging procedures. The pathogenesis of the acute CS of the lower leg is associated with external pressure or internal hemorrhage. If the tissue pressure were to rise above 30-40 mm Hg for 4-12 h, irreversible muscular damage would result. Emergency surgical intervention is the only appropriate form of treatment in acute CS. In chronic CS, where elevated pressures exist on a transient basis, influenced by activity, conservative management procedures are felt to be effective. However, if these methods are not helpful, surgical intervention may be necessary. The etiology of pain associated with SS is not associated with compartmental pressure elevations, but rather, results from periostitis occurring along the tibia caused by muscular and tendinous strain associated with inflammation. Conservative management is most appropriate for this disorder, with surgical intervention being an uncommon treatment approach. Although clinical findings are useful in the diagnosis of these disorders, fluid pressure findings may be necessary to

Modeling Human Performance in Restless Bandits with Particle Filters (Preprint)

DTIC Science & Technology

2009-01-01

respond to changes ( Gallistel , 2001). Here, we use a particle filter approach to finding solutions to the restless bandit problem. Particle...Experimental Psychology: Learning, Memory, and Cognition, 10(2), 258-270. Gallistel , C. R., Mark, T., King, A., & Latham, P. E. (2001). The rat

Sleep-related problems in common medical conditions.

PubMed

Parish, James M

2009-02-01

Common medical problems are often associated with abnormalities of sleep. Patients with chronic medical disorders often have fewer hours of sleep and less restorative sleep compared to healthy individuals, and this poor sleep may worsen the subjective symptoms of the disorder. Individuals with lung disease often have disturbed sleep related to oxygen desaturations, coughing, or dyspnea. Both obstructive lung disease and restrictive lung diseases are associated with poor quality sleep. Awakenings from sleep are common in untreated or undertreated asthma, and cause sleep disruption. Gastroesophageal reflux is a major cause of disrupted sleep due to awakenings from heartburn, dyspepsia, acid brash, coughing, or choking. Patients with chronic renal disease commonly have sleep complaints often due to insomnia, insufficient sleep, sleep apnea, or restless legs syndrome. Complaints related to sleep are very common in patients with fibromyalgia and other causes of chronic pain. Sleep disruption increases the sensation of pain and decreases quality of life. Patients with infectious diseases, including acute viral illnesses, HIV-related disease, and Lyme disease, may have significant problems with insomnia and hypersomnolence. Women with menopause have from insomnia, sleep-disordered breathing, restless legs syndrome, or fibromyalgia. Patients with cancer or receiving cancer therapy are often bothered by insomnia or other sleep disturbances that affect quality of life and daytime energy. The objective of this article is to review frequently encountered medical conditions and examine their impact on sleep, and to review frequent sleep-related problems associated with these common medical conditions.

Sleep disturbance and depressive affect in patients treated with haemodialysis.

PubMed

Maung, Stephanie; Sara, Ammar El; Cohen, Danielle; Chapman, Cherylle; Saggi, Subodh; Cukor, Daniel

2017-03-01

Sleep disorders and depression are prevalent conditions in patients with end-stage kidney disease. These co-morbidities have significant overlap and compounded morbidity and mortality burden. This overlap presents challenges to optimal clinical assessment and treatment. The goal of this study was to assess the prevalence of sleep disturbance in patients on maintenance haemodialysis, and to assess the impact of depressive affect. This was a single-site, single group, cross-sectional study of 69 English-speaking patients undergoing maintenance haemodialysis. Self-reported assessments included those of sleep quality (Pittsburgh Sleep Quality Index), depression (Beck Depression Inventory), daytime sleepiness (Epworth's Sleepiness Scale), a dialysis-specific sleep questionnaire, and standard laboratory values. No objective sleep information was collected. All participants were well dialysed, and represented all four daily shifts. Fifty-eight per cent reported clinically significant sleep difficulty, with elevated yet sub-threshold daytime sleepiness. Mean depressive affect was also elevated, yet sub-diagnostic and was positively correlated with increased age. Participants scoring above the diagnostic threshold for depression had significantly more disturbed sleep quality, more daytime sleepiness and had more problems sleeping due to restless leg syndrome than people with minimal depressive affect. Poor sleep quality is prevalent in patients on maintenance haemodialysis, and is associated with increased daytime sleepiness. Depression further compounds this relationship, and is significantly associated with increased daytime sleepiness and restless leg syndrome. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Key sleep neurologic disorders

PubMed Central

St. Louis, Erik K.

2014-01-01

Summary Sleep disorders are frequent comorbidities in neurologic patients. This review focuses on clinical aspects and prognosis of 3 neurologic sleep disorders: narcolepsy, restless legs syndrome/Willis-Ekbom disease (RLS/WED), and REM sleep behavior disorder (RBD). Narcolepsy causes pervasive, enduring excessive daytime sleepiness, adversely affecting patients' daily functioning. RLS/WED is characterized by an uncomfortable urge to move the legs before sleep, often evolving toward augmentation and resulting in daylong bothersome symptoms. RBD causes potentially injurious dream enactment behaviors that often signify future evolution of overt synucleinopathy neurodegeneration in as many as 81% of patients. Timely recognition, referral for polysomnography, and longitudinal follow-up of narcolepsy, RLS/WED, and RBD patients are imperatives for neurologists in providing quality comprehensive patient care. PMID:24605270

Somnambulism (sleepwalking).

PubMed

Remulla, Agnes; Guilleminault, Christian

2004-10-01

Somnambulism is an arousal parasomnia consisting of a series of complex behaviours that result in large movements in bed or walking during sleep. It occurs in 2-14% of children and 1.6-2.4% of adults. Occasional benign episodes are managed conservatively. However, recurrent sleepwalking with a risk of injury to self or others mandates immediate treatment with pharmacotherapy while awaiting work-up. The most commonly used medications are benzodiazepines, particularly clonazepam, with tricyclic antidepressants and serotonin selective re-uptake inhibitors also administered. Treatment of underlying causes such as obstructive sleep apnoea, upper airway resistance syndrome, restless legs syndrome and periodic limb movements, is currently the best approach and usually eliminates somnambulism in children and adults.

Surgical treatment of chronic exertional compartment syndrome of the leg: failure rates and postoperative disability in an active patient population.

PubMed

Waterman, Brian R; Laughlin, Matthew; Kilcoyne, Kelly; Cameron, Kenneth L; Owens, Brett D

2013-04-03

Chronic exertional compartment syndrome of the leg is a frequent source of lower-extremity pain in military personnel, competitive athletes, and runners. We are not aware of any previous study in which the authors rigorously evaluated the rates of return to full activity, persistent disability, and surgical revision after operative management of chronic exertional compartment syndrome of the leg in a large, physically active population. Individuals who had undergone surgical fasciotomy of the anterior, lateral, and/or posterior compartments (current procedural terminology [CPT] codes 27600, 27601, and 27602) for nontraumatic compartment syndrome of the lower extremity (International Classification of Diseases, Ninth Revision [ICD-9] code 729.72) between 2003 and 2010 were identified from the Military Health System Management Analysis and Reporting Tool (M2). Demographic variables including age, sex, and rank were extracted, and rates of postoperative complications, activity limitations, and revision surgery or medical discharge were obtained from the electronic medical record and U.S. Army Physical Disability Agency database. A total of 611 patients underwent 754 surgical procedures. The average patient age was 28.0 years, and 91.8% of the patients were male. Of the surgical procedures, 77.4% involved only anterior and lateral compartment releases; 19.4% addressed the anterior, lateral, and posterior compartments; and 2.2% addressed the posterior compartments alone. Symptom recurrence was reported by 44.7% of the patients, and 27.7% were unable to return to full activity. Surgical complications were documented for 15.7% of the patients, 5.9% underwent surgical revision, and 17.3% were referred for medical discharge because of chronic exertional compartment syndrome. Univariate analysis of prognostic factors revealed that surgical failure was associated with bilateral involvement (odds ratio [OR], 1.64), perioperative complications (OR, 2.12), activity limitations

The Restless Context: Military Institutional Awareness of Social Change

DTIC Science & Technology

1978-04-03

dependence upon theistic explanations for meaning and purpose in life and upsurge in restless irrationality and immersion in cults (to what bases of...the evolution of appropriate missions, weapons systems, mobility and logistics systems, and tactical concepts appropriate for various future combat...and Multinational Corporations Nonconsonant Detente and NATO Deterrence and Detente The Impact of Crises on the Evolution of Strategy and 1’orces in

Exercise Related Leg Pain (ERLP): a Review of The Literature

PubMed Central

2007-01-01

Exercise related leg pain (ERLP) is a regional pain syndrome described as pain between the knee and ankle which occurs with exercise. Indiscriminant use of terminology such as “shin splints” has resulted in ongoing confusion regarding the pathoanatomic entities associated with this pain syndrome. Each of the pathoanatomic entities – medial tibial stress syndrome, chronic exertional compartment syndrome, tibial and fibular stress fractures, tendinopathy, nerve entrapment, and vascular pathology – which manifest as ERLP are each described in terms of relevant anatomy, epidemiology, clinical presentation, associated pathomechanics, and intervention strategies. Evidence regarding risk factors for ERLP general and specific pathoanatomic entities are presented in the context of models of sports injury prevention. PMID:21522213

Chronic exertional compartment syndrome of the superficial posterior compartment: Soleus syndrome.

PubMed

Gross, Christopher E; Parekh, Bela J; Adams, Samuel B; Parekh, Selene G

2015-01-01

Chronic exertional compartment syndrome (CECS) represents the second most-common cause of exertional leg pain with incidence of 27-33%. CECS of the superficial posterior compartment, or soleus syndrome, is rare and has only been discussed briefly in the literature. We discuss the management of two patients with bilateral soleus syndrome or CECS of the superficial posterior compartment.

Report of a man with heterotopic ossification of the legs.

PubMed

García-Arpa, Mónica; Flores-Terry, Miguel A; Franco-Muñoz, Monserrat; Villasanti-Rivas, Natalia; González-Ruiz, Lucía; Banegas-Illescas, M Eugenia

2018-05-21

Heterotopic ossification is an uncommon disorder that consists of deposition of ectopic bone outside the extraskeletal tissues. In the skin, it can be primary, in association with genetic syndromes, or be secondary to different disorders. The latter include subcutaneous ossification of the legs in chronic venousinsufficiency, an infrequent and unrecognized complication. We report the case of a patient with subcutaneous ossification of both legs secondary to venous insufficiency and review the literature. Copyright © 2018 Sociedad Española de Reumatologña y Colegio Mexicano de Reumatologña. Publicado por Elsevier España, S.L.U. All rights reserved.

The medial tibial stress syndrome. A cause of shin splints.

PubMed

Mubarak, S J; Gould, R N; Lee, Y F; Schmidt, D A; Hargens, A R

1982-01-01

The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

Cause analysis, prevention, and treatment of postoperative restlessness after general anesthesia in children with cleft palate.

PubMed

Xu, Hao; Mei, Xiao-Peng; Xu, Li-Xian

2017-03-01

Cleft palate is one of the most common congenital malformations of the oral and maxillofacial region, with an incidence rate of around 0.1%. Early surgical repair is the only method for treatment of a cleft lip and palate. However, because of the use of inhalation anesthesia in children and the physiological characteristics of the cleft palate itself combined with the particularities of cleft palate surgery, the incidence rate of postoperative emergence agitation (EA) in cleft palate surgery is significantly higher than in other types of interventions. The exact mechanism of EA is still unclear. Although restlessness after general anesthesia in children with cleft palate is self-limiting, its effects should be considered by clinicians. In this paper, the related literature on restlessness after surgery involving general anesthesia in recent years is summarized. This paper focuses on induction factors as well as prevention and treatment of postoperative restlessness in children with cleft palate after general anesthesia. The corresponding countermeasures to guide clinical practice are also presented in this paper.

Active and Inactive Leg Hemodynamics during Sequential Single-Leg Interval Cycling.

PubMed

Gordon, Nicole; Abbiss, Chris R; Ihsan, Mohammed; Maiorana, Andrew J; Peiffer, Jeremiah J

2018-06-01

Leg order during sequential single-leg cycling (i.e., exercising both legs independently within a single session) may affect local muscular responses potentially influencing adaptations. This study examined the cardiovascular and skeletal muscle hemodynamic responses during double-leg and sequential single-leg cycling. Ten young healthy adults (28 ± 6 yr) completed six 1-min double-leg intervals interspersed with 1 min of passive recovery and, on a separate occasion, 12 (six with one leg followed by six with the other leg) 1-min single-leg intervals interspersed with 1 min of passive recovery. Oxygen consumption, heart rate, blood pressure, muscle oxygenation, muscle blood volume, and power output were measured throughout each session. Oxygen consumption, heart rate, and power output were not different between sets of single-leg intervals, but the average of both sets was lower than the double-leg intervals. Mean arterial pressure was higher during double-leg compared with sequential single-leg intervals (115 ± 9 vs 104 ± 9 mm Hg, P < 0.05) and higher during the initial compared with second set of single-leg intervals (108 ± 10 vs 101 ± 10 mm Hg, P < 0.05). The increase in muscle blood volume from baseline was similar between the active single leg and the double leg (267 ± 150 vs 214 ± 169 μM·cm, P = 0.26). The pattern of change in muscle blood volume from the initial to second set of intervals was significantly different (P < 0.05) when the leg was active in the initial (-52.3% ± 111.6%) compared with second set (65.1% ± 152.9%). These data indicate that the order in which each leg performs sequential single-leg cycling influences the local hemodynamic responses, with the inactive muscle influencing the stimulus experienced by the contralateral leg.

[Neurological Disorders and Pregnancy].

PubMed

Berlit, P

2016-02-01

Neurological disorders caused by pregnancy and puerperium include the posterior reversible encephalopathy syndrome, the amniotic fluid embolism syndrome (AFES), the postpartum angiopathy due to reversible vasoconstriction syndrome, and the Sheehan syndrome. Hypertension and proteinuria are the hallmarks of preeclampsia, seizures define eclampsia. Hemolysis, elevated liver enzymes and low platelets constitute the HELLP syndrome. Vision disturbances including cortical blindness occur in the posterior reversible encephalopathy syndrome (PRES). The Sheehan syndrome presents with panhypopituitarism post partum due to apoplexia of the pituitary gland in severe peripartal blood loss leading to longstanding hypotension. Some neurological disorders occur during pregnancy and puerperium with an increased frequency. These include stroke, sinus thrombosis, the restless legs syndrome and peripheral nerve syndromes, especially the carpal tunnel syndrome. Chronic neurologic diseases need an interdisciplinary approach during pregnancy. Some anticonvulsants double the risk of birth defects. The highest risk exists for valproic acid, the lowest for lamotrigine and levetiracetam. For MS interval treatment, glatiramer acetate and interferones seem to be safe during pregnancy. All other drugs should be avoided. © Georg Thieme Verlag KG Stuttgart · New York.

Prevalence of sleep complaints in Colombia at different altitudes.

PubMed

Ruiz, A J; Sepúlveda, Martín Alonso Rondón; Martínez, Patricia Hidalgo; Muñoz, Martín Cañón; Mendoza, Liliana Otero; Centanaro, Olga Patricia Panqueva; Carrasco, Luis Felipe Uriza; García, Juan Camilo Ospina

2016-01-01

To determine the prevalence of sleep complaints in adults in Colombia at different altitudes. Cross-sectional, population-based and observational study. Urban areas in three cities (Bogotá, Bucaramanga, Santa Marta) located between 15 and 2640 masl. Subjects Over 18 years old. Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Berlin questionnaire, STOP-Bang questionnaire and diagnostic criteria for restless leg syndrome (IRLSSG). The overall prevalence of sleep complaints was 59.6% (CI 95%: 57.3; 61.8%). According to the Pittsburgh scale, 45.3% (CI 95%: 43.0; 47.5) required medical assistance. The Berlin questionnaire indicated that 19.0% (CI 95%: 17.3; 20.8%) had a high risk of sleep apnea (OSA) compared to 26.9% (CI 95%: 24.9; 29.0%) according to STOP-Bang. Among the subjects, 13.7% (CI 95%: 12.3; 15.3%) had excessive daytime sleepiness and 37.7% (CI 95%: 35.5; 39.8%) had a restless leg syndrome. When comparing cities, significant differences in the overall frequency of subjects requiring care were found between Santa Marta (higher frequency) and the other two cities. Differences in sleep problem frequency (Pittsburgh) were observed between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (higher frequency) and the other two cities. The high risk of OSA (STOP-Bang) was different between Bogota (higher frequency) and Bucaramanga and also between Santa Marta (high frequency) and Bucaramanga. We observed a high prevalence of sleep complaints with significant differences among the cities, indicating a need to pay a greater attention to these problems.

The effects of sleep dysfunction on cognition, affect, and quality of life in individuals with cerebellar ataxia.

PubMed

Sonni, Akshata; Kurdziel, Lauri B F; Baran, Bengi; Spencer, Rebecca M C

2014-05-15

Cerebellar ataxia comprises a group of debilitating diseases that are the result of progressive cerebellar degeneration. Recent studies suggest that, like other neurodegenerative diseases, sleep impairments are common in cerebellar ataxia. In light of the role of sleep in mood regulation and cognition, we sought to assess interactions between sleep, cognition, and affect in individuals with cerebellar ataxia. A survey of 176 individuals with cerebellar ataxia was conducted. The battery of instruments included a modified International Cooperative Ataxia Rating Scale, Pittsburgh Sleep Quality Index, Restless Leg Syndrome Questionnaire, REM Behavior Disorder Questionnaire, Beck Depression Inventory, Epworth Sleepiness Scale, and a Composite Cognitive Questionnaire. Fifty-one percent of individuals indicated significant sleep disturbances on the Pittsburgh Sleep Quality Index, 73% of participants had two or more symptoms of restless leg syndrome, and 88% had two or more symptoms of REM behavior disorder. Ataxia severity, based on the modified International Cooperative Ataxia Rating Scale, predicted scores on the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and REM Behavior Disorder Questionnaire. Median split analyses revealed that cognitive function appeared to be reduced and depressive symptoms were greater for those individuals with poor subjective sleep quality and severe RLS. Importantly, sleep appears to play a mediatory role between disease severity and depressive symptoms. These results suggest that disturbed sleep may have detrimental effects on cognition and affect in individuals with cerebellar ataxia. While objective measures are needed, such results suggest that treating sleep deficits in these individuals may improve cognitive and mental health as well as overall quality of life.

[Symptoms of obstructive sleep apnea-hypopnea syndrome in children].

PubMed

Gregório, Paloma Baiardi; Athanazio, Rodrigo Abensur; Bitencourt, Almir Galvão Vieira; Neves, Flávia Branco Cerqueira Serra; Terse, Regina; Hora, Francisco

2008-06-01

To investigate the symptoms most frequently found in children with a polysomnographic diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS). We evaluated 38 children consecutively referred to the sleep laboratory with suspicion of OSAHS between June of 2003 and December of 2004. The patients were submitted to a pre-sleep questionnaire and to polysomnography. The mean age was 7.8 +/- 4 years (range, 2-15 years), and 50% of the children were male. Children without apnea accounted for 7.9% of the sample. The obstructive sleep apnea observed in the remainder was mild in 42.1%, moderate in 28.9% and severe in 22.1%. Severe cases of apnea were most common among children under the age of six (pre-school age). In children with OSAHS, the most common symptoms were snoring and nasal obstruction, which were observed in 74.3 and 72.7% of the children, respectively. Excessive sleepiness and bruxism were seen in 29.4 and 34.3%, respectively, and reflux disease was seen in only 3.1%. Restless legs and difficulty in falling asleep were identified in 65 and 33%, respectively. All of the children diagnosed with severe OSAHS also presented snoring and bruxism. Snoring and nasal obstruction were the most common symptoms found in our sample of children and adolescents with OSAHS. In addition, OSAHS severity was associated with being in the lower age bracket.

Sleep disturbances in children with attention-deficit/hyperactivity disorder

PubMed Central

Spruyt, Karen; Gozal, David

2011-01-01

In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth questioning on sleepiness, sleep-disordered breathing or problematic behaviors at bedtime, during the night and upon awakening, as well as night-to-night sleep duration variability. The relationships between sleep and attention-deficit/hyperactivity disorder (ADHD) are complex and are routinely overlooked by practitioners. Motricity and somnolence, the most consistent complaints and objectively measured sleep problems in children with ADHD, may develop as a consequence of multidirectional and multifactorial pathways. Therefore, subjectively perceived or reported restless sleep should be evaluated with specific attention to restless legs syndrome or periodic limb movement disorder, and awakenings should be queried with regard to parasomnias, dyssomnias and sleep-disordered breathing. Sleep hygiene logs detailing sleep onset and offset quantitatively, as well as qualitatively, are required. More studies in children with ADHD are needed to reveal the 24-h phenotype, or its sleep comorbidities. PMID:21469929

Sleep medicine knowledge, attitudes, and practices among medical students in Guangzhou, China.

PubMed

Luo, Miao; Feng, Yuan; Li, Taoping

2013-05-01

This study aimed to describe the knowledge, attitudes, and practices of Chinese medical students towards sleep medicine. The authors surveyed medical students at Southern Medical University in 2009. Students completed a questionnaire before and after attending a 3-h sleep disorders course. All 324 questionnaires were returned. Less than one half of the students were aware that restless legs syndrome, somniloquy, and teeth grinding are sleep disorders. Only a small percentage of students knew that sleep disorders are related to diabetes, anemia, hyperlipidemia, and attention deficit syndrome. After the 3-h sleep disorders course, the percentage of students who regarded snoring, restless legs syndrome, nightmares, and somniloquy as sleep disorders increased from 64.9 to 92.7 %, 40.8 to 64.4 %, 48.0 to 60.3 %, and 33.5 to 59.9 % (P < 0.001), respectively. Sleep problems were considered to be a significant issue by 93.8 % of the students. The students thought that people with sleep disorders should seek treatment. Of the students, 81.3 % were interested in sleep medicine. The students considered that it is necessary to set up specialized sleep medicine departments to manage sleep disorders. Of the students, 76.8 % thought they or their friends had sleep problems, and 44.8 % consulted physicians about sleep problems. Greater than two thirds of the students (67.1 %) did not have formal education about sleep medicine. Few students were aware of medical schools offering a course in sleep medicine. Most of the students liked learning in the form of elective courses, lectures, or online course. The students also realized that having sleep medicine knowledge is needed as a physician. Chinese medical students attached importance to sleep disorders, but knew little about sleep disorders. Knowledge of sleep medicine can be improved with a short training course.

Active and explorative individuals are often restless and excluded from studies measuring resting metabolic rate: Do alternative metabolic rate measures offer a solution?

PubMed

Jäger, Jörg; Schradin, Carsten; Pillay, Neville; Rimbach, Rebecca

2017-05-15

It has often been proposed that bolder, more explorative or more active individuals also have a higher resting metabolic rate (RMR), indicating metabolic costs of these personality types. However, such individuals might often be restless and thus excluded from RMR datasets, leading to a significant sampling bias. We tested (1) whether such a bias occurs when animals are measured for a relatively common but short time period of 3h, and if so, (2) whether alternative measures of metabolic rate, that allow the incorporation of non-resting individuals, would reveal associations between metabolism and personality. For this, we studied free-living individuals of the African striped mouse (Rhabdomys pumilio) both during the moist season (N=25 individuals) with high food availability and the dry season (N=48 individuals) with low food availability. We assessed variation in the latency to explore a novel object, and the time spent active and time spent in the centre of a neutral arena. We examined links between personality and (i) RMR and (ii) four alternative metabolic rate (MR) metrics: average MR, highest MR, lowest MR and span of MR. Twenty-nine percent of the measured individuals had to be excluded from our RMR study because they remained restless during respirometry trials. Striped mice showed a behavioural syndrome where fast explorers also spent more time in centre and more time active than slow explorers. Individuals that did not rest during respirometry trials were faster explorers and in the moist season, they were also more active and spent more time in the centre than individuals that rested. We found no relationship between RMR and the behavioural syndrome, which might be due to the exclusion of individuals with a certain behavioural type, leaving a subset of compliant individuals. In the moist season, we found positive relationships between the behavioural syndrome and span of MR and lowest MR. In the dry season, low food availability may mask links between

POSTTHROMBOPHLEBITIC SYNDROME—Rehabilitation of Patients

PubMed Central

Popkin, Roy J.

1956-01-01

A common cause of disability in industrial workers is the postthrombophlebitic syndrome. Swelling of one or both lower extremities may require frequent rest periods during the day for relief. The disabling symptoms are aching, burning, heaviness, and bursting or throbbing pains in the legs. The nights are often disturbed by restlessness of the legs in which it is difficult to find a comfortable position to sleep. It follows from a few days to even years an inflammation of the veins of the legs. Treatment is directed at reducing the swelling of the legs. This often necessitates a change in the patient's routine of daily living. Frequent rest periods are often required with the legs in the horizontal position. Elastic bandages or stockings must be worn, and drugs must be taken to improve blood flow. The adjustment is necessary not only at work, but also at home. If the patient cannot continue at his previous job, efforts should be made to place him in a new job where the necessary adjustments can be made. This is possible primarily in industries manufacturing small items such as instruments, toys and appliances. PMID:13374563

Leg size and muscle functions associated with leg compliance

NASA Technical Reports Server (NTRS)

Convertino, Victor A.; Doerr, Donald F.; Flores, Jose F.; Hoffler, G. Wyckliffe; Buchanan, Paul

1988-01-01

The relationship between the leg compliance and factors related to the size of leg muscle and to physical fitness was investigated in ten healthy subjects. Vascular compliance of the leg, as determined by a mercury strain gauge, was found to be not significantly correlated with any variables associated with physical fitness per se (e.g., peak O2 uptake, calf strength, age, body weight, or body composition. On the other hand, leg compliance correlated with the calf cross-sectional area (CSA) and the calculated calf volume, with the CSA of calf muscle being the most dominant contributing factor (while fat and bone were poor predicators). It is suggested that leg compliance can be lowered by increasing calf muscle mass, thus providing structural support to limit the expansion of leg veins.

Leg CT scan

MedlinePlus

CAT scan - leg; Computed axial tomography scan - leg; Computed tomography scan - leg; CT scan - leg ... CT scan makes detailed pictures of the body very quickly. The test may help look for: An abscess ...

Leg kinematics and kinetics in landing from a single-leg hop for distance. A comparison between dominant and non-dominant leg.

PubMed

van der Harst, J J; Gokeler, A; Hof, A L

2007-07-01

Anterior cruciate ligament (ACL) deficiency can be a major problem for athletes and subsequent reconstruction of the ACL may be indicated if a conservative regimen has failed. After ACL reconstruction signs of abnormality in the use of the leg remain for a long time. It is expected that the landing after a single-leg hop for distance (horizontal hop) might give insight in the differences in kinematics and kinetics between uninjured legs and ACL-reconstructed legs. Before the ACL-reconstructed leg can be compared with the contralateral leg, knowledge of differences between legs of uninjured subjects is needed. Kinematic and kinetic variables of both legs were measured with an optoelectronic system and a force plate and calculated by inverse dynamics. The dominant leg (the leg with biggest horizontal hop distance) and the contralateral leg of nine uninjured subjects were compared. No significant differences were found in most of the kinematic and kinetic variables between dominant leg and contralateral leg of uninjured subjects. Only hop distance and hip extension angles differed significantly. This study suggests that there are no important differences between dominant leg and contralateral leg in healthy subjects. As a consequence, the uninvolved leg of ACL-reconstructed patients can be used as a reference. The observed variables of this study can be used as a reference of normal values and normal differences between legs in healthy subjects.

Anatomical variations within the deep posterior compartment of the leg and important clinical consequences.

PubMed

Hislop, M; Tierney, P

2004-09-01

The management of musculoskeletal conditions makes up a large part of a sports medicine practitioner's practice. A thorough knowledge of anatomy is an essential component of the armament necessary to decipher the large number of potential conditions that may confront these practitioners. To cloud the issue further, anatomical variations may be present, such as supernumerary muscles, thickened fascial bands or variant courses of nerves and blood vessels, which can themselves manifest as acute or chronic conditions that lead to significant morbidity or limitation of activity. There are a number of contentious areas within the literature surrounding the anatomy of the leg, particularly involving the deep posterior compartment. Conditions such as chronic exertional compartment syndrome, tibial periostitis (shin splints), peripheral nerve entrapment and tarsal tunnel syndrome may all be affected by subtle anatomical variations. This paper primarily focuses on the deep posterior compartment of the leg and uses the gross dissection of cadaveric specimens to describe definitively the anatomy of the deep posterior compartment. Variant fascial attachments of flexor digitorum longus are documented and potential clinical sequelae such as chronic exertional compartment syndrome and tarsal tunnel syndrome are discussed.

[Low back pain vs. leg dominant pain].

PubMed

Kovac, Ida

2011-01-01

There are two patterns of back pain: 1) back-dominant pain and 2) leg pain dominant, greater than back pain. The causes of back pain are very different and numerous, but mostly are due to vertebral, mechanical etiology, and rarely because of non vertebral, visceral etiology. Leg pain greater than back pain is mostly disease of spinal nerve root, generally presented by radicular pain in a dermatomal distribution. Mechanical compression of spinal roots, caused by disc herniation or by spinal stenosis, results in radicular symptoms. Rarely, in about 1% of patients, there are some other reasons except vertebral mechanical cause, like infection, tumor or fracture. There are several causes of pseudoradicular pain like periferal neuropathy, myifascial syndromes, vascular diseases, osteoarthritis. Spondylarthropathies should be taken in cosideration as well. A complete history and physical examination is important to determine further diagnostic evaluation and to provide eficient therapy.

Restless Tuneup of High-Fidelity Qubit Gates

NASA Astrophysics Data System (ADS)

Rol, M. A.; Bultink, C. C.; O'Brien, T. E.; de Jong, S. R.; Theis, L. S.; Fu, X.; Luthi, F.; Vermeulen, R. F. L.; de Sterke, J. C.; Bruno, A.; Deurloo, D.; Schouten, R. N.; Wilhelm, F. K.; DiCarlo, L.

2017-04-01

We present a tuneup protocol for qubit gates with tenfold speedup over traditional methods reliant on qubit initialization by energy relaxation. This speedup is achieved by constructing a cost function for Nelder-Mead optimization from real-time correlation of nondemolition measurements interleaving gate operations without pause. Applying the protocol on a transmon qubit achieves 0.999 average Clifford fidelity in one minute, as independently verified using randomized benchmarking and gate-set tomography. The adjustable sensitivity of the cost function allows the detection of fractional changes in the gate error with a nearly constant signal-to-noise ratio. The restless concept demonstrated can be readily extended to the tuneup of two-qubit gates and measurement operations.

Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study.

PubMed

Sharma, S K; Nehra, A; Sinha, S; Soneja, M; Sunesh, K; Sreenivas, V; Vedita, D

2016-03-01

Sleep disturbances such as insomnia, nocturnal awakenings, restless legs syndrome, habitual snoring, and excessive daytime sleepiness are frequent during pregnancy, and these have been linked to adverse maternal and fetal outcomes. A prospective observational study was performed in high-risk Indian pregnant women. We used modified Berlin questionnaire (MBQ), Pittsburgh sleep quality index (PSQI), International Restless Legs Syndrome Study Group 2011 criteria, and Epworth sleepiness scale to diagnose various sleep disorders, such as symptomatic OSA, poor sleep quality and insomnia, RLS, and excessive daytime sleepiness, respectively, in successive trimesters of pregnancy. Outcome variables of interest were development of gestational hypertension (GH), gestational diabetes mellitus (GDM), and cesarean delivery (CS); the Apgar scores; and low birth weight (LBW). The relationship between sleep disorders and outcomes was explored using logistic regression analysis. Outcome data were obtained in 209 deliveries. As compared to nonsnorers, women who reported snoring once, twice, and thrice or more had odds ratios for developing GH-4.0 (95 % CI 1.3-11.9), 1.5 (95 % CI 0.5-4.5), and 2.9 (95 % CI 1.0-8.2) and for undergoing CS-5.3 (95 % CI 1.7-16.3), 4.9 (95 % CI 1.8-13.1), and 5.1 (95 % CI 1.9-14.9), respectively. Pregnant women who were persistently positive on MBQ had increased odds for GH and CS. Snoring and high-risk MBQ in pregnant women are strong risk factors for GH and CS. In view of the significant morbidity and health care costs, simple screening of pregnant women with questionnaires such as MBQ may have clinical utility.

Muscle involvement in Schönlein-Henoch syndrome.

PubMed Central

Somekh, E; Fried, D; Hanukoglu, A

1983-01-01

Three patients with Schönlein-Henoch syndrome developed severe muscle pain in the legs. The pain, so severe that they were bedridden, subsided within a few days and was caused, we believe, by bleeding into the leg muscles. PMID:6651331

Are differences in leg length predictive of lateral patello-femoral pain?

PubMed

Carlson, Mary; Wilkerson, Jerry

2007-03-01

Lateral patello-femoral pain can shorten an athletic career and generally decrease an individual's physical activity and functional level, such as preventing stair climbing and reducing the ability to rise from a chair. Leg length inequality is associated with patello-femoral pain. A leg length test that best distinguishes the difference between people who have lateral patello-femoral pain and those who do not would have clinical utility. The purpose of the present study was, first, to determine if unilateral, lateral patello-femoral pain was associated with the longer leg when inequality of leg lengths existed and, second, to determine if leg length direct measurement, indirect measurement or quadriceps angle (Q angle) could correctly classify participants according to the presence or absence of patello-femoral pain. The study used an ex post facto, two-group quasi-experimental design. A volunteer sample of 52 participants (14 males, 38 females), ranged in age from 18 to 52 years. Three methods were used to measure leg lengths: palpation meter (PALM) on anterior superior iliac spines (ASIS) while participants maintained centred weight-bearing position on a high resolution pressure mat; tape measurement from ASIS to medial malleolus (supine); tape measurement from ASIS to lateral malleolus (supine). Additionally, Q angle was measured in supine position. Patellar grind test, medial retinacular and lateral patellar palpation screened for patello-femoral pain. Logistic regression analysis determined correctness of membership in painful and non-painful patello-femoral groups. The PALM method of indirect measurement of leg length differences overall correctly classified approximately 83 % of the participants. Tape measure to medial and lateral malleoli as well as Q angle did not yield significant results. The results suggested that the PALM method of measuring leg length differences may have clinical utility in differentiating between patients who are likely to sustain

Task driven optimal leg trajectories in insect-scale legged microrobots

NASA Astrophysics Data System (ADS)

Doshi, Neel; Goldberg, Benjamin; Jayaram, Kaushik; Wood, Robert

Origami inspired layered manufacturing techniques and 3D-printing have enabled the development of highly articulated legged robots at the insect-scale, including the 1.43g Harvard Ambulatory MicroRobot (HAMR). Research on these platforms has expanded its focus from manufacturing aspects to include design optimization and control for application-driven tasks. Consequently, the choice of gait selection, body morphology, leg trajectory, foot design, etc. have become areas of active research. HAMR has two controlled degrees-of-freedom per leg, making it an ideal candidate for exploring leg trajectory. We will discuss our work towards optimizing HAMR's leg trajectories for two different tasks: climbing using electroadhesives and level ground running (5-10 BL/s). These tasks demonstrate the ability of single platform to adapt to vastly different locomotive scenarios: quasi-static climbing with controlled ground contact, and dynamic running with un-controlled ground contact. We will utilize trajectory optimization methods informed by existing models and experimental studies to determine leg trajectories for each task. We also plan to discuss how task specifications and choice of objective function have contributed to the shape of these optimal leg trajectories.

[Minimally invasive fasciotomy in the treatment of chronic exertional anterior compartment syndrome of the leg: personal technique].

PubMed

Bramante, Carmelo; Gandolfo, Luigi; Bosco, Vincenzo

2008-01-01

Numerous fasciotomy techniques have been proposed for the treatment of chronic exertional anterior compartment syndrome. In this work we evaluate the efficacy of a personal surgical technique whereby the fasciotomy is performed through a small cutaneous incision using endo mini-shears. From 2004 to 2006 19 patients, all professional skaters, were submitted to bilateral fasciotomy (38 legs). No complications were observed. Only two patients used pain-killers. In the follow-up (12 months), resumption of competitive activity was achieved by the fourth week in 63.2% of cases (12 patients), by the fifth week in 26.3% (5 patients), and by the sixth week in 10.5% (2 patients). All patients achieved sporting performance comparable to that present before the onset of symptoms. There were no recurrences. This technique is relatively simple to perform, is easily repeatable, does not require a long learning curve, is practically complication-free, and is characterised by a virtually painless postoperative course.

Pharmacological treatment of sleep disorders and its relationship with neuroplasticity.

PubMed

Abad, Vivien C; Guilleminault, Christian

2015-01-01

Sleep and wakefulness are regulated by complex brain circuits located in the brain stem, thalamus, subthalamus, hypothalamus, basal forebrain, and cerebral cortex. Wakefulness and NREM and REM sleep are modulated by the interactions between neurotransmitters that promote arousal and neurotransmitters that promote sleep. Various lines of evidence suggest that sleep disorders may negatively affect neuronal plasticity and cognitive function. Pharmacological treatments may alleviate these effects but may also have adverse side effects by themselves. This chapter discusses the relationship between sleep disorders, pharmacological treatments, and brain plasticity, including the treatment of insomnia, hypersomnias such as narcolepsy, restless legs syndrome (RLS), obstructive sleep apnea (OSA), and parasomnias.

Cannabidiol for the treatment of cannabis withdrawal syndrome: a case report.

PubMed

Crippa, J A S; Hallak, J E C; Machado-de-Sousa, J P; Queiroz, R H C; Bergamaschi, M; Chagas, M H N; Zuardi, A W

2013-04-01

  Cannabis withdrawal in heavy users is commonly followed by increased anxiety, insomnia, loss of appetite, migraine, irritability, restlessness and other physical and psychological signs. Tolerance to cannabis and cannabis withdrawal symptoms are believed to be the result of the desensitization of CB1 receptors by THC.   This report describes the case of a 19-year-old woman with cannabis withdrawal syndrome treated with cannabidiol (CBD) for 10 days. Daily symptom assessments demonstrated the absence of significant withdrawal, anxiety and dissociative symptoms during the treatment.   CBD can be effective for the treatment of cannabis withdrawal syndrome. © 2012 Blackwell Publishing Ltd.

A low arm and leg muscle mass to total body weight ratio is associated with an increased prevalence of metabolic syndrome: The Korea National Health and Nutrition Examination Survey 2010-2011.

PubMed

Kim, Yong Hwan; So, Wi-Young

2016-09-14

The aim of this study was to investigate the association between metabolic syndrome (MetS) and arm and leg muscle mass to total weight ratios in Korean adults. This was a randomized, controlled, cross-sectional study. Data from 2,383 adults (1,030 men and 1,353 women) were collected from the Korea National Health and Nutrition Examination Survey 2010-2011. Blood lipid profiles, blood pressure, and anthropometric characteristics, including weight, height, waist circumference, and muscle mass on dual energy X-ray absorptiometry (DXA), were evaluated in the participants. MetS was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III. The average mass of both arms and legs was determined using regional muscle analysis by DXA. Afterwards, the arm and leg muscle mass to total body weight ratio was determined and classified into 4 quartiles (i.e., quartile 1 [highest muscle ratio] to quartile 4 [lowest muscle ratio]). According to the arm muscle and leg muscle ratios, there was a higher prevalence of MetS in quartile 4 than in quartile 1 in both men and women. A low arm and leg muscle mass to body weight ratio was associated with a higher prevalence of MetS after adjusting for age, physical activity, frequency of smoking, and frequency of alcohol consumption. In conclusion, MetS patients demonstrated a lower arm and leg muscle mass to body weight ratio. Strength training for the lower and upper extremities is recommended because it can have a positive effect on MetS prevention.

Loss restlessness and gain calmness: durable effects of losses and gains on choice switching.

PubMed

Yechiam, Eldad; Zahavi, Gal; Arditi, Eli

2015-08-01

While the traditional conceptualization of the effect of losses focuses on bias in the subjective weight of losses compared with respective gains, some accounts suggest more global task-related effects of losses. Based on a recent attentional theory, we predicted a positive after-effect of losses on choice switching in later tasks. In two experimental studies, we found increased choice switching rates in tasks with losses compared to tasks with no losses. Additionally, this heightened shifting behavior was maintained in subsequent tasks that do not include losses, a phenomenon we refer to as "loss restlessness." Conversely, gains were found to have an opposite "calming" effect on choice switching. Surprisingly, the loss restlessness phenomenon was observed following an all-losses payoff regime but not after a task with symmetric mixed gains and losses. This suggests that the unresolved mental account following an all-losses regime increases search behavior. Potential implications to macro level phenomena, such as the leverage effect, are discussed.

Presentation, diagnosis, and management of popliteal artery entrapment syndrome: 11 years of experience with 61 legs.

PubMed

Corneloup, L; Labanère, C; Chevalier, L; Jaussaud, J; Mignot, A; Gencel, L; Corneloup, O; Midy, D

2018-02-01

Popliteal artery entrapment syndrome (PAES) is still underdiagnosed yet it may significantly interfere with lifestyle, especially among young sportspeople, with symptoms like intermittent claudication. Although case reports and small case series are sometimes published, studies with larger populations are quite rare. This study summarizes our experience with PAES on 61 limbs (35 patients) over a period of 11 years, describing the demographics, the disease, and the diagnostic and therapeutic methods used with PAES patients. In a population of 327 consecutive explored symptomatic sportspersons, PAES was confirmed in 35 patients on 61 pathologic limbs. The median time with the symptoms before diagnosis was 34 months (range, 3-180 months). The mean age of patients was 30.5 years (range, 17-52 years) with 83% of males. The proportion of patients diagnosed with bilateral PAES was 74%. The main sports practiced were running (15 patients, 43%), soccer (nine patients, 26%), rugby (two patients), and athletics (two patients). Among 21 patients, intra-compartmental pressure measurements (ICP) found 18 (86%) to have an associated chronic exertional compartment syndrome (CECS). Among the patients followed up after PAES surgery, 80% were able to resume sport at a level comparable to that before the onset of pain. PAES could be sought earlier in young sportspeople who experience unexplained leg pain during exercise to diagnose the disease and avoid complications in a timely manner. Compartmental pressures should systematically be measured in the search for an associated CECS. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Restless Tuneup of High-Fidelity Qubit Gates

NASA Astrophysics Data System (ADS)

Rol, M. A.; Bultink, C. C.; O'Brien, T. E.; de Jong, S. R.; Theis, L. S.; Fu, X.; Luthi, F.; Vermeulen, R. F. L.; de Sterke, J. C.; Bruno, A.; Deurloo, D.; Schouten, R. N.; Wilhelm, F. K.; Dicarlo, L.

We present a tuneup protocol for qubit gates with tenfold speedup over traditional methods reliant on qubit initialization by energy relax- ation. This speedup is achieved by constructing a cost function for Nelder-Mead optimization from real-time correlation of non-demolition measurements interleaving gate operations without pause. Applying the protocol on a transmon qubit achieves 0.999 average Clifford fidelity in one minute, as independently verified using randomized benchmarking and gate set tomography. The adjustable sensitivity of the cost function allows detecting fractional reductions in gate error with constant signal- to-noise ratio. The restless concept here demonstrated can be readily extended to the tuneup of two-qubit gates and measurement operations. Research funded by IARPA, an ERC Synergy Grant, Microsoft Research, and the China Scholarship Council.

The neuropathic postural tachycardia syndrome

NASA Technical Reports Server (NTRS)

Jacob, G.; Costa, F.; Shannon, J. R.; Robertson, R. M.; Wathen, M.; Stein, M.; Biaggioni, I.; Ertl, A.; Black, B.; Robertson, D.

2000-01-01

BACKGROUND: The postural tachycardia syndrome is a common disorder that is characterized by chronic orthostatic symptoms and a dramatic increase in heart rate on standing, but that does not involve orthostatic hypotension. Several lines of evidence indicate that this disorder may result from sympathetic denervation of the legs. METHODS: We measured norepinephrine spillover (the rate of entry of norepinephrine into the venous circulation) in the arms and legs both before and in response to exposure to three stimuli (the cold pressor test, sodium nitroprusside infusion, and tyramine infusion) in 10 patients with the postural tachycardia syndrome and in 8 age- and sex-matched normal subjects. RESULTS: At base line, the mean (+/-SD) plasma norepinephrine concentration in the femoral vein was lower in the patients with the postural tachycardia syndrome than in the normal subjects (135+/-30 vs. 215+/-55 pg per milliliter [0.80+/-0.18 vs. 1.27+/-0.32 nmol per liter], P=0.001). Norepinephrine spillover in the arms increased to a similar extent in the two groups in response to each of the three stimuli, but the increases in the legs were smaller in the patients with the postural tachycardia syndrome than in the normal subjects (0.001+/-0.09 vs. 0.12+/-0.12 ng per minute per deciliter of tissue [0.006+/-0.53 vs. 0.71+/-0.71 nmol per minute per deciliter] with the cold pressor test, P=0.02; 0.02+/-0.07 vs. 0.23+/-0.17 ng per minute per deciliter [0.12+/-0.41 vs. 1.36+/-1.00 nmol per minute per deciliter] with nitroprusside infusion, P=0.01; and 0.008+/-0.09 vs. 0.19+/-0.25 ng per minute per deciliter [0.05+/-0.53 vs. 1.12+/-1.47 nmol per minute per deciliter] with tyramine infusion, P=0.04). CONCLUSIONS: The neuropathic postural tachycardia syndrome results from partial sympathetic denervation, especially in the legs.

Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces.

PubMed

Zimmermann, Wes O; Helmhout, P H; Beutler, A

2017-04-01

Overuse injuries of the leg are a common problem for young soldiers. This article reviews the literature concerning the prevention and treatment of exercise related leg pain in military settings and presents the latest developments in proposed mechanisms and treatments. Current practice and treatment protocols from the Dutch Armed Forces are reviewed, with an emphasis on the most prevalent conditions of medial tibial stress syndrome and chronic exertional compartment syndrome. The conclusion is that exercise related leg pain in the military is an occupational problem that deserves further study. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Lindsay Leg Club: supporting the NHS to provide leg ulcer care.

PubMed

McKenzie, Morag

2013-06-01

Public health services will need to cope with additional demands due to an ageing society and the increasing prevalence of chronic conditions. Lower-limb ulceration is a long-term, life-changing condition and leg ulcer management can be challenging for nursing staff. The Lindsay Leg Club model is a unique partnership between community nurses, members and the local community, which provides quality of care and empowerment for patients with leg ulcers, while also supporting and educating nursing staff. The Leg Club model works in accord with core themes of Government and NHS policy. Patient feedback on the Leg Club model is positive and the Leg Clubs provide a service to members which is well accepted by patients, yet is more economically efficient than the traditional district nursing practice of home visits. Lindsay Leg Clubs provide a valuable support service to the NHS in delivering improved quality of care while improving efficiency.

Basal Ganglia Calcification with Tetanic Seizure Suggest Mitochondrial Disorder.

PubMed

Finsterer, Josef; Enzelsberger, Barbara; Bastowansky, Adam

2017-04-09

BACKGROUND Basal ganglia calcification (BGC) is a rare sporadic or hereditary central nervous system (CNS) abnormality, characterized by symmetric or asymmetric calcification of the basal ganglia. CASE REPORT We report the case of a 65-year-old Gypsy female who was admitted for a tetanic seizure, and who had a history of polyneuropathy, restless-leg syndrome, retinopathy, diabetes, hyperlipidemia, osteoporosis with consecutive hyperkyphosis, cervicalgia, lumbalgia, struma nodosa requiring thyroidectomy and consecutive hypothyroidism, adipositas, resection of a vocal chord polyp, arterial hypertension, coronary heart disease, atheromatosis of the aorta, peripheral artery disease, chronic obstructive pulmonary disease, steatosis hepatis, mild renal insufficiency, long-term hypocalcemia, hyperphosphatemia, impingement syndrome, spondylarthrosis of the lumbar spine, and hysterectomy. History and clinical presentation suggested a mitochondrial defect which also manifested as hypoparathyroidism or Fanconi syndrome resulting in BGC. After substitution of calcium, no further tetanic seizures occurred. CONCLUSIONS Patients with BGC should be investigated for a mitochondrial disorder. A mitochondrial disorder may also manifest as tetanic seizure.

Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain.

PubMed

Yunus, Muhammad B

2007-06-01

Patients with widespread pain or fibromyalgia syndrome have many symptoms besides musculoskeletal pain: e.g. fatigue, sleep difficulties, a swollen feeling in tissues, paresthesia, cognitive dysfunction, dizziness, and symptoms of overlapping conditions such as irritable bowel syndrome, headaches and restless legs syndrome. There is evidence for central sensitization in these conditions, but further studies are needed. Anxiety, stress and depression are also present in 30-45% of patients. Other factors that may contribute to symptoms include endocrine dysfunction, psychosocial distress, trauma, and disrupted sleep. Evaluation of a patient presenting with widespread pain includes history and physical examination to diagnose both fibromyalgia and associated or concomitant conditions. Fibromyalgia should be diagnosed by its own characteristic features. Some patients with otherwise typical symptoms of fibromyalgia may have as few as four to six tender points in clinical practice. Patients with rheumatoid arthritis and systemic lupus erythematosus should be evaluated for fibromyalgia, since 20-30% of them have associated fibromyalgia, requiring a different treatment approach.

Characterizing sleep disorders of adults with tuberous sclerosis complex: a questionnaire-based study and review.

PubMed

van Eeghen, Agnies M; Numis, Adam I; Staley, Brigid A; Therrien, Samuel E; Thibert, Ronald L; Thiele, Elizabeth A

2011-01-01

An adult cohort with tuberous sclerosis complex was investigated for the prevalence of sleep disturbances and the relationship with seizure variables, medication, and psychological functioning. Information on 35 adults was gathered using four questionnaires: Epworth Sleepiness Scale (ESS), Sleep and Epilepsy Questionnaire (SEQ), Sleep Diagnosis List (SDL), and Adult Self-Report Scale (ASR). In addition, clinical, genetic and electrophysiological data were collected. Of 35 respondents, 25 had a history of epilepsy. A subjective sleep disorder was found in 31% of the cohort. Insomnia scores showed a significant positive correlation with obstructive sleep apnea syndrome and restless legs syndrome scores. Significant correlations were found between daytime sleepiness and scores on depression, antisocial behavior, and use of mental health medication. A subgroup using antiepileptic medication showed high correlations between daytime sleepiness, attention deficits, and anxiety scores. Copyright © 2010 Elsevier Inc. All rights reserved.

Sensory aspects of movement disorders

PubMed Central

Patel, Neepa; Jankovic, Joseph; Hallett, Mark

2016-01-01

Movement disorders, which include disorders such as Parkinson’s disease, dystonia, Tourette’s syndrome, restless legs syndrome, and akathisia, have traditionally been considered to be disorders of impaired motor control resulting predominantly from dysfunction of the basal ganglia. This notion has been revised largely because of increasing recognition of associated behavioural, psychiatric, autonomic, and other non-motor symptoms. The sensory aspects of movement disorders include intrinsic sensory abnormalities and the effects of external sensory input on the underlying motor abnormality. The basal ganglia, cerebellum, thalamus, and their connections, coupled with altered sensory input, seem to play a key part in abnormal sensorimotor integration. However, more investigation into the phenomenology and physiological basis of sensory abnormalities, and about the role of the basal ganglia, cerebellum, and related structures in somatosensory processing, and its effect on motor control, is needed. PMID:24331796

Diagnosis and treatment of sleep disorders: a brief review for clinicians

PubMed Central

Abad, Vivien C.; Guilleminault, Christian

2003-01-01

Sleep disorders encompass a wide spectrum of diseases with significant individual health consequences and high economic costs to society. To facilitate the diagnosis and treatment of sleep disorders, this review provides a framework using the International Classification of Sleep Disorders, Primary and secondary insomnia are differentiated, and pharmacological and nonpharmacological treatments are discussed. Common circadian rhythm disorders are described in conjunction with interventions, including chronotherapy and light therapy. The diagnosis and treatment of restless legs syndrome/periodic limb movement disorder is addressed. Attention is focused on obstructive sleep apnea and upper airway resistance syndrome, and their treatment. The constellation of symptoms and findings in narcolepsy are reviewed together with diagnostic testing and therapy, Parasomnias, including sleep terrors, somnambulism, and rapid eye movement (REM) behavior sleep disorders are described, together with associated laboratory testing results and treatment. PMID:22033666

Chronic Exertional Compartment Syndrome.

PubMed

Braver, Richard T

2016-04-01

Increased tissue pressure within a fascial compartment may be the result from any increase in volume within its contents, or any decrease in size of the fascial covering or its distensibility. This may lead to symptoms of leg tightness, pain or numbness brought about by exercise. There are multiple differential diagnoses of exercise induced leg pain and the proper diagnoses of chronic exertional compartment syndrome (CECS) is made by a careful history and by exclusion of other maladies and confirmed by compartment syndrome testing as detailed in this text. Surgical fasciotomies for the anterior, lateral, superficial and deep posterior compartments are described in detail along with ancillary procedures for chronic shin splints that should allow the athlete to return to competitive activity. Copyright © 2016 Elsevier Inc. All rights reserved.

[Klinefelter's syndrome associated with mixed connective tissue disease (Sharp's syndrome) and thrombophilia with postthrombotic syndrome].

PubMed

Kasten, Robert; Pfirrmann, Gudrun; Voigtländer, Volker

2005-08-01

A 43-year-old male with eunuchoid body proportions and a history of deep venous thromboses in the right leg presented with recurrent ulcers in the right perimalleolar region for 6 years. Karyotyping revealed a 47 XXY Klinefelter's syndrome, while serologic testing showed protein S deficiency, hyperhomocysteinemia and positive lupus anticoagulant. He also had mixed connective tissue disease (Sharp's syndrome) with acrosclerosis, proximal finger edema, Raynaud's phenomenon, and high titers of ANA and U1-RNP-antibodies, as well as osteoporosis. There is evidence that patients with Klinefelter's syndrome are prone to develop connective tissue diseases and thrombophilia as a result of low androgen levels. Substitution of testosterone in Klinefelter's syndrome can have a favorable therapeutic effect on the associated connective tissue disease, thrombophilia and osteoporosis.

Reliability of the Structured Clinical Interview for DSM-5 Sleep Disorders Module.

PubMed

Taylor, Daniel J; Wilkerson, Allison K; Pruiksma, Kristi E; Williams, Jacob M; Ruggero, Camilo J; Hale, Willie; Mintz, Jim; Organek, Katherine Marczyk; Nicholson, Karin L; Litz, Brett T; Young-McCaughan, Stacey; Dondanville, Katherine A; Borah, Elisa V; Brundige, Antoinette; Peterson, Alan L

2018-03-15

To develop and demonstrate interrater reliability for a Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Sleep Disorders (SCISD). The SCISD was designed to be a brief, reliable, and valid interview assessment of adult sleep disorders as defined by the DSM-5. A sample of 106 postdeployment active-duty military members seeking cognitive behavioral therapy for insomnia in a randomized clinical trial were assessed with the SCISD prior to treatment to determine eligibility. Audio recordings of these interviews were double-scored for interrater reliability. The interview is 8 pages long, includes 20 to 51 questions, and takes 10 to 20 minutes to administer. Of the nine major disorders included in the SCISD, six had prevalence rates high enough (ie, n ≥ 5) to include in analyses. Cohen kappa coefficient (κ) was used to assess interrater reliability for insomnia, hypersomnolence, obstructive sleep apnea hypopnea (OSAH), circadian rhythm sleep-wake, nightmare, and restless legs syndrome disorders. There was excellent interrater reliability for insomnia (1.0) and restless legs syndrome (0.83); very good reliability for nightmare disorder (0.78) and OSAH (0.73); and good reliability for hypersomnolence (0.50) and circadian rhythm sleep-wake disorders (0.50). The SCISD is a brief, structured clinical interview that is easy for clinicians to learn and use. The SCISD showed moderate to excellent interrater reliability for six of the major sleep disorders in the DSM-5 among active duty military seeking cognitive behavioral therapy for insomnia in a randomized clinical trial. Replication and extension studies are needed. Registry: ClinicalTrials.gov; Title: Comparing Internet and In-Person Brief Cognitive Behavioral Therapy of Insomnia; Identifier: NCT01549899; URL: https://clinicaltrials.gov/ct2/show/NCT01549899. © 2018 American Academy of Sleep Medicine.

Association of Sleep Disorders with Nonalcoholic Fatty Liver Disease (NAFLD): A Population-based Study.

PubMed

Mir, Heshaam M; Stepanova, Maria; Afendy, Hena; Cable, Rebecca; Younossi, Zobair M

2013-09-01

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease. In smaller studies, sleep apnea has been previously associated with NAFLD. The aim of this study was to assess the prevalence and independent associations of sleep disorders in patients with NAFLD using recent population-based data. Three cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2010 were used. The diagnosis of NAFLD was established as elevated liver enzymes in the absence of all other causes of chronic liver disease. Sleep disorders were diagnosed using sleep disorder questionnaires completed by NHANES participants, and included self-reported history of sleep apnea, insomnia, and restless leg syndrome. The prevalence of sleep disorders was compared between those with and without NAFLD. A total of 10,541 adult NHANES participants with complete demographic, clinical, and laboratory data were included. Of those, 15.0% had NAFLD and 7.2% reported having sleep disorders. Of those with sleep disorders, 64.7% reported history of sleep apnea, 16.0% had history of insomnia, and 4.0% had restless leg syndrome. Individuals with NAFLD were more likely to be male (53.8% vs. 45.7%, P < 0.0001), obese (50.1% vs. 33.4%, P < 0.0001) and had higher prevalence of sleep disorders (9.1% vs. 6.9%, P = 0.0118). In multivariate analysis, having any sleep disorder, sleep apnea and insomnia were all independently associated with NAFLD [OR (95% CI) = 1.40 (1.11-1.76), OR = 1.39 (0.98-1.97), and OR = 2.17 (1.19-3.95); respectively)]. This large population-based data suggests that NAFLD is associated with sleep disorders. Although the exact mechanism is unknown, this association is most likely through metabolic conditions associated with NAFLD.

Association of Sleep Disorders with Nonalcoholic Fatty Liver Disease (NAFLD): A Population-based Study

PubMed Central

Mir, Heshaam M.; Stepanova, Maria; Afendy, Hena; Cable, Rebecca; Younossi, Zobair M.

2013-01-01

Background Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease. In smaller studies, sleep apnea has been previously associated with NAFLD. The aim of this study was to assess the prevalence and independent associations of sleep disorders in patients with NAFLD using recent population-based data. Methods Three cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2010 were used. The diagnosis of NAFLD was established as elevated liver enzymes in the absence of all other causes of chronic liver disease. Sleep disorders were diagnosed using sleep disorder questionnaires completed by NHANES participants, and included self-reported history of sleep apnea, insomnia, and restless leg syndrome. The prevalence of sleep disorders was compared between those with and without NAFLD. Results A total of 10,541 adult NHANES participants with complete demographic, clinical, and laboratory data were included. Of those, 15.0% had NAFLD and 7.2% reported having sleep disorders. Of those with sleep disorders, 64.7% reported history of sleep apnea, 16.0% had history of insomnia, and 4.0% had restless leg syndrome. Individuals with NAFLD were more likely to be male (53.8% vs. 45.7%, P < 0.0001), obese (50.1% vs. 33.4%, P < 0.0001) and had higher prevalence of sleep disorders (9.1% vs. 6.9%, P = 0.0118). In multivariate analysis, having any sleep disorder, sleep apnea and insomnia were all independently associated with NAFLD [OR (95% CI) = 1.40 (1.11–1.76), OR = 1.39 (0.98–1.97), and OR = 2.17 (1.19–3.95); respectively)]. Conclusions This large population-based data suggests that NAFLD is associated with sleep disorders. Although the exact mechanism is unknown, this association is most likely through metabolic conditions associated with NAFLD. PMID:25755498

The Relationship among Leg Strength, Leg Power and Alpine Skiing Success.

ERIC Educational Resources Information Center

Gettman, Larry R.; Huckel, Jack R.

The purpose of this study was to relate leg strength and power to alpine skiing success as measured by FIS points. Isometric leg strength was represented by the knee extension test described by Clarke. Leg power was measured by the vertical jump test and the Margaria-Kalamen stair run. Results in the strength and power tests were correlated with…

Chronic Exertional Compartment Syndrome

MedlinePlus

... Sometimes chronic exertional compartment syndrome is mistaken for shin splints, a more common cause of leg pain in ... such as running. If you think you have shin splints but they don't get better with self- ...

Single-leg squats can predict leg alignment in dancers performing ballet movements in "turnout".

PubMed

Hopper, Luke S; Sato, Nahoko; Weidemann, Andries L

2016-01-01

The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve "turning out" or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in "turned out" postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat.

[Improvement of Stress Resistance and Quality of Life of Adults with Nervous Restlessness after Treatment with a Passion Flower Dry Extract].

PubMed

Gibbert, Judith; Kreimendahl, Fabian; Lebert, Jennifer; Rychlik, Reinhard; Trompetter, Inga

The passion flower dried ethanolic extract investigated in this non-interventional study has well-documented calmative effects and good tolerability. We investigated the effects of this extract on the stress resistance (resilience) and quality of life (QoL) of patients suffering from nervous restlessness. The addiction potential of the drug and the course of symptoms were also evaluated. Adult patients aged ≤ 95 years with the diagnosis 'nervous restlessness' were treated for 12 weeks with a dried ethanolic extract of passion flower (Passiflora incarnata L.). Standardized questionnaires were used to evaluate the resilience (RS-13), QoL (EQ-5D including EQ-VAS), and the addiction potential (BDEPQ). After 12 weeks of treatment, significant (p < 0.001) improvements were measured in the patients' resilience (RS-13: from 52.1 to 67.7 points) and QoL (EQ-VAS: from 47.9 to 75.0 points). Also, the mean BDEPQ score was significantly (p < 0.001) reduced (from 23.0 to 19.3 points). The mean values of all accompanying symptoms (inner restlessness, sleep disturbance, exhaustion, fear, lack of concentration, transpiration, nausea, trembling, and palpitation) improved significantly (p < 0.001). Tolerability of treatment was rated as 'very good' or 'good' by the majority of the patients. Three cases of mild adverse events (tiredness) were reported. The passion flower extract investigated in the present study appears to be effective in improving resilience and QoL in patients suffering from nervous restlessness and is well tolerated. © 2017 S. Karger GmbH, Freiburg.

Myotonic dystrophy type 1, daytime sleepiness and REM sleep dysregulation.

PubMed

Dauvilliers, Yves A; Laberge, Luc

2012-12-01

Myotonic dystrophy type 1 (DM1), or Steinert's disease, is the most common adult-onset form of muscular dystrophy. DM1 also constitutes the neuromuscular condition with the most significant sleep disorders including excessive daytime sleepiness (EDS), central and obstructive sleep apneas, restless legs syndrome (RLS), periodic leg movements in wake (PLMW) and periodic leg movements in sleep (PLMS) as well as nocturnal and diurnal rapid eye movement (REM) sleep dysregulation. EDS is the most frequent non-muscular complaint in DM1, being present in about 70-80% of patients. Different phenotypes of sleep-related problems may mimic several sleep disorders, including idiopathic hypersomnia, narcolepsy without cataplexy, sleep apnea syndrome, and periodic leg movement disorder. Subjective and objective daytime sleepiness may be associated with the degree of muscular impairment. However, available evidence suggests that DM1-related EDS is primarily caused by a central dysfunction of sleep regulation rather than by sleep fragmentation, sleep-related respiratory events or periodic leg movements. EDS also tends to persist despite successful treatment of sleep-disordered breathing in DM1 patients. As EDS clearly impacts on physical and social functioning of DM1 patients, studies are needed to identify the best appropriate tools to identify hypersomnia, and clarify the indications for polysomnography (PSG) and multiple sleep latency test (MSLT) in DM1. In addition, further structured trials of assisted nocturnal ventilation and randomized trials of central nervous system (CNS) stimulant drugs in large samples of DM1 patients are required to optimally treat patients affected by this progressive, incurable condition. Copyright © 2012 Elsevier Ltd. All rights reserved.

Leg length, body proportion, and health: a review with a note on beauty.

PubMed

Bogin, Barry; Varela-Silva, Maria Inês

2010-03-01

Decomposing stature into its major components is proving to be a useful strategy to assess the antecedents of disease, morbidity and death in adulthood. Human leg length (femur + tibia), sitting height (trunk length + head length) and their proportions, for example, (leg length/stature), or the sitting height ratio (sitting height/stature x 100), among others) are associated with epidemiological risk for overweight (fatness), coronary heart disease, diabetes, liver dysfunction and certain cancers. There is also wide support for the use of relative leg length as an indicator of the quality of the environment for growth during infancy, childhood and the juvenile years of development. Human beings follow a cephalo-caudal gradient of growth, the pattern of growth common to all mammals. A special feature of the human pattern is that between birth and puberty the legs grow relatively faster than other post-cranial body segments. For groups of children and youth, short stature due to relatively short legs (i.e., a high sitting height ratio) is generally a marker of an adverse environment. The development of human body proportions is the product of environmental x genomic interactions, although few if any specific genes are known. The HOXd and the short stature homeobox-containing gene (SHOX) are genomic regions that may be relevant to human body proportions. For example, one of the SHOX related disorders is Turner syndrome. However, research with non-pathological populations indicates that the environment is a more powerful force influencing leg length and body proportions than genes. Leg length and proportion are important in the perception of human beauty, which is often considered a sign of health and fertility.

Leg Length, Body Proportion, and Health: A Review with a Note on Beauty

PubMed Central

Bogin, Barry; Varela-Silva, Maria Inês

2010-01-01

Decomposing stature into its major components is proving to be a useful strategy to assess the antecedents of disease, morbidity and death in adulthood. Human leg length (femur + tibia), sitting height (trunk length + head length) and their proportions, for example, (leg length/stature), or the sitting height ratio (sitting height/stature × 100), among others) are associated with epidemiological risk for overweight (fatness), coronary heart disease, diabetes, liver dysfunction and certain cancers. There is also wide support for the use of relative leg length as an indicator of the quality of the environment for growth during infancy, childhood and the juvenile years of development. Human beings follow a cephalo-caudal gradient of growth, the pattern of growth common to all mammals. A special feature of the human pattern is that between birth and puberty the legs grow relatively faster than other post-cranial body segments. For groups of children and youth, short stature due to relatively short legs (i.e., a high sitting height ratio) is generally a marker of an adverse environment. The development of human body proportions is the product of environmental x genomic interactions, although few if any specific genes are known. The HOXd and the short stature homeobox-containing gene (SHOX) are genomic regions that may be relevant to human body proportions. For example, one of the SHOX related disorders is Turner syndrome. However, research with non-pathological populations indicates that the environment is a more powerful force influencing leg length and body proportions than genes. Leg length and proportion are important in the perception of human beauty, which is often considered a sign of health and fertility. PMID:20617018

Dynamically Stable Legged Locomotion.

DTIC Science & Technology

1983-01-27

sweeps the leg during stance, and the third places the foot during flight and controls body attitude during stance. Each of the three methods elucidates...secondary strategy has been to examine systems with springy legs, so that the role of resonant oscillatory leg behavior might be better understood. ’ The ...body attitude : I lopping _leit: ’ The control system rcgulate:; hopping height by manlil)Lulating hopping energy. The leg is springy, so hopping is a

Patellofemoral Pain Syndrome

MedlinePlus

... But do this slowly, increasing the amount of time you do the sports activity a little at a time. Talk to ... 20 seconds. Do the exercise 6 to 10 times and then switch legs. Citations Management of Patellofemoral Pain Syndrome by S Dixit, M.D., ...

Case report: comprehensive management of medial tibial stress syndrome

PubMed Central

Krenner, Bernard John

2002-01-01

Abstract Activity or exercise-induced leg pain is a common complication among competitive and “weekend warrior” athletes. Shin splints is a term that has been used to describe all lower leg pain as a result of activity. There are many different causes of “shin splints,” one of which is medial tibial stress syndrome, and the treating clinician must be aware of potentially serious causes of activity related leg pain. Restoring proper biomechanics to the entire kinetic chain and rehabilitation of the injured area should be the primary aim of treatment to optimize shock absorption. The role inflammation plays in medial tibial stress syndrome is controversial, but in this case, seemed to be a causative factor as symptomatology was dramatically decreased with the addition of proteolytic enzymes. Medial tibial stress syndrome can be quite difficult to treat and keeping athletes away from activities that will slow healing or aggravate the condition can be challenging. “Active” rest is the best way in which to allow proper healing while allowing the athlete to maintain their fitness. PMID:19674573

Effect of squatting velocity on hip muscle latency in women with patellofemoral pain syndrome.

PubMed

Orozco-Chavez, Ignacio; Mendez-Rebolledo, Guillermo

2018-03-01

[Purpose] Neuromuscular activity has been evaluated in patellofemoral pain syndrome but movement velocity has not been considered. The aim was to determine differences in onset latency of hip and knee muscles between individuals with and without patellofemoral pain syndrome during a single leg squat, and whether any differences are dependent on movement velocity. [Subjects and Methods] Twenty-four females with patellofemoral pain syndrome and 24 healthy females participated. Onset latency of gluteus maximus, anterior and posterior gluteus medius, rectus femoris, vastus medialis, vastus lateralis and biceps femoris during a single leg squat at high and low velocity were evaluated. [Results] There was an interaction between velocity and diagnosis for posterior gluteus medius. Healthy subjects showed a later posterior gluteus medius onset latency at low velocity than high velocity; and also later than patellofemoral pain syndrome subjects at low velocity and high velocity. [Conclusion] Patellofemoral pain syndrome subjects presented an altered latency of posterior gluteus medius during a single leg squat and did not generate adaptations to velocity variation, while healthy subjects presented an earlier onset latency in response to velocity increase.

[Pseudo-radicular referred leg pain].

PubMed

von Heymann, W

2015-12-01

Pseudo-radicular leg pain as initially described by Bruegger more than 55 years ago was at that time a genius explanation for so many non-radicular pain syndromes that needed not any kind of surgical intervention but in first line a manual treatment or a treatment by therapeutic local anesthetics. Today we describe this pain as a "referred pain" originating from other anatomic structures that may occur during the development of chronic pain. Nevertheless this pain is found in many patients and it still seems to be a big problem for many physicians and surgeons. Imaging does not help either. The history and the clinical symptoms, the examinations, the chain reactions in the motor system as well as the treatment options from the point of view of manual medicine are described.

Complex Regional Pain Syndrome

MedlinePlus

Complex regional pain syndrome (CRPS) is a chronic pain condition. It causes intense pain, usually in the arms, hands, legs, or feet. ... in skin temperature, color, or texture Intense burning pain Extreme skin sensitivity Swelling and stiffness in affected ...

Relationship of serum ferritin level and tic severity in children with Tourette syndrome.

PubMed

Ghosh, Debabrata; Burkman, Elizabeth

2017-08-01

Tics can be considered hyperkinetic movements akin to restless leg syndrome (RLS). Drawing the analogy of iron deficiency as an etiology of RLS, it is conceivable that iron deficiency may underlie or worsen tics in Tourette syndrome (TS). The purpose of this study was to evaluate the relationship between serum ferritin levels and tic severity, as well as consequent impact on life, in children with TS. Children <18 years, diagnosed with TS during 2009-2015, were reviewed. Only those with serum ferritin testing were included. The following data were collected: tic severity, impact on life, medication, comorbidities, blood count, and serum ferritin at diagnosis and follow-up. In fifty-seven patients, M:F = 2:1, serum ferritin was 48.0 ± 33.28 ng/mL, tic severity score 2.3 ± 0.80, impact on life score 2.2 ± 0.93, and composite score 4.57 ± 1.6. Serum ferritin was not influenced by comorbid obsessive compulsive disorder (OCD), attention deficit hyperactive disorder (ADHD), or anxiety (P > 0.16). Thirty-eight percent with low serum ferritin (≤50 ng/mL) (n = 37) had severe tics (>5 composite score), compared with 25% in normal ferritin group (n = 20). Over 6-12 months, tic severity score improved in both iron treated groups, deficient (2.70 to 1.90) and sufficient (2.40 to 1.95), whereas tics worsened or remained the same when not treated with iron. Our data suggest iron deficiency may be associated with more severe tics with higher impact on TS children, independent of the presence of OCD, ADHD, or anxiety. Iron supplementation showed a trend towards improvement of tic severity upon follow-up. We suggest a double-blind, placebo-controlled prospective study to reach a definite conclusion.

Venous leg ulcers

PubMed Central

2011-01-01

Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids

Single-leg squats can predict leg alignment in dancers performing ballet movements in “turnout”

PubMed Central

Hopper, Luke S; Sato, Nahoko; Weidemann, Andries L

2016-01-01

The physical assessments used in dance injury surveillance programs are often adapted from the sports and exercise domain. Bespoke physical assessments may be required for dance, particularly when ballet movements involve “turning out” or external rotation of the legs beyond that typically used in sports. This study evaluated the ability of the traditional single-leg squat to predict the leg alignment of dancers performing ballet movements with turnout. Three-dimensional kinematic data of dancers performing the single-leg squat and five ballet movements were recorded and analyzed. Reduction of the three-dimensional data into a one-dimensional variable incorporating the ankle, knee, and hip joint center positions provided the strongest predictive model between the single-leg squat and the ballet movements. The single-leg squat can predict leg alignment in dancers performing ballet movements, even in “turned out” postures. Clinicians should pay careful attention to observational positioning and rating criteria when assessing dancers performing the single-leg squat. PMID:27895518

The association between pulse wave velocity and metabolic syndrome in Korean.

PubMed

Lee, M H; Yoo, Sun K; Jee, S H; Kim, Jungchae

2013-03-01

The objective of this study was to compare aortic (the common carotid to femoral artery) PWV, arm (the brachial to radial artery) PWV, and leg (the femoral to dorsalis pedis artery) PWV in people with or without component of the metabolic syndrome. We analyzed 3345 Korean subjects (1907 men, age 44.6 ± 8.5, 1438 women, age 43.3 ± 8.9). Unpaired t-test was used to compare mean values of various metabolic parameters between subjects with and without Metabolic Syndrome (MetS), and one-way analysis of variance was used to compare these variables among groups satisfying different numbers of the components of MetS. In addition, we compared of Pearson correlation coefficient between age and PWV (arotic PWV, arm PWV and leg PWV) levels of according to whether the subject had components of the metabolic syndrome or not. The present study shows that leg PWV level was found to be significantly associated with the features of the metabolic syndrome in Korean men and women. And, we confirmed that blood pressure is significantly associated with the PWV values at three locations. And, this study shows that Pearson correlation coefficient of arotic PWV and leg PWV were about 10% higher than without diabetes according to age. Further studies need to be performed to evaluate the optimal cut-off value of PWV for diabetes, hypertension, and MetS in Korean.

Plans for living on a restless planet sets NASA's solid Earth agenda

NASA Technical Reports Server (NTRS)

Solomon, S. C.; Baker, V. R.; Bloxham, J.; Booth, J.; Donnellan, A.; Elachi, C.; Evans, D.; Rignot, E.; Burbank, D.; Chao, B. F.;

Venous leg ulcers

PubMed Central

2008-01-01

Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha2 antagonists, zinc), peri

Economic implications of sleep disorders.

PubMed

Skaer, Tracy L; Sclar, David A

2010-01-01

Sleep disorders such as insomnia, obstructive sleep apnoea (OSA), excessive daytime sleepiness (EDS) and fatigue, sleep deprivation and restless legs syndrome (RLS) are increasingly seen in clinical practice. Sleep is considered vital for preserving daytime cognitive function and physiological well-being. Sleep insufficiency may have deleterious effects on work-life balance, overall health and safety. The consequential economic burden at both the individual and societal levels is significant. Moreover, sleep disorders are commonly associated with other major medical problems such as chronic pain, cardiovascular disease, mental illness, dementias, gastrointestinal disorders and diabetes mellitus. Thus, in order to properly care for patients presenting with sleep-related morbidity, and to reduce the consequential economic burden, accurate screening efforts and efficacious/cost-effective treatments need to be developed and employed.

Exploring sleep disorders in patients with chronic kidney disease.

PubMed

Nigam, Gaurav; Camacho, Macario; Chang, Edward T; Riaz, Muhammad

2018-01-01

Kidney disorders have been associated with a variety of sleep-related disorders. Therefore, researchers are placing greater emphasis on finding the role of chronic kidney disease (CKD) in the development of obstructive sleep apnea and restless legs syndrome. Unfortunately, the presence of other sleep-related disorders with CKDs and non-CKDs has not been investigated with the same clinical rigor. Recent studies have revealed that myriad of sleep disorders are associated with CKDs. Furthermore, there are a few non-CKD-related disorders that are associated with sleep disorders. In this narrative review, we provide a balanced view of the spectrum of sleep disorders (as identified in International Classification of Sleep disorders-3) related to different types of renal disorders prominently including but not exclusively limited to CKD.

Spanish translation and cross-language validation of a sleep habits questionnaire for use in clinical and research settings.

PubMed

Baldwin, Carol M; Choi, Myunghan; McClain, Darya Bonds; Celaya, Alma; Quan, Stuart F

2012-04-15

To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings. Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated. All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively. The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples.

Increasing trunk flexion transforms human leg function into that of birds despite different leg morphology.

PubMed

Aminiaghdam, Soran; Rode, Christian; Müller, Roy; Blickhan, Reinhard

2017-02-01

Pronograde trunk orientation in small birds causes prominent intra-limb asymmetries in the leg function. As yet, it is not clear whether these asymmetries induced by the trunk reflect general constraints on the leg function regardless of the specific leg architecture or size of the species. To address this, we instructed 12 human volunteers to walk at a self-selected velocity with four postures: regular erect, or with 30 deg, 50 deg and maximal trunk flexion. In addition, we simulated the axial leg force (along the line connecting hip and centre of pressure) using two simple models: spring and damper in series, and parallel spring and damper. As trunk flexion increases, lower limb joints become more flexed during stance. Similar to birds, the associated posterior shift of the hip relative to the centre of mass leads to a shorter leg at toe-off than at touchdown, and to a flatter angle of attack and a steeper leg angle at toe-off. Furthermore, walking with maximal trunk flexion induces right-skewed vertical and horizontal ground reaction force profiles comparable to those in birds. Interestingly, the spring and damper in series model provides a superior prediction of the axial leg force across trunk-flexed gaits compared with the parallel spring and damper model; in regular erect gait, the damper does not substantially improve the reproduction of the human axial leg force. In conclusion, mimicking the pronograde locomotion of birds by bending the trunk forward in humans causes a leg function similar to that of birds despite the different morphology of the segmented legs. © 2017. Published by The Company of Biologists Ltd.

Steerable Hopping Six-Legged Robot

NASA Technical Reports Server (NTRS)

Younse, Paulo; Aghazarian, Hrand

2010-01-01

The figure depicts selected aspects of a six-legged robot that moves by hopping and that can be steered in the sense that it can be launched into a hop in a controllable direction. This is a prototype of hopping robots being developed for use in scientific exploration of rough terrain on remote planets that have surface gravitation less than that of Earth. Hopping robots could also be used on Earth, albeit at diminished hopping distances associated with the greater Earth gravitation. The upper end of each leg is connected through two universal joints to an upper and a lower hexagonal frame, such that the tilt of the leg depends on the relative position of the two frames. Two non-back-driveable worm-gear motor drives are used to control the relative position of the two frames along two axes 120 apart, thereby controlling the common tilt of all six legs and thereby, further, controlling the direction of hopping. Each leg includes an upper and a lower aluminum frame segment with a joint between them. A fiberglass spring, connected via hinges to both segments, is used to store hopping energy prior to launch into a hop and to cushion the landing at the end of the hop. A cable for loading the spring is run into each leg through the center of the universal joints and then down along the center lines of the segments to the lower end of the leg. A central spool actuated by a motor with a harmonic drive and an electromagnetic clutch winds in all six cables to compress all six springs (thereby also flexing all six legs) simultaneously. To ensure that all the legs push off and land in the same direction, timing- belt pulley drives are attached to the leg segments, restricting the flexing and extension of all six legs to a common linear motion. In preparation for a hop, the spool can be driven to load the spring legs by an amount corresponding to a desired hop distance within range. The amount of compression can be computed from the reading of a shaft-angle encoder that

Leg Injuries and Disorders

MedlinePlus

... are important for motion and standing. Playing sports, running, falling, or having an accident can damage your legs. Common leg injuries include sprains and strains, joint dislocations, and fractures. ...

Sleep Disturbances Associated with Parkinson's Disease

PubMed Central

Suzuki, Keisuke; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Iwanami, Masaoki; Hirata, Koichi

2011-01-01

Sleep disturbances are common problems affecting the quality life of Parkinson's disease (PD) patients and are often underestimated. The causes of sleep disturbances are multifactorial and include nocturnal motor disturbances, nocturia, depressive symptoms, and medication use. Comorbidity of PD with sleep apnea syndrome, restless legs syndrome, rapid eye movement sleep behavior disorder, or circadian cycle disruption also results in impaired sleep. In addition, the involvement of serotoninergic, noradrenergic, and cholinergic neurons in the brainstem as a disease-related change contributes to impaired sleep structures. Excessive daytime sleepiness is not only secondary to nocturnal disturbances or dopaminergic medication but may also be due to independent mechanisms related to impairments in ascending arousal system and the orexin system. Notably, several recent lines of evidence suggest a strong link between rapid eye movement sleep behavior disorder and the risk of neurodegenerative diseases such as PD. In the present paper, we review the current literature concerning sleep disorders in PD. PMID:21876839

Extraintestinal manifestations of celiac disease: 33-mer gliadin binding to glutamate receptor GRINA as a new explanation.

PubMed

Garcia-Quintanilla, Albert; Miranzo-Navarro, Domingo

2016-05-01

We propose a biochemical mechanism for celiac disease and non-celiac gluten sensitivity that may rationalize many of the extradigestive disorders not explained by the current immunogenetic model. Our hypothesis is based on the homology between the 33-mer gliadin peptide and a component of the NMDA glutamate receptor ion channel - the human GRINA protein - using BLASTP software. Based on this homology the 33-mer may act as a natural antagonist interfering with the normal interactions of GRINA and its partners. The theory is supported by numerous independent data from the literature, and provides a mechanistic link with otherwise unrelated disorders, such as cleft lip and palate, thyroid dysfunction, restless legs syndrome, depression, ataxia, hearing loss, fibromyalgia, dermatitis herpetiformis, schizophrenia, toxoplasmosis, anemia, osteopenia, Fabry disease, Barret's adenocarcinoma, neuroblastoma, urinary incontinence, recurrent miscarriage, cardiac anomalies, reduced risk of breast cancer, stiff person syndrome, etc. The hypothesis also anticipates better animal models, and has the potential to open new avenues of research. © 2016 WILEY Periodicals, Inc.

Kinematic and electromyographic analysis in patients with patellofemoral pain syndrome during single leg triple hop test.

PubMed

Kalytczak, Marcelo Martins; Lucareli, Paulo Roberto Garcia; Dos Reis, Amir Curcio; Bley, André Serra; Biasotto-Gonzalez, Daniela Aparecida; Correa, João Carlos Ferrari; Politti, Fabiano

2016-09-01

Possible delays in pre-activation or deficiencies in the activity of the dynamic muscle stabilizers of the knee and hip joints are the most common causes of the patellofemoral pain syndrome (PFPS). The aim of the study was to compare kinematic variables and electromyographic activity of the vastus lateralis, biceps femoris, gluteus maximus and gluteus medius muscles between patients with PFPS and health subjects during the single leg triple hop test (SLTHT). This study included 14 female with PFPS (PFPS group) and 14 female healthy with no history of knee pain (Healthy group). Kinematic and EMG data ware collected through participants performed a single session of the SLTHT. The PFPS group exhibited a significant increase (p<0.05) in the EMG activity of the biceps femoris and vastus lateralis muscles, when compared with the healthy group in pre-activity and during the stance phase. This same result was also found for the vastus lateralis muscle (p<0.05) when analyzing the EMG activity during the eccentric phase of the stance phase. In kinematic analysis, no significant differences were found between the groups. These results indicate that biceps femoris and vastus lateralis muscles mainly during the pre-activation phase and stance phases of the SLTHT are more active in PFPS group among healthy group. Copyright © 2016 Elsevier B.V. All rights reserved.

[The concept and definition of locomotive syndrome in a super-aged society].

PubMed

Nakamura, Kozo; Yoshimura, Noriko; Akune, Toru; Ogata, Toru; Tanaka, Sakae

2014-10-01

The population of elderly individuals who need nursing care is rapidly increasing in Japan. Locomotive syndrome involves a decrease in mobility due to locomotive organ dysfunction, and increases risk for dependency on nursing care service. Because gait speed and chair stand time are correlated with such risks, patients with locomotive syndrome are assessed using brief methods such as the two-step test, which involves dividing the maximum stride length by the height of the patient, and the stand-up test, which involves standing on one or both legs at different heights. One leg standing and squatting are recommended as beneficial locomotive home exercises. Locomotive syndrome has been recognized widely in Japan, and included in the National Health Promotion Movement (2013-2022).

Periodic Leg Movements during Sleep Are Associated with Polymorphisms in BTBD9, TOX3/BC034767, MEIS1, MAP2K5/SKOR1, and PTPRD

PubMed Central

Moore, Hyatt; Winkelmann, Juliane; Lin, Ling; Finn, Laurel; Peppard, Paul; Mignot, Emmanuel

2014-01-01

Study Objectives: To examine association between periodic leg movements (PLM) and 13 single nucleotide polymorphisms (SNPs) in 6 loci known to increase risk of restless legs syndrome (RLS). Setting: Stanford Center for Sleep Sciences and Medicine and Clinical Research Unit of University of Wisconsin Institute for Clinical and Translational Research. Patients: Adult participants (n = 1,090, mean age = 59.7 years) from the Wisconsin Sleep Cohort (2,394 observations, 2000-2012). Design and Interventions: A previously validated automatic detector was used to measure PLMI. Thirteen SNPs within BTBD9, TOX3/BC034767, MEIS1 (2 unlinked loci), MAP2K5/SKOR1, and PTPRD were tested. Analyses were performed using a linear model and by PLM category using a 15 PLM/h cutoff. Statistical significance for loci was Bonferroni corrected for 6 loci (P < 8.3 × 10-3). RLS symptoms were categorized into four groups: likely, possible, no symptoms, and unknown based on a mailed survey response. Measurements and Results: Prevalence of PLMI ≥ 15 was 33%. Subjects with PLMs were older, more likely to be male, and had more frequent RLS symptoms, a shorter total sleep time, and higher wake after sleep onset. Strong associations were found at all loci except one. Highest associations for PLMI > 15/h were obtained using a multivariate model including age, sex, sleep disturbances, and the best SNPs for each loci, yielding the following odds ratios (OR) and P values: BTBD9 rs3923809(A) OR = 1.65, P = 1.5×10-8; TOX3/BC034767 rs3104788(T) OR = 1.35, P = 9.0 × 10-5; MEIS1 rs12469063(G) OR = 1.38, P = 2.0 × 10-4; MAP2K5/SKOR1 rs6494696(G) OR = 1.24, P = 1.3×10-2; and PTPRD(A) rs1975197 OR = 1.31, P = 6.3×10-3. Linear regression models also revealed significant PLM effects for BTBD9, TOX3/BC034767, and MEIS1. Co-varying for RLS symptoms only modestly reduced the genetic associations. Conclusions: Single nucleotide polymorphisms demonstrated to increase risk of RLS are strongly linked to increased

Kinematic Differences During Single-Leg Step-Down Between Individuals With Femoroacetabular Impingement Syndrome and Individuals Without Hip Pain.

PubMed

Lewis, Cara L; Loverro, Kari L; Khuu, Anne

2018-04-01

Study Design Controlled laboratory study, case-control design. Background Despite recognition that femoroacetabular impingement syndrome (FAIS) is a movement-related disorder, few studies have examined dynamic unilateral tasks in individuals with FAIS. Objectives To determine whether movements of the pelvis and lower extremities in individuals with FAIS differ from those in individuals without hip pain during a single-leg step-down, and to analyze kinematic differences between male and female participants within groups. Methods Individuals with FAIS and individuals without hip pain performed a single-leg step-down while kinematic data were collected. Kinematics were evaluated at 60° of knee flexion. A linear regression analysis assessed the main effects of group, sex, and side, and the interaction of sex by group. Results Twenty individuals with FAIS and 40 individuals without hip pain participated. Individuals with FAIS performed the step-down with greater hip flexion (4.9°; 95% confidence interval [CI]: 0.5°, 9.2°) and anterior pelvic tilt (4.1°; 95% CI: 0.9°, 7.3°) than individuals without hip pain. Across groups, female participants performed the task with more hip flexion (6.1°; 95% CI: 1.7°, 10.4°), hip adduction (4.8°; 95% CI: 2.2°, 7.4°), anterior pelvic tilt (5.8°; 95% CI: 2.6°, 9.0°), pelvic drop (1.4°; 95% CI: 0.3°, 2.5°), and thigh adduction (2.7°; 95% CI: 1.3°, 4.2°) than male participants. Conclusion The results of this study suggest that individuals with FAIS have alterations in pelvic motion during a dynamic unilateral task. The noted altered movement patterns in the FAIS group may contribute to the development of hip pain and may be due to impairments that are modifiable through rehabilitation. J Orthop Sports Phys Ther 2018;48(4):270-279. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7794.

Parental Symptom Report and Periodic Limb Movements of Sleep in Children

PubMed Central

Martin, Bradley T.; Williamson, Bruce D.; Edwards, Natalie; Teng, Arthur Y

2008-01-01

Study Objectives: To examine the prevalence of raised periodic limb movements of sleep (PLMS) index in children referred for polysomnography (PSG) and whether parental report of symptoms correlates with objective measurement during PSG. Methods: Records of children undergoing PSG from January 2006 to July 2006 were retrospectively reviewed. At their initial sleep clinic visit, parents had been asked whether their child was restless or moved their legs excessively during sleep. Their response to these questions was compared to the child's PLMS index (number of periodic limb movements per hour) during a full PSG. PLMS were scored according to internationally accepted criteria. Results: Data were examined for 101 children (60 male) with mean age 6.5 years (range 1.2 to 17.6 years). Excessive leg movements were reported by parents in 50% and restlessness in 73%. A raised PLMS index (defined as >5 per hour) was noted in 10 cases (prevalence 10%). Asking parents about whether their child kicks their legs excessively in sleep had sensitivity 50%, specificity 51%, positive predictive value (PPV) 10%, negative predictive value (NPV) 90% and positive likelihood ratio (LR+) 1.02 when compared to objective analysis. Asking parents about whether their child is restless in sleep had sensitivity 70%, specificity 26%, PPV 9%, NPV 89% and LR+ 0.95. Conclusions: Asking parents about their child's symptoms is not an accurate predictor of raised PLMS index. We recommend that leg electromyography be used in all pediatric sleep studies to record PLMS. Citation: Martin BT; Williamson BD; Edwards N; Teng AY. Parental symptom report and periodic limb movements of sleep in children. J Clin Sleep Med 2008;4(1):57-61. PMID:18350964

INDEXABILITY AND OPTIMAL INDEX POLICIES FOR A CLASS OF REINITIALISING RESTLESS BANDITS.

PubMed

Villar, Sofía S

2016-01-01

Motivated by a class of Partially Observable Markov Decision Processes with application in surveillance systems in which a set of imperfectly observed state processes is to be inferred from a subset of available observations through a Bayesian approach, we formulate and analyze a special family of multi-armed restless bandit problems. We consider the problem of finding an optimal policy for observing the processes that maximizes the total expected net rewards over an infinite time horizon subject to the resource availability. From the Lagrangian relaxation of the original problem, an index policy can be derived, as long as the existence of the Whittle index is ensured. We demonstrate that such a class of reinitializing bandits in which the projects' state deteriorates while active and resets to its initial state when passive until its completion possesses the structural property of indexability and we further show how to compute the index in closed form. In general, the Whittle index rule for restless bandit problems does not achieve optimality. However, we show that the proposed Whittle index rule is optimal for the problem under study in the case of stochastically heterogenous arms under the expected total criterion, and it is further recovered by a simple tractable rule referred to as the 1-limited Round Robin rule. Moreover, we illustrate the significant suboptimality of other widely used heuristic: the Myopic index rule, by computing in closed form its suboptimality gap. We present numerical studies which illustrate for the more general instances the performance advantages of the Whittle index rule over other simple heuristics.

INDEXABILITY AND OPTIMAL INDEX POLICIES FOR A CLASS OF REINITIALISING RESTLESS BANDITS

PubMed Central

Villar, Sofía S.

2016-01-01

Motivated by a class of Partially Observable Markov Decision Processes with application in surveillance systems in which a set of imperfectly observed state processes is to be inferred from a subset of available observations through a Bayesian approach, we formulate and analyze a special family of multi-armed restless bandit problems. We consider the problem of finding an optimal policy for observing the processes that maximizes the total expected net rewards over an infinite time horizon subject to the resource availability. From the Lagrangian relaxation of the original problem, an index policy can be derived, as long as the existence of the Whittle index is ensured. We demonstrate that such a class of reinitializing bandits in which the projects’ state deteriorates while active and resets to its initial state when passive until its completion possesses the structural property of indexability and we further show how to compute the index in closed form. In general, the Whittle index rule for restless bandit problems does not achieve optimality. However, we show that the proposed Whittle index rule is optimal for the problem under study in the case of stochastically heterogenous arms under the expected total criterion, and it is further recovered by a simple tractable rule referred to as the 1-limited Round Robin rule. Moreover, we illustrate the significant suboptimality of other widely used heuristic: the Myopic index rule, by computing in closed form its suboptimality gap. We present numerical studies which illustrate for the more general instances the performance advantages of the Whittle index rule over other simple heuristics. PMID:27212781

Intramuscular pressures beneath elastic and inelastic leggings

NASA Technical Reports Server (NTRS)

Murthy, G.; Ballard, R. E.; Breit, G. A.; Watenpaugh, D. E.; Hargens, A. R.

1994-01-01

Leg compression devices have been used extensively by patients to combat chronic venous insufficiency and by astronauts to counteract orthostatic intolerance following spaceflight. However, the effects of elastic and inelastic leggings on the calf muscle pump have not been compared. The purpose of this study was to compare in normal subjects the effects of elastic and inelastic compression on leg intramuscular pressure (IMP), an objective index of calf muscle pump function. IMP in soleus and tibialis anterior muscles was measured with transducer-tipped catheters. Surface compression between each legging and the skin was recorded with an air bladder. Subjects were studied under three conditions: (1) control (no legging), (2) elastic legging, and (3) inelastic legging. Pressure data were recorded for each condition during recumbency, sitting, standing, walking, and running. Elastic leggings applied significantly greater surface compression during recumbency (20 +/- 1 mm Hg, mean +/- SE) than inelastic leggings (13 +/- 2 mm Hg). During recumbency, elastic leggings produced significantly higher soleus IMP of 25 +/- 1 mm Hg and tibialis anterior IMP of 28 +/- 1 mm Hg compared to 17 +/- 1 mm Hg and 20 +/- 2 mm Hg, respectively, generated by inelastic leggings and 8 +/- 1 mm Hg and 11 +/- 1 mm Hg, respectively, without leggings. During sitting, walking, and running, however, peak IMPs generated in the muscular compartments by elastic and inelastic leggings were similar. Our results suggest that elastic leg compression applied over a long period in the recumbent posture may impede microcirculation and jeopardize tissue viability.(ABSTRACT TRUNCATED AT 250 WORDS).

Functional nerve disorders in the athlete's foot, ankle, and leg.

PubMed

Baxter, D E

1993-01-01

Although neuropathies in the athlete's foot, ankle, and leg are uncommon, they are often underdiagnosed, primarily because of the complex interplay of causative factors. The physician should be aware of the possible occurrence of these neuropathies, and should be familiar with the anatomy and course of the nerves. Often, the problem only occurs during functional activity and cannot be demonstrated during the routine static examination. Other problems should also be considered when there is the possibility of a nerve compression syndrome. Metabolic processes, such as diabetes or abuse of alcohol, can certainly cause neuropathies. A double crush syndrome or pain from a higher source should also be considered. Finally, if surgery is done for chronic problems, only the area of constriction should be released, without interfering with the nerve itself. Release the fascia but leave the perineural fat intact. If instability is a factor, the joint should also be stabilized.

Trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during a single-leg squat in males and females with and without patellofemoral pain syndrome.

PubMed

Nakagawa, Theresa H; Moriya, Erika T U; Maciel, Carlos D; Serrão, Fábio V

2012-06-01

Controlled laboratory study using a cross-sectional design. To determine whether there are any differences between the sexes in trunk, pelvis, hip, and knee kinematics, hip strength, and gluteal muscle activation during the performance of a single-leg squat in individuals with patellofemoral pain syndrome (PFPS) and control participants. Though there is a greater incidence of PFPS in females, PFPS is also quite common in males. Trunk kinematics may affect hip and knee function; however, there is a lack of studies of the influence of the trunk in individuals with PFPS. Eighty subjects were distributed into 4 groups: females with PFPS, female controls, males with PFPS, and male controls. Trunk, pelvis, hip, and knee kinematics and gluteal muscle activation were evaluated during a single-leg squat. Hip abduction and external rotation eccentric strength was measured on an isokinetic dynamometer. Group differences were assessed using a 2-way multivariate analysis of variance (sex by PFPS status). Compared to controls, subjects with PFPS had greater ipsilateral trunk lean (mean ± SD, 9.3° ± 5.3° versus 6.7° ± 3.0°; P = .012), contralateral pelvic drop (10.3° ± 4.7° versus 7.4° ± 3.8°; P = .003), hip adduction (14.8° ± 7.8° versus 10.8° ± 5.6°; P<.0001), and knee abduction (9.2° ± 5.0° versus 5.8° ± 3.4°; P<.0001) when performing a single-leg squat. Subjects with PFPS also had 18% less hip abduction and 17% less hip external rotation strength. Compared to female controls, females with PFPS had more hip internal rotation (P<.05) and less muscle activation of the gluteus medius (P = .017) during the single-leg squat. Despite many similarities in findings for males and females with PFPS, there may be specific sex differences that warrant consideration in future studies and when clinically evaluating and treating females with PFPS.

[Fentanyl Citrate Sublingual Tablets Were Effective in Relieving Symptoms of Akathisia - A Case Report].

PubMed

Kessoku, Takaomi; Kusakabe, Akihiko; Matsuura, Tetsuya; Honda, Yasushi; Yoshimi, Asuka; Goto, Ayumu; Yoshida, Haruhisa; Sukegawa, Akiko; Hata, Chiaki; Saito, Yukie; Miyashita, Yoko; Yashiro, Ryoko; Komori, Tomoya; Arai, Sachiko; Nakajima, Atsushi; Ichikawa, Yasushi

2018-03-01

Akathisia is a condition wherein sitting calmly and quietly is impossible, with a representative complaint of restless legs. It is generally assumed to be caused by anti-dopamine activity. In severe cases, it has been known to result in suicide attempt. We reported a case of drug-induced akathisia with difficulty in oral intake, in which fentanyl citrate sublingual tablets were found to be effective in relieving symptoms. The patient was a female aged 50's who had a gastric cancer with peritoneal dissemination causing pain and vomiting. Palliative care was requested for management of symptoms. Metoclopramide and haloperidol were administered for vomiting. However, because of the complaints of restless legs, the case was diagnosed as drug-induced akathisia. Fentanyl citrate sublingual tablets were then administered for pain management, resulting in temporary improvement of akathisia symptoms.

Are the hamstrings from the drive leg or landing leg more active in baseball pitchers? An electromyographic study.

PubMed

Erickson, Brandon J; Zaferiou, Antonia; Chalmers, Peter N; Ruby, Deana; Malloy, Phillip; Luchetti, Timothy J; Verma, Nikhil N; Romeo, Anthony A

2017-11-01

Ulnar collateral ligament reconstruction (UCLR) has become a common procedure among baseball players of all levels. There are several graft choices in performing UCLR, one of which is a hamstring (gracilis or semitendinosus) autograft. It is unclear whether the hamstring muscle from a pitcher's drive leg (ipsilateral side of the UCLR) or landing leg (contralateral side of the UCLR) is more active during the pitching motion. We hypothesized that the landing leg semitendinosus will be more electromyographically active than the drive leg. Healthy, elite male pitchers aged 16-21 years were recruited. Sixteen pitchers (average age, 17.6 ± 1.6 years; 67% threw right handed) underwent electromyographic analysis. Pitchers threw 5 fastballs at 100% effort from the wind-up with electromyographic analysis of every pitch. Activation of the semitendinosus and biceps femoris in both legs was compared within pitchers and between pitchers. Hamstring activity was higher in the drive leg than in the landing leg during each phase and in sum, although the difference was significant only during the double support phase (P = .021). On within-pitcher analysis, 10 of 16 pitchers had significantly more sum hamstring activity in the drive leg than in the landing leg, while only 4 of 16 had more activity in the landing leg (P = .043). During the baseball pitch, muscle activity of the semitendinosus was higher in the drive leg than in the landing leg in most pitchers. Surgeons performing UCLR using hamstring autograft should consider harvesting the graft from the pitcher's landing leg to minimize disruption to the athlete's pitching motion. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Lower Leg Anterior and Lateral Intracompartmental Pressure Changes Before and After Classic Versus Skate Nordic Rollerskiing.

PubMed

Woods, Katherine M; Petron, David J; Shultz, Barry B; Hicks-Little, Charlie A

2015-08-01

Chronic exertional compartment syndrome (CECS) is a debilitating condition resulting in loss of function and a decrease in athletic performance. Cases of CECS are increasing among Nordic skiers; therefore, analysis of intracompartmental pressures (ICPs) before and after Nordic skiing is warranted. To determine if lower leg anterior and lateral ICPs and subjective lower leg pain levels increased after a 20-minute Nordic rollerskiing time trial and to examine if differences existed between postexercise ICPs for the 2 Nordic rollerskiing techniques, classic and skate. Crossover study. Outdoor paved loop. Seven healthy Division I Nordic skiers (3 men, 4 women; age = 22.71 ± 1.38 y, height = 175.36 ± 6.33 cm, mass = 70.71 ± 6.58 kg). Participants completed two 20-minute rollerskiing time trials using the classic and skate technique in random order. The time trials were completed 7 days apart. Anterior and lateral ICPs and lower leg pain scores were obtained at baseline and at minutes 1 and 5 after rollerskiing. Anterior and lateral ICPs (mm Hg) were measured using a Stryker Quic STIC handheld monitor. Subjective measures of lower leg pain were recorded using the 11-point Numeric Rating Scale. Increases in both anterior (P = .000) and lateral compartment (P = .002) ICPs were observed, regardless of rollerskiing technique used. Subjective lower leg pain increased after the classic technique for the men from baseline to 1 minute postexercise and after the skate technique for the women. Significant 3-way interactions (technique × time × sex) were observed for the anterior (P = .002) and lateral (P = .009) compartment ICPs and lower leg pain (P = .005). Postexercise anterior and lateral ICPs increased compared with preexercise ICPs after both classic and skate rollerskiing techniques. Lower leg pain is a primary symptom of CECS. The subjective lower leg pain 11-point Numeric Rating Scale results indicate that increases in lower leg ICPs sustained during Nordic

Static balance according to hip joint angle of unsupported leg during one-leg standing.

PubMed

Cha, Ju-Hyung; Kim, Jang-Joon; Ye, Jae-Gwan; Lee, Seul-Ji; Hong, Jeong-Mi; Choi, Hyun-Kyu; Choi, Ho-Suk; Shin, Won-Seob

2017-05-01

[Purpose] This study aimed to determine static balance according to hip joint angle of the unsupported leg during one-leg standing. [Subjects and Methods] Subjects included 45 healthy adult males and females in their 20s. During one-leg standing on the non-dominant leg, the position of the unsupported leg was classified according to hip joint angles of point angle was class. Static balance was then measured using a force plate with eyes open and closed. The total length, sway velocity, maximum deviation, and velocity on the mediolateral and anteroposterior axes of center of pressure were measured. [Results] In balance assessment with eyes open, there were significant differences between groups according to hip joint angle, except for maximum deviation on the anteroposterior axis. In balance assessment with eyes closed, there were significant differences between total length measurements at 0° and 30°, 60° and between 30° and 90°. There were significant differences between sway velocity measurements at 0° and 30° and between 30° and 90°. [Conclusion] Thus, there were differences in static balance according to hip joint angle. It is necessary to clearly identify the hip joint angle during one-leg standing testing.

Quality of life in patients with an idiopathic rapid eye movement sleep behaviour disorder in Korea.

PubMed

Kim, Keun Tae; Motamedi, Gholam K; Cho, Yong Won

2017-08-01

There have been few quality of life studies in patients with idiopathic rapid eye movement sleep behaviour disorder. We compared the quality of life in idiopathic rapid eye movement sleep behaviour disorder patients to healthy controls, patients with hypertension, type 2 diabetes mellitus without complication and idiopathic restless legs syndrome. Sixty patients with idiopathic rapid eye movement sleep behaviour disorder (24 female; mean age: 61.43 ± 8.99) were enrolled retrospectively. The diagnosis was established based on sleep history, overnight polysomnography, neurological examination and Mini-Mental State Examination to exclude secondary rapid eye movement sleep behavior disorder. All subjects completed questionnaires, including the Short Form 36-item Health Survey for quality of life. The total quality of life score in idiopathic rapid eye movement sleep behaviour disorder (70.63 ± 20.83) was lower than in the healthy control group (83.38 ± 7.96) but higher than in the hypertension (60.55 ± 24.82), diabetes mellitus (62.42 ± 19.37) and restless legs syndrome (61.77 ± 19.25) groups. The total score of idiopathic rapid eye movement sleep behaviour disorder patients had a negative correlation with the Pittsburg Sleep Quality Index (r = -0.498, P < 0.001), Insomnia Severity Index (r = -0.645, P < 0.001) and the Beck Depression Inventory-2 (r = -0.694, P < 0.001). Multiple regression showed a negative correlation between the Short Form 36-item Health Survey score and the Insomnia Severity Index (β = -1.100, P = 0.001) and Beck Depression Inventory-2 (β = -1.038, P < 0.001). idiopathic rapid eye movement sleep behaviour disorder had a significant negative impact on quality of life, although this effect was less than that of other chronic disorders. This negative effect might be related to a depressive mood associated with the disease. © 2016 European Sleep Research Society.

The development of a sleep disorder screening program in Australian community pharmacies.

PubMed

Tran, Adam; Fuller, Joanne M; Wong, Keith K; Krass, Ines; Grunstein, Ron; Saini, Bandana

2009-08-01

To develop, pilot and determine the feasibility of a sleep-specific screening and awareness program in community pharmacies. The screening was piloted in five Australian community pharmacies. The Pharmacy Tool for Assessment of Sleep Health was constructed by drawing on known relationships between sleep disorders, and lifestyle factors, medical conditions and medications. Four validated instruments were used in the screening tool: the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Multivariable Apnea Prediction Index (MAPI) and International Restless Legs Syndrome Study Group Screening Criteria (IRLS). These instruments were used to predict the participant's risk of a sleep disorder and the results were compared with reported lifestyle, medical and medication factors. On-site training of consenting pharmacists was provided, followed by an eight week client recruiting and screening period. Feedback was elicited from participating pharmacists and clients. The feasibility of, and trends found from, the developed screening tool and protocol. Of 167 clients who requested or were invited to participate by pharmacists, 84 (50.3%) were screened. Analysis of collected data indicated that 33.3%, 21.4% and 27.4% of participants were at risk of having or developing insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS) respectively, while 38.1% were not at risk of any of the screened disorders. OSA odds increased 12.8 times (95% CI: 3.2-50.4) with diabetes and 4.9 times (1.2-20.9) with opioid use, while shift workers were 8.4 times (1.6-43.2) more likely to have insomnia. Participants and pharmacists reported the screening protocol and instrument was user friendly and feasible. The development and pilot of this screening tool was successful. The prevalence of sleep disorders in the sampled population was high but generally consistent with previous studies on the general population. Furthermore, associations found may form a foundation for a

An unusual case of calcineurine inhibitor pain syndrome.

PubMed

Nickavar, Azar; Mehrazma, Mitra; Hallaji, Farideh

2014-09-01

Cyclosporine induced pain syndrome (CIPS) is a newly diagnosed complication of calcineurine inhibitors, mainly observed in solid organ and hematopoetic transplantations. The present case is a male child with steroid resistant nephrotic syndrome on low therapeutic level cyclosporine treatment. He presented with intractable and debilitating leg pain, with no reported history of previous injury or trauma. The pain was reluctant to antimicrobial and sedative treatment. MRI revealed bone marrow and soft tissue edema in the mid shaft of patient's right leg. Inspite of unusual manifestations, CIPS was suggested and cyclosporine discontinued. However, the pain did not improve and was resistant to calcium blocker. Subsequently, core decompression was performed as an unusual treatment of CIPS, revealing normal bone morphology. The pain improved rapidly and the patient was discharged a few days later.

Sleep Problems in Children and Adolescents with Common Medical Conditions

PubMed Central

Lewandowski, Amy S.; Ward, Teresa M.; Palermo, Tonya M.

2011-01-01

Synopsis Sleep is critically important to children’s health and well-being. Untreated sleep disturbances and sleep disorders pose significant adverse daytime consequences and place children at considerable risk for poor health outcomes. Sleep disturbances occur at a greater frequency in children with acute and chronic medical conditions compared to otherwise healthy peers. Sleep disturbances in medically ill children can be associated with sleep disorders (e.g., sleep disordered breathing, restless leg syndrome), co-morbid with acute and chronic conditions (e.g., asthma, arthritis, cancer), or secondary to underlying disease-related mechanisms (e.g. airway restriction, inflammation) treatment regimens, or hospitalization. Clinical management should include a multidisciplinary approach with particular emphasis on routine, regular sleep assessments and prevention of daytime consequences and promotion of healthy sleep habits and health outcomes. PMID:21600350

Sleep disorders and chronic kidney disease.

PubMed

Maung, Stephanie C; El Sara, Ammar; Chapman, Cherylle; Cohen, Danielle; Cukor, Daniel

2016-05-06

Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease (CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.

SLEEP AND CIRCADIAN RHYTHM DISORDERS IN PARKINSON'S DISEASE.

PubMed

Gros, Priti; Videnovic, Aleksandar

2017-09-01

Sleep disorders are among the most challenging non-motor features of Parkinson's disease (PD) and significantly affect quality of life. Research in this field has gained recent interest among clinicians and scientists and is rapidly evolving. This review is dedicated to sleep and circadian dysfunction associated with PD. Most primary sleep disorders may co-exist with PD; majority of these disorders have unique features when expressed in the PD population. We discuss the specific considerations related to the common sleep problems in Parkinson's disease including insomnia, rapid eye movement sleep behavior disorder, restless legs syndrome, sleep disordered breathing, excessive daytime sleepiness and circadian rhythm disorders. Within each of these sleep disorders, we present updated definitions, epidemiology, etiology, diagnosis, clinical implications and management. Furthermore, areas of potential interest for further research are outlined.

Lesson of the month 2: An unusual adverse reaction associated with pramipexole.

PubMed

Tashkent, Yasmina; Aiyappan, Vinod

2018-06-01

Dopamine agonists such as pramipexole are commonly used in the treatment of restless legs syndrome (RLS) as well as Parkinson's disease. Pramipexole's common side effects are well documented; however, adverse skin reactions are less well known. In this case, a 45-year-old male farmer presented with excessive daytime tiredness and reported a history suggestive of RLS. He was initiated on pramipexole but developed a maculopapular erythematous rash in sun-exposed areas 8 days after its commencement. The skin rash resolved following pramipexole's cessation and it is thought the patient experienced a drug-induced photosensitivity reaction to pramipexole. This case highlights the potential for photosensitivity reactions to pramipexole, which is especially significant in countries like Australia where UV solar radiation is especially high. © Royal College of Physicians 2018. All rights reserved.

Selective detection of dopamine in the presence of ascorbic acid via fluorescence quenching of InP/ZnS quantum dots

PubMed Central

Ankireddy, Seshadri Reddy; Kim, Jongsung

2015-01-01

Dopamine is a neurotransmitter of the catecholamine family and has many important roles, especially in human brain. Several diseases of the nervous system, such as Parkinson’s disease, attention deficit hyperactivity disorder, restless legs syndrome, are believed to be related to deficiency of dopamine. Several studies have been performed to detect dopamine by using electrochemical analysis. In this study, quantum dots (QDs) were used as sensing media for the detection of dopamine. The surface of the QDs was modified with l-cysteine by coupling reaction to increase the selectivity of dopamine. The fluorescence of cysteine-capped indium phosphide/zinc sulfide QDs was quenched by dopamine with various concentrations in the presence of ascorbic acid. This method shows good selectivity for dopamine detection, and the detection limit was 5 nM. PMID:26347250

Selective detection of dopamine in the presence of ascorbic acid via fluorescence quenching of InP/ZnS quantum dots.

PubMed

Ankireddy, Seshadri Reddy; Kim, Jongsung

2015-01-01

Dopamine is a neurotransmitter of the catecholamine family and has many important roles, especially in human brain. Several diseases of the nervous system, such as Parkinson's disease, attention deficit hyperactivity disorder, restless legs syndrome, are believed to be related to deficiency of dopamine. Several studies have been performed to detect dopamine by using electrochemical analysis. In this study, quantum dots (QDs) were used as sensing media for the detection of dopamine. The surface of the QDs was modified with l-cysteine by coupling reaction to increase the selectivity of dopamine. The fluorescence of cysteine-capped indium phosphide/zinc sulfide QDs was quenched by dopamine with various concentrations in the presence of ascorbic acid. This method shows good selectivity for dopamine detection, and the detection limit was 5 nM.

Myotonic dystrophy mimicking postpolio syndrome in a polio survivor.

PubMed

Lim, Jae-Young; Kim, Kyoung-Eun; Choe, Gheeyoung

2009-02-01

We describe a 38-yr-old polio survivor with newly developed weakness from myotonic dystrophy. He suffered muscle atrophy and weakness in his legs as a result of poliomyelitis at the age of 3 yrs. After a stable interval of about 30 yrs, he felt new weakness and fatigue in his legs. Electromyography revealed generalized myotonic discharges, early recruitment, and findings of chronic denervation in his left leg. Genetic testing was consistent with myotonic dystrophy type 1. A biopsy from the right gastrocnemius revealed findings of both myotonic dystrophy and chronic denervation. This case report shows the importance of considering other uncommon conditions in the differential diagnoses of postpolio syndrome.

The Motor and the Brake of the Trailing Leg in Human Walking: Leg Force Control Through Ankle Modulation and Knee Covariance

PubMed Central

Toney, Megan E.; Chang, Young-Hui

2016-01-01

Human walking is a complex task, and we lack a complete understanding of how the neuromuscular system organizes its numerous muscles and joints to achieve consistent and efficient walking mechanics. Focused control of select influential task-level variables may simplify the higher-level control of steady state walking and reduce demand on the neuromuscular system. As trailing leg power generation and force application can affect the mechanical efficiency of step-to-step transitions, we investigated how joint torques are organized to control leg force and leg power during human walking. We tested whether timing of trailing leg force control corresponded with timing of peak leg power generation. We also applied a modified uncontrolled manifold analysis to test whether individual or coordinated joint torque strategies most contributed to leg force control. We found that leg force magnitude was adjusted from step-to-step to maintain consistent leg power generation. Leg force modulation was primarily determined by adjustments in the timing of peak ankle plantar-flexion torque, while knee torque was simultaneously covaried to dampen the effect of ankle torque on leg force. We propose a coordinated joint torque control strategy in which the trailing leg ankle acts as a motor to drive leg power production while trailing leg knee torque acts as a brake to refine leg power production. PMID:27334888

A colored leg banding technique for Amazona parrots

USGS Publications Warehouse

Meyers, J.M.

1995-01-01

A technique for individual identification of Amazona was developed using plastic leg bands. Bands were made from 5- and 7-mm-wide strips of laminated PVC coiled 2.5 times with an inside diameter 4-5 mm gt the maximum diameter of the parrot's leg. Seventeen parrots were captured in Puerto Rico, marked with individual plastic leg bands, and observed for 204-658 d with only one lost or damaged plastic band. Plastic leg bands did not cause injury to or calluses on parrots' legs. The plastic material used for making leg bands was available in 18 colors in 1994, which would allow unique marking of 306 individuals using one plastic leg band on each leg.

Foot, leg, and ankle swelling

MedlinePlus

... feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... 31. Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: diagnosis and management. Am Fam Physician . 2013;88( ...

Pipe crawler with extendable legs

DOEpatents

Zollinger, William T.

1992-01-01

A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long a leg assembly is wide and the crawler can crawl through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler.

Pipe crawler with extendable legs

DOEpatents

Zollinger, W.T.

1992-06-16

A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long as a leg assembly is wide and the crawler can crawl through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler. 8 figs.

Pipe crawler with extendable legs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zollinger, W.T.

1992-06-16

A pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair lying in the same axial plane as another pair. Therefore, the cylinders can be as long as a leg assembly is wide and the crawler can crawlmore » through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler. 8 figs.« less

The Benslimane's Artistic Model for Leg Beauty.

PubMed

Benslimane, Fahd

2012-08-01

In 2000, the author started observing legs considered to be attractive. The goal was to have an ideal aesthetic model and compare the disparity between this model and a patient's reality. This could prove helpful during leg sculpturing to get closer to this ideal. Postoperatively, the result could then be compared to the ideal curves of the model legs and any remaining deviations from the ideal curves could be pointed out and eventually corrected in a second session. The lack of anthropometric studies of legs from the knee to the ankle led the author to select and study attractive legs to find out the common denominators of their beauty. The study consisted in analyzing the features that make legs look attractive. The legs of models in magazines were scanned and inserted into a PowerPoint program. The legs of live models, Barbie dolls, and athletes were photographed. Artistic drawings by Leonardo da Vinci were reviewed and Greek sculptures studied. Sculptures from the National Archaeological Museum of Athens were photographed and included in the PowerPoint program. This study shows that the first criterion for beautiful legs is the straightness of the leg column. Not a single attractive leg was found to deviate from the vertical, and each was in absolute continuity with the thigh. The second criterion is the similarity of curve distribution and progression from knee to ankle. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

On the Biomimetic Design of Agile-Robot Legs

PubMed Central

Garcia, Elena; Arevalo, Juan Carlos; Muñoz, Gustavo; Gonzalez-de-Santos, Pablo

2011-01-01

The development of functional legged robots has encountered its limits in human-made actuation technology. This paper describes research on the biomimetic design of legs for agile quadrupeds. A biomimetic leg concept that extracts key principles from horse legs which are responsible for the agile and powerful locomotion of these animals is presented. The proposed biomimetic leg model defines the effective leg length, leg kinematics, limb mass distribution, actuator power, and elastic energy recovery as determinants of agile locomotion, and values for these five key elements are given. The transfer of the extracted principles to technological instantiations is analyzed in detail, considering the availability of current materials, structures and actuators. A real leg prototype has been developed following the biomimetic leg concept proposed. The actuation system is based on the hybrid use of series elasticity and magneto-rheological dampers which provides variable compliance for natural motion. From the experimental evaluation of this prototype, conclusions on the current technological barriers to achieve real functional legged robots to walk dynamically in agile locomotion are presented. PMID:22247667

On the biomimetic design of agile-robot legs.

PubMed

Garcia, Elena; Arevalo, Juan Carlos; Muñoz, Gustavo; Gonzalez-de-Santos, Pablo

2011-01-01

The development of functional legged robots has encountered its limits in human-made actuation technology. This paper describes research on the biomimetic design of legs for agile quadrupeds. A biomimetic leg concept that extracts key principles from horse legs which are responsible for the agile and powerful locomotion of these animals is presented. The proposed biomimetic leg model defines the effective leg length, leg kinematics, limb mass distribution, actuator power, and elastic energy recovery as determinants of agile locomotion, and values for these five key elements are given. The transfer of the extracted principles to technological instantiations is analyzed in detail, considering the availability of current materials, structures and actuators. A real leg prototype has been developed following the biomimetic leg concept proposed. The actuation system is based on the hybrid use of series elasticity and magneto-rheological dampers which provides variable compliance for natural motion. From the experimental evaluation of this prototype, conclusions on the current technological barriers to achieve real functional legged robots to walk dynamically in agile locomotion are presented.

Acute Exertional Compartment Syndrome with Rhabdomyolysis: Case Report and Review of Literature

PubMed Central

Gaunder, Christopher; Schumer, Ross

2018-01-01

Patient: Male, 17 Final Diagnosis: Acute exertional compartment syndrome Symptoms: Foot drop • leg pain • paresthesia Medication: — Clinical Procedure: Fasciotomy Specialty: Orthopedics and Traumatology Objective: Rare disease Background: Acute exertional compartment syndrome (AECS) is a rare cause of leg pain often associated with a delay in diagnosis and potentially leading to irreversible muscle and nerve damage. Case Report: We present the case of a previously healthy, high-level athlete who presented with the acute onset of unilateral anterior leg pain and foot drop the day after a strenuous workout. He was diagnosed with compartment syndrome and rhabdomyolysis. His management included emergent fluid resuscitation, fasciotomies, debridement of necrotic muscle from his anterior compartment, and delayed primary closure. After six months of intensive outpatient physical therapy, including the use of blood flow restriction treatments, the patient returned to sports and received a NCAA Division I Football scholarship. Conclusions: We describe the details of this patient’s case and review the literature related to acute exertional compartment syndrome. The occurrence of acute compartment syndrome in the absence of trauma or fracture, though rare, can have devastating consequences following delays in treatment. AECS requires prompt diagnosis and surgical intervention to prevent these consequences. Diagnosis of atraumatic cases can be difficult, which is why awareness is equally as important as history and physical examination. While diagnosis is primarily clinical, it can be supported with direct intra-compartmental pressure measurements and maintaining a high index of suspicion in acute presentations of exertional limb pain. PMID:29415981

Passive zero-gravity leg restraint

NASA Technical Reports Server (NTRS)

Miller, Christopher R. (Inventor)

1989-01-01

A passive zero or microgravity leg restraint is described which includes a central support post with a top and a bottom. Extending from the central support post are a calf pad tab, to which calf pad is attached, and a foot pad tab, to which foot tab is attached. Also extending from central support post are knee pads. When the restraint is in use the user's legs are forced between pads by a user imposed scissors action of the legs. The user's body is then supported in a zero or microgravity neutral body posture by the leg restraint. The calf pad has semi-ridig elastic padding material covering structural stiffener. The foot pad has padding material and a structural stiffener. Knee pads have s structural tube stiffener at their core.

Self-reported sleep bruxism and nocturnal gastroesophageal reflux disease in patients with obstructive sleep apnea: relationship to gender and ethnicity.

PubMed

Hesselbacher, Sean; Subramanian, Shyam; Rao, Shweta; Casturi, Lata; Surani, Salim

2014-01-01

Nocturnal bruxism is associated with gastroesophageal reflux disease (GERD), and GERD is strongly associated with obstructive sleep apnea (OSA). Gender and ethnic differences in the prevalence and clinical presentation of these often overlapping sleep disorders have not been well documented. Our aim was to examine the associations between, and the symptoms associated with, nocturnal GERD and sleep bruxism in patients with OSA, and to examine the influence of gender and ethnicity. A retrospective chart review was performed of patients diagnosed with OSA at an academic sleep center. The patients completed a sleep questionnaire prior to undergoing polysomnography. Patients with confirmed OSA were evaluated based on gender and ethnicity. Associations were determined between sleep bruxism and nocturnal GERD, and daytime sleepiness, insomnia, restless legs symptoms, and markers of OSA severity in each group. In these patients with OSA, the prevalence of nocturnal GERD (35%) and sleep bruxism (26%) were higher than the general population. Sleep bruxism was more common in Caucasians than in African Americans or Hispanics; there was no gender difference. Nocturnal GERD was similar among all gender and ethnic groups. Bruxism was associated with nocturnal GERD in females, restless legs symptoms in all subjects and in males, sleepiness in African Americans, and insomnia in Hispanics. Nocturnal GERD was associated with sleepiness in males and African Americans, insomnia in females, and restless legs symptoms in females and in Caucasians. Patients with OSA commonly have comorbid sleep bruxism and nocturnal GERD, which may require separate treatment. Providers should be aware of differences in clinical presentation among different ethnic and gender groups.

Marked improvement of Churg–Strauss syndrome neuropathy by intravenous immunoglobulin and cyclophosphamide

PubMed Central

Umeda, Akira; Yamane, Tateki; Takeuchi, Jin; Imai, Yasuo; Suzuki, Keisuke; Yumura, Wako

2014-01-01

A 42-year-old Japanese man developed Churg–Strauss syndrome 7 years after being diagnosed with chronic eosinophilic pneumonia. Prominent eosinophilia, subcutaneous nodules, and neuropathy in the left leg were seen. A pathological diagnosis of necrotizing vasculitis was determined by a biopsy of a subcutaneous nodule. The leg pain was severe and there was prominent atrophy of the thigh and calf, but the muscle weakness was mild. Serum anti-myeloperoxidase anti-neutrophil cytoplasmic antibody was positive. Because the initial treatment with an intravenous methylprednisolone pulse at 1 g/day for 3 days was not sufficient, a onetime treatment with intravenous cyclophosphamide at 15 mg/kg and intravenous immunoglobulin therapy (IVIG) at 400 mg/kg/day for 5 days were administered. Peripheral eosinophilia improved and the leg pain significantly improved. IVIG was repeated 1 month later and symptoms gradually improved further. The early diagnosis of Churg–Strauss syndrome and the early initiation of IVIG with cyclophosphamide were thought to be important. PMID:25473575

Lower Leg Anterior and Lateral Intracompartmental Pressure Changes Before and After Classic Versus Skate Nordic Rollerskiing

PubMed Central

Woods, Katherine M.; Petron, David J.; Shultz, Barry B.; Hicks-Little, Charlie A.

2015-01-01

Context Chronic exertional compartment syndrome (CECS) is a debilitating condition resulting in loss of function and a decrease in athletic performance. Cases of CECS are increasing among Nordic skiers; therefore, analysis of intracompartmental pressures (ICPs) before and after Nordic skiing is warranted. Objective To determine if lower leg anterior and lateral ICPs and subjective lower leg pain levels increased after a 20-minute Nordic rollerskiing time trial and to examine if differences existed between postexercise ICPs for the 2 Nordic rollerskiing techniques, classic and skate. Design Crossover study. Setting Outdoor paved loop. Patients or Other Participants Seven healthy Division I Nordic skiers (3 men, 4 women; age = 22.71 ± 1.38 y, height = 175.36 ± 6.33 cm, mass = 70.71 ± 6.58 kg). Intervention(s) Participants completed two 20-minute rollerskiing time trials using the classic and skate technique in random order. The time trials were completed 7 days apart. Anterior and lateral ICPs and lower leg pain scores were obtained at baseline and at minutes 1 and 5 after rollerskiing. Main Outcome Measure(s) Anterior and lateral ICPs (mm Hg) were measured using a Stryker Quic STIC handheld monitor. Subjective measures of lower leg pain were recorded using the 11-point Numeric Rating Scale. Results Increases in both anterior (P = .000) and lateral compartment (P = .002) ICPs were observed, regardless of rollerskiing technique used. Subjective lower leg pain increased after the classic technique for the men from baseline to 1 minute postexercise and after the skate technique for the women. Significant 3-way interactions (technique × time × sex) were observed for the anterior (P = .002) and lateral (P = .009) compartment ICPs and lower leg pain (P = .005). Conclusions Postexercise anterior and lateral ICPs increased compared with preexercise ICPs after both classic and skate rollerskiing techniques. Lower leg pain is a primary symptom of CECS. The subjective

Why do flamingos stand on one leg?

PubMed

Anderson, Matthew J; Williams, Sarah A

2010-01-01

A series of observational studies of captive Caribbean flamingos Phoenicopterus ruber were conducted to determine why flamingos rest on one leg. While frequently asked by the general public, this basic question has remained unanswered by the scientific community. Here we suggest that the latency of flamingos to initiate forward locomotion following resting on one leg is significantly longer than following resting on two, discounting the possibility that unipedal resting reduces muscle fatigue or enhances predatory escape. Additionally, we demonstrate that flamingos do not display lateral preferences at the individual or group levels when resting on one leg, with each bird dividing its resting time across both legs. We show that while flamingos prefer resting on one leg to two regardless of location, the percentage of birds resting on one leg is significantly higher among birds standing in the water than among those on land. Finally, we demonstrate a negative relationship between temperature and the percentage of observed birds resting on one leg, such that resting on one leg decreases as temperature rises. Results strongly suggest that unipedal resting aids flamingos in thermoregulation. (c) 2009 Wiley-Liss, Inc.

Pipe crawler with extendable legs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zollinger, W.T.

1991-04-02

This invention is comprised of a pipe crawler for moving through a pipe in inchworm fashion having front and rear leg assemblies separated by air cylinders to increase and decrease the spacing. between assemblies. Each leg of the four legs of an assembly is moved between a wall-engaging, extended position and a retracted position by a separate air cylinder. The air cylinders of the leg assemblies are preferably arranged in pairs of oppositely directed cylinders with no pair laying in the same axial plane as another pair. Therefore, the cylinders can be as long as a leg assembly is widemore » and the crawler can crawl through sections of pipes where the diameter is twice that of other sections. The crawler carries a valving system, a manifold to distribute air supplied by a single umbilical air hose to the various air cylinders in a sequence controlled electrically by a controller. The crawler also utilizes a rolling mechanism, casters in this case, to reduce friction between the crawler and pipe wall thereby further extending the range of the pipe crawler.« less

The Legs Problem--For All Ages

ERIC Educational Resources Information Center

Way, Jenni

2005-01-01

This article presents an example of a versatile multi-solution problem that can be used right across the primary years. The basic problem is: "Noah saw 16 legs go past him into the Ark. How many creatures did he see?" Any even number can be used, although, 2 legs allows only one answer and with 16 legs there are already 14 different…

Multisystemic Sarcoidosis Presenting as Pretibial Leg Ulcers.

PubMed

Wollina, Uwe; Baunacke, Anja; Hansel, Gesina

2016-09-01

Sarcoidosis is a multisystemic disease of unknown etiology. Up to 30% of patients develop cutaneous manifestations, either specific or nonspecific. Ulcerating sarcoidosis leading to leg ulcers is a rare observation that may lead to confusions with other, more common types of chronic leg ulcers. We report the case of a 45-year-old female patient with chronic multisystemic sarcoidosis presenting with pretibial leg ulcers. Other etiology could be excluded. Histology revealed nonspecific findings. Therefore, the diagnosis of nonspecific leg ulcers in sarcoidosis was confirmed. Treatment consisted of oral prednisolone and good ulcer care. Complete healing was achieved within 6 months. Sarcoidosis is a rare cause of leg ulcers and usually sarcoid granulomas can be found. Our patient illustrates that even in the absence of sarcoid granulomas, leg ulcers can be due to sarcoidosis. © The Author(s) 2016.

How is agitation and restlessness managed in the last 24 h of life in patients whose care is supported by the Liverpool care pathway for the dying patient?

PubMed

Gambles, M; McGlinchey, T; Latten, R; Dickman, A; Lowe, D; Ellershaw, J E

2011-12-01

Guidance regarding the patient centred management of agitation and restlessness reinforces the importance of considering underlying causes, non-pharmacological approaches to treatment and judicious use of medications titrated to patient need. In contrast, recent reports in the literature suggest that the practice of continuous deep sedation until death is prevalent in the UK. To use data from the National Care of the Dying Audit-Hospitals (NCDAH) to explore the administration of medication for management of agitation and restlessness in the last 24 h of life. Hospitals submitted data from up to 30 consecutive adult patients whose care in the final hours/days of life was supported by the Liverpool Care Pathway for the Dying Patient (LCP). Data on the total dose received in the last 24 h of life PRN and the last dose prescribed for administration via continuous subcutaneous infusion (CSCI) for agitation and restlessness were submitted. 155 hospitals provided data from 3893 patients. Median total doses in the last 24 h for midazolam, haloperidol and levomepromazine, respectively, were: PRN only, 2.5, 1.5 and 6.25 mg; CSCI only, 10, 3 and 6.25 mg; PRN+CSCI, 15, 3 and 12.5 mg. Only 51% of patients received medication to alleviate agitation and restlessness in the last 24 h of life. Median doses were low in comparison to doses recommended for continuous deep sedation, suggesting that there is no 'blanket' policy for continuous deep sedation at the end of life for patients whose care is supported by the LCP.

Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi

PubMed Central

Ikegami, Akiko; Kondo, Takeshi; Tsukamoto, Tomoko; Ohira, Yoshiyuki; Ikusaka, Masatomi

2015-01-01

We report a rare case of iliac vein compression syndrome caused by urethral calculus. A 71-year-old man had a history of urethral stenosis. He complained of bilateral leg edema and dysuria for 1 week. Physical examination revealed bilateral distention of the superficial epigastric veins, so obstruction of both common iliac veins or the inferior vena cava was suspected. Plain abdominal computed tomography showed a calculus in the pendulous urethra, distention of the bladder (as well as the right renal pelvis and ureter), and compression of the bilateral common iliac veins by the distended bladder. Iliac vein compression syndrome was diagnosed. Bilateral iliac vein compression due to bladder distention (secondary to neurogenic bladder, benign prostatic hyperplasia, or urethral calculus as in this case) is an infrequent cause of acute bilateral leg edema. Detecting distention of the superficial epigastric veins provides a clue for diagnosis of this syndrome. PMID:25802794

Does a crouched leg posture enhance running stability and robustness?

PubMed

Blum, Yvonne; Birn-Jeffery, Aleksandra; Daley, Monica A; Seyfarth, Andre

2011-07-21

Humans and birds both walk and run bipedally on compliant legs. However, differences in leg architecture may result in species-specific leg control strategies as indicated by the observed gait patterns. In this work, control strategies for stable running are derived based on a conceptual model and compared with experimental data on running humans and pheasants (Phasianus colchicus). From a model perspective, running with compliant legs can be represented by the planar spring mass model and stabilized by applying swing leg control. Here, linear adaptations of the three leg parameters, leg angle, leg length and leg stiffness during late swing phase are assumed. Experimentally observed kinematic control parameters (leg rotation and leg length change) of human and avian running are compared, and interpreted within the context of this model, with specific focus on stability and robustness characteristics. The results suggest differences in stability characteristics and applied control strategies of human and avian running, which may relate to differences in leg posture (straight leg posture in humans, and crouched leg posture in birds). It has been suggested that crouched leg postures may improve stability. However, as the system of control strategies is overdetermined, our model findings suggest that a crouched leg posture does not necessarily enhance running stability. The model also predicts different leg stiffness adaptation rates for human and avian running, and suggests that a crouched avian leg posture, which is capable of both leg shortening and lengthening, allows for stable running without adjusting leg stiffness. In contrast, in straight-legged human running, the preparation of the ground contact seems to be more critical, requiring leg stiffness adjustment to remain stable. Finally, analysis of a simple robustness measure, the normalized maximum drop, suggests that the crouched leg posture may provide greater robustness to changes in terrain height

Don't break a leg: running birds from quail to ostrich prioritise leg safety and economy on uneven terrain.

PubMed

Birn-Jeffery, Aleksandra V; Hubicki, Christian M; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W; Daley, Monica A

2014-11-01

Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force-length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force-length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. © 2014. Published by The Company of Biologists Ltd.

Don't break a leg: running birds from quail to ostrich prioritise leg safety and economy on uneven terrain

PubMed Central

Birn-Jeffery, Aleksandra V.; Hubicki, Christian M.; Blum, Yvonne; Renjewski, Daniel; Hurst, Jonathan W.; Daley, Monica A.

2014-01-01

Cursorial ground birds are paragons of bipedal running that span a 500-fold mass range from quail to ostrich. Here we investigate the task-level control priorities of cursorial birds by analysing how they negotiate single-step obstacles that create a conflict between body stability (attenuating deviations in body motion) and consistent leg force–length dynamics (for economy and leg safety). We also test the hypothesis that control priorities shift between body stability and leg safety with increasing body size, reflecting use of active control to overcome size-related challenges. Weight-support demands lead to a shift towards straighter legs and stiffer steady gait with increasing body size, but it remains unknown whether non-steady locomotor priorities diverge with size. We found that all measured species used a consistent obstacle negotiation strategy, involving unsteady body dynamics to minimise fluctuations in leg posture and loading across multiple steps, not directly prioritising body stability. Peak leg forces remained remarkably consistent across obstacle terrain, within 0.35 body weights of level running for obstacle heights from 0.1 to 0.5 times leg length. All species used similar stance leg actuation patterns, involving asymmetric force–length trajectories and posture-dependent actuation to add or remove energy depending on landing conditions. We present a simple stance leg model that explains key features of avian bipedal locomotion, and suggests economy as a key priority on both level and uneven terrain. We suggest that running ground birds target the closely coupled priorities of economy and leg safety as the direct imperatives of control, with adequate stability achieved through appropriately tuned intrinsic dynamics. PMID:25355848

Effects of myofascial release leg pull and sagittal plane isometric contract-relax techniques on passive straight-leg raise angle.

PubMed

Hanten, W P; Chandler, S D

1994-09-01

Experimental evidence does not currently exist to support the claims of clinical effectiveness for myofascial release techniques. This presents an obvious need to document the effects of myofascial release. The purpose of this study was to compare the effects of two techniques, sagittal plane isometric contract-relax and myofascial release leg pull for increasing hip flexion range of motion (ROM) as measured by the angle of passive straight-leg raise. Seventy-five nondisabled, female subjects 18-29 years of age were randomly assigned to contract-relax, leg pull, or control groups. Pretest hip flexion ROM was measured for each subject's right hip with a passive straight-leg raise test using a fluid-filled goniometer. Subjects in the treatment groups received either contract-relax or leg pull treatment applied to the right lower extremity; subjects in the control group remained supine quietly for 5 minutes. Following treatment, posttest straight-leg raise measurements were performed. A one-way analysis of variance followed by a Newman-Keuls post hoc comparison of mean gain scores showed that subjects receiving contract-relax treatment increased their ROM significantly more than those who received leg pull treatment, and the increase in ROM of subjects in both treatment groups was significantly higher than those of the control group. The results suggest that while both contract-relax and leg pull techniques can significantly increase hip flexion ROM in normal subjects, contract-relax treatment may be more effective and efficient than leg pull treatment.

[Replantation at lower leg level].

PubMed

Daigeler, A; Fansa, H; Westphal, T; Schneider, W

2003-11-01

Replantation in reconstructive surgery is an established procedure due to microsurgical techniques. It can be routinely performed in unilateral lower leg amputation. In some cases of bilateral amputation, in which orthotopic replantation is not possible due to the complex trauma, heterotopic replantation is a therapeutic option. This avoids prosthetic fitting. We report five cases of orthotopic and two of heterotopic lower limb replantations. Functional outcome concerning sensibility, mobility, pain, and aesthetic result were assessed clinically and using a questionnaire. Functional outcome and patient satisfaction were good. The psychological situation of the patients as well as mobility and stability of the replanted limbs were satisfying. Heterotopically replanted patients found the replanted legs superior to the prostheses. We conclude that, in lower leg amputation, attempts should be made to replant the extremity. In bilateral lower leg amputations, at least one limb should be reconstructed, even if "only" a heterotopic replantation can be performed.

Ratio of Trunk to Leg Volume as a New Body Shape Metric for Diabetes and Mortality

PubMed Central

Wilson, Joseph P.; Kanaya, Alka M.; Fan, Bo; Shepherd, John A.

2013-01-01

Background Body shape is a known risk factor for diabetes and mortality, but the methods estimating body shape, BMI and waist circumference are crude. We determined whether a novel body shape measure, trunk to leg volume ratio, was independently associated with diabetes and mortality. Methods Data from the National Health and Nutritional Examination Survey 1999–2004, a study representative of the US population, were used to generate dual-energy X-ray absorptiometry-derived trunk to leg volume ratio and determine its associations to diabetes, metabolic covariates, and mortality by BMI category, gender, and race/ethnicity group. Results The prevalence of pre-diabetes and diabetes increased with age, BMI, triglycerides, blood pressure, and decreased HDL level. After adjusting for covariates, the corresponding fourth to first quartile trunk to leg volume ratio odds ratios (OR) were 6.8 (95% confidence interval [CI], 4.9–9.6) for diabetes, 3.9 (95% CI, 3.0–5.2) for high triglycerides, 1.8 (95% CI, 1.6–2.1) for high blood pressure, 3.0 (95% CI, 2.4–3.8) for low HDL, 3.6 (95% CI, 2.8–4.7) for metabolic syndrome, and 1.76 (95% CI, 1.20–2.60) for mortality. Additionally, trunk to leg volume ratio was the strongest independent measure associated with diabetes (P<0.001), even after adjusting for BMI and waist circumference. Even among those with normal BMI, those in the highest quartile of trunk to leg volume ratio had a higher likelihood of death (5.5%) than those in the lowest quartile (0.2%). Overall, trunk to leg volume ratio is driven by competing mechanisms of changing adiposity and lean mass. Conclusions A high ratio of trunk to leg volume showed a strong association to diabetes and mortality that was independent of total and regional fat distributions. This novel body shape measure provides additional information regarding central adiposity and appendicular wasting to better stratify individuals at risk for diabetes and mortality, even among those with

Leg stiffness and expertise in men jumping.

PubMed

Laffaye, Guillaume; Bardy, Benoît G; Durey, Alain

2005-04-01

The aim of the present study is to investigate: a) the leg spring behavior in the one-leg vertical jump, b) the contribution of impulse parameters to this behavior, and c) the effect of jumping expertise on leg stiffness. Four categories of experts (handball, basketball, volleyball players, and Fosbury athletes), as well as novice subjects performed a run-and-jump test to touch a ball with the head. Five experimental conditions were tested from 55 to 95% of the maximum jump height. Kinematic and kinetic data were collected using six cameras and a force plate. The mechanical behavior of the musculoskeleton component of the human body can be modeled as a simple mass-spring system, from which leg stiffness values can be extracted to better understand energy transfer during running or jumping. The results indicate that leg stiffness (mean value of 11.5 kN.m) decreased with jumping height. Leg shortening at takeoff also increased with jumping height, whereas contact time decreased (-18%). No difference was found between experts and novices for leg stiffness. However, a principal components analysis (PCA) indicated the contribution of two main factors to the performance. The first factor emerged out of vertical force, stiffness, and duration of impulse. The second factor included leg shortening and jumping height. Differences between experts and novices were observed in terms of the contribution of leg stiffness to jump height, and more importantly, clear differences existed between experts in jumping parameters. The analysis performed on the sport categories indeed revealed different jumping profiles, characterized by specific, sport-related impulse parameters.

Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry

PubMed Central

Knutson, Gary A

2005-01-01

Background Part II of this review examines the functional "short leg" or unloaded leg length alignment asymmetry, including the relationship between an anatomic and functional leg-length inequality. Based on the reviewed evidence, an outline for clinical decision making regarding functional and anatomic leg-length inequality will be provided. Methods Online databases: Medline, CINAHL and Mantis. Plus library searches for the time frame of 1970–2005 were done using the term "leg-length inequality". Results and Discussion The evidence suggests that an unloaded leg-length asymmetry is a different phenomenon than an anatomic leg-length inequality, and may be due to suprapelvic muscle hypertonicity. Anatomic leg-length inequality and unloaded functional or leg-length alignment asymmetry may interact in a loaded (standing) posture, but not in an unloaded (prone/supine) posture. Conclusion The unloaded, functional leg-length alignment asymmetry is a likely phenomenon, although more research regarding reliability of the measurement procedure and validity relative to spinal dysfunction is needed. Functional leg-length alignment asymmetry should be eliminated before any necessary treatment of anatomic LLI. PMID:16080787

INTRA-RATER RELIABILITY OF THE MULTIPLE SINGLE-LEG HOP-STABILIZATION TEST AND RELATIONSHIPS WITH AGE, LEG DOMINANCE AND TRAINING.

PubMed

Sawle, Leanne; Freeman, Jennifer; Marsden, Jonathan

2017-04-01

Balance is a complex construct, affected by multiple components such as strength and co-ordination. However, whilst assessing an athlete's dynamic balance is an important part of clinical examination, there is no gold standard measure. The multiple single-leg hop-stabilization test is a functional test which may offer a method of evaluating the dynamic attributes of balance, but it needs to show adequate intra-tester reliability. The purpose of this study was to assess the intra-rater reliability of a dynamic balance test, the multiple single-leg hop-stabilization test on the dominant and non-dominant legs. Intra-rater reliability study. Fifteen active participants were tested twice with a 10-minute break between tests. The outcome measure was the multiple single-leg hop-stabilization test score, based on a clinically assessed numerical scoring system. Results were analysed using an Intraclass Correlations Coefficient (ICC 2,1 ) and Bland-Altman plots. Regression analyses explored relationships between test scores, leg dominance, age and training (an alpha level of p = 0.05 was selected). ICCs for intra-rater reliability were 0.85 for the dominant and non-dominant legs (confidence intervals = 0.62-0.95 and 0.61-0.95 respectively). Bland-Altman plots showed scores within two standard deviations. A significant correlation was observed between the dominant and non-dominant leg on balance scores (R 2 =0.49, p<0.05), and better balance was associated with younger participants in their non-dominant leg (R 2 =0.28, p<0.05) and their dominant leg (R 2 =0.39, p<0.05), and a higher number of hours spent training for the non-dominant leg R 2 =0.37, p<0.05). The multiple single-leg hop-stabilisation test demonstrated strong intra-tester reliability with active participants. Younger participants who trained more, have better balance scores. This test may be a useful measure for evaluating the dynamic attributes of balance. 3.

Compartment syndrome after tibial plateau fracture☆

PubMed Central

Pitta, Guilherme Benjamin Brandão; dos Santos, Thays Fernanda Avelino; dos Santos, Fernanda Thaysa Avelino; da Costa Filho, Edelson Moreira

2014-01-01

Fractures of the tibial plateau are relatively rare, representing around 1.2% of all fractures. The tibia, due to its subcutaneous location and poor muscle coverage, is exposed and suffers large numbers of traumas, not only fractures, but also crush injuries and severe bruising, among others, which at any given moment, could lead compartment syndrome in the patient. The case is reported of a 58-year-old patient who, following a tibial plateau fracture, presented compartment syndrome of the leg and was submitted to decompressive fasciotomy of the four right compartments. After osteosynthesis with internal fixation of the tibial plateau using an L-plate, the patient again developed compartment syndrome. PMID:26229779

Nephrotic syndrome and Guillan-Barré Syndrome: a rare association in child.

PubMed

Bouyahia, Olfa; Khelifi, Ibtissem; Gharsallah, Lamia; Harzallah, Kais; Mrad, Sonia Mazigh; Ghargah, Tahar; Boukthir, Samir; Azza, Sammoud El Gharbi

2010-01-01

Only few cases of nephrotic syndrome associated with Guillain-Barre Syndrome (GBS) have been reported in the adult and pediatric literature. A 3-year-old boy was initially admitted to our hospital following five days of progressive weakness of his extremities, fatigue, right leg pain and numbness. There was no past history of renal or neurological disease. Cerebro-spinal fluid studies showed a protein level of 92 mg/dL and a white cell count of 1 per high-power field. The diagnosis of GBS was verified with a nerve conduction velocity test as well as. The GBS symptoms improved gradually on intravenous immunoglobulin. Three weeks later, he developed severe proteinuria and edema; laboratory investigation showed nephrotic syndrome which responded to steroid therapy. Renal biopsy showed minimal change glomerulonephritis. He remained free of proteinuria during his 20 months of follow-up.

Antiphospholipid antibody syndrome complicated by Grave's disease.

PubMed

Takahashi, Ayumi; Tamura, Atsushi; Ishikawa, Osamu

2002-12-01

The report describes a woman with primary antiphospholipid antibody syndrome complicated with Grave's disease. Developing symptoms included a small cutaneous nodule on her finger and subsequently ecchymotic purpura on the cheeks, ears, buttocks and lower legs. Histological examinations showed thrombosed vessels in the dermis without or with hemorrhage, respectively. Laboratory investigation revealed positive lupus anticoagulant and immunogenic hyperthyroidism due to Grave's disease. There is a close relationship between the cutaneous manifestation of antiphospholipid antibody syndrome and the activities of Grave's disease and a possible link of antiphospholipid antibody syndrome with Grave's disease was suggested both by the etiology of the disease as well as the disease activity.

Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll.

PubMed

Chasens, Eileen R; Twerski, Sarah R; Yang, Kyeongra; Umlauf, Mary Grace

2010-01-01

The 2007 Sleep in America poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchical regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.

Critical review of ropinirole and pramipexole - putative dopamine D(3)-receptor selective agonists - for the treatment of RLS.

PubMed

Varga, L I; Ako-Agugua, N; Colasante, J; Hertweck, L; Houser, T; Smith, J; Watty, A A; Nagar, S; Raffa, R B

2009-10-01

Ropinirole hydrochloride (REQUIP, ADARTREL) and pramipexole dihydrochloride (MIRAPEX, SIFROL) are two putative dopamine D(3) receptor subtype-selective agonists recently approved by the FDA for the treatment of 'restless legs syndrome' (RLS). RLS is a difficult to define condition that is possibly more prevalent than previously thought. Direct-to-consumer advertising has raised public and professional awareness of RLS, but questions, even skepticism about the very existence of the condition, persist. The drugs have adverse effects that can negatively impact on quality of life and thus, as true for all drugs, require consideration of the benefit : risk ratio. We review the definition, diagnostic criteria, pathophysiology, and treatment of RLS, and assess the clinical and preclinical evidence for a pharmacologic rationale for D(3) agonism in general and of the claimed D(3) selectivity of ropinirole and pramipexole in particular.

Genetics of Sleep and Sleep disorders

PubMed Central

Sehgal, Amita; Mignot, Emmanuel

2011-01-01

Sleep remains one of the least understood phenomena in biology – even its role in synaptic plasticity remains debatable. Since sleep was recognized to be regulated genetically, intense research has launched on two fronts: the development of model organisms for deciphering the molecular mechanisms of sleep and attempts to identify genetic underpinnings of human sleep disorders. In this Review, we describe how unbiased, high-throughput screens in model organisms are uncovering sleep regulatory mechanisms and how pathways, such as the circadian clock network and specific neurotransmitter signals, have conserved effects on sleep from Drosophila to humans. At the same time, genome-wide association (GWA) studies have uncovered ~14 loci increasing susceptibility to sleep disorders, such as narcolepsy and restless leg syndrome. To conclude, we discuss how these different strategies will be critical to unambiguously defining the function of sleep. PMID:21784243

Broken Leg

MedlinePlus

... devices into the broken bone to maintain proper alignment during healing. Other injuries may be treated with ... that extend into the joint and poor bone alignment can cause osteoarthritis years later. If your leg ...

Bruxism in Movement Disorders: A Comprehensive Review.

PubMed

Ella, Bruno; Ghorayeb, Imad; Burbaud, Pierre; Guehl, Dominique

2017-10-01

Bruxism is an abnormal repetitive movement disorder characterized by jaw clenching and tooth gnashing or grinding. It is classified into two overlapping types: awake bruxism (AB) and sleep bruxism (SB). Theories on factors causing bruxism are a matter of controversy, but a line of evidence suggests that it may to some extent be linked to basal ganglia dysfunction although so far, this topic has received little attention. The purpose of this article was to review cases of bruxism reported in various movement disorders. The biomedical literature was searched for publications reporting the association of bruxism with various types of movement disorders. As a whole, very few series were found, and most papers corresponded to clinical reports. In Parkinsonian syndromes, AB was rarely reported, but seems to be exacerbated by medical treatment, whereas SB is mainly observed during non-REM sleep, as in restless leg syndrome. AB is occasionally reported in Huntington's disease, primary dystonia, and secondary dystonia; however, its highest incidence and severity is reported in syndromes combining stereotypies and cognitive impairment, such as Rett's syndrome (97%), Down syndrome (42%), and autistic spectrum disorders (32%). Taken as a whole, AB seems to be more frequent in hyperkinetic movement disorders, notably those with stereotypies, and is influenced by anxiety, suggesting an involvement of the limbic part of the basal ganglia in its pathophysiology. © 2016 by the American College of Prosthodontists.

Disseminated viridians streptococcus (Streptococcus mitis) infection presenting with toxic shock-like syndrome.

PubMed

Intalapaporn, Poj; Wongcharoen, Sunee; Chinapha, Anongnart; Jariyasethpong, Tavatchai

2013-03-01

The authors report a case of a 35-year-old man with no known underlying disease who presented with fever, cellulitis with hemorrhagic blebs on the left leg, monoarthricular left knee arthritis, multiple organ failure and septic shock. His clinical syndrome was compatible with toxic shock syndrome and his blood grew alpha hemolytic (viridians) Streptococcus mitis. To our knowledge, there are few reported cases of toxic shock syndrome cause by Streptococcus mitis in immune-competent adults.

Severe, childhood-onset, idiopathic, life-long insomnia responding selectively to opiate therapy: case report with 19 year follow-up.

PubMed

Schenck, C H; Mahowald, M W

2001-11-01

Idiopathic (primary) insomnia can be difficult to treat; only two prior cases responsive to opiate therapy have been reported. A case is now presented of severe, idiopathic, childhood-onset, familial insomnia, with increased libido, absence of psychopathology, tardive emergence of restless legs syndrome (RLS), and selective response to opiate therapy. A 39-year-old woman was referred in 1981 by her physician who had discovered 3 years earlier that propoxyphene treatment of migraines also controlled her chronic insomnia. She had experienced severe insomnia since childhood, and during early adulthood the insomnia intensified, as she would sleep 0-3 h nightly and never napped. Daily generalized motor restlessness resulted in her frequently walking around the house while feeling exhausted. The quality of her life was considerably compromised by her insomnia, motor restlessness, and by an increased libido that was present since puberty and that was only partially relieved by having sex repeatedly with her husband. Nightly opiate therapy for 19 years has controlled the insomnia, motor restlessness, and excessive libido without affecting her normal libido. The insomnia had not responded to treatment with >25 agents covering >10 pharmacologic categories. During her first (unmedicated) polysomnographic (PSG) study in 1981, she slept 0 min while spending 436 min in bed. In 1984, four consecutive PSG studies were conducted in a design that confirmed the efficacy of propoxyphene therapy of her insomnia. In 1990, an ambulatory PSG revealed two runs of EEG rhythmic paroxysmal activity arising from sleep and wakefulness, without clinical correlate. Neurologic history was negative for seizures, but positive for complete right carotid artery occlusion and three transient ischemic attacks. At age 55 years, typical RLS emerged that was controlled with levodopa therapy, and a concurrent relapse of insomnia was controlled with oxycodone replacing propoxyphene. Nightly opiate therapy of

Evaluation of arm-leg coordination in flat breaststroke.

PubMed

Chollet, D; Seifert, L; Leblanc, H; Boulesteix, L; Carter, M

2004-10-01

This study proposes a new method to evaluate arm-leg coordination in flat breaststroke. Five arm and leg stroke phases were defined with a velocity-video system. Five time gaps quantified the time between arm and leg actions during three paces of a race (200 m, 100 m and 50 m) in 16 top level swimmers. Based on these time gaps, effective glide, effective propulsion, effective leg insweep and effective recovery were used to identify the different stroke phases of the body. A faster pace corresponded to increased stroke rate, decreased stroke length, increased propulsive phases, shorter glide phases, and a shorter T1 time gap, which measured the effective body glide. The top level swimmers showed short time gaps (T2, T3, T4, measuring the timing of arm-leg recoveries), which reflected the continuity in arm and leg actions. The measurement of these time gaps thus provides a pertinent evaluation of swimmers' skill in adapting their arm-leg coordination to biomechanical constraints.

Modulation of corticospinal input to the legs by arm and leg cycling in people with incomplete spinal cord injury.

PubMed

Zhou, R; Alvarado, L; Kim, S; Chong, S L; Mushahwar, V K

2017-10-01

The spinal cervico-lumbar interaction during rhythmic movements in humans has recently been studied; however, the role of arm movements in modulating the corticospinal drive to the legs is not well understood. The goals of this study were to investigate the effect of active rhythmic arm movements on the corticospinal drive to the legs ( study 1 ) and assess the effect of simultaneous arm and leg training on the corticospinal pathway after incomplete spinal cord injury (iSCI) ( study 2). In study 1 , neurologically intact (NI) participants or participants with iSCI performed combinations of stationary and rhythmic cycling of the arms and legs while motor evoked potentials (MEPs) were recorded from the vastus lateralis (VL) muscle. In the NI group, arm cycling alone could facilitate the VL MEP amplitude, suggesting that dynamic arm movements strongly modulate the corticospinal pathway to the legs. No significant difference in VL MEP between conditions was found in participants with iSCI. In study 2 , participants with iSCI underwent 12 wk of electrical stimulation-assisted cycling training: one group performed simultaneous arm and leg (A&L) cycling and the other legs-only cycling. MEPs in the tibialis anterior (TA) muscle were compared before and after training. After training, only the A&L group had a significantly larger TA MEP, suggesting increased excitability in the corticospinal pathway. The findings demonstrate the importance of arm movements in modulating the corticospinal drive to the legs and suggest that active engagement of the arms in lower limb rehabilitation may produce better neural regulation and restoration of function. NEW & NOTEWORTHY This study aimed to demonstrate the importance of arm movements in modulating the corticospinal drive to the legs. It provides direct evidence in humans that active movement of the arms could facilitate corticospinal transmission to the legs and, for the first time, shows that facilitation is absent after spinal cord

Self-Reported Sleep Bruxism and Nocturnal Gastroesophageal Reflux Disease in Patients with Obstructive Sleep Apnea: Relationship to Gender and Ethnicity§

PubMed Central

Hesselbacher, Sean; Subramanian, Shyam; Rao, Shweta; Casturi, Lata; Surani, Salim

2014-01-01

Study Objectives : Nocturnal bruxism is associated with gastroesophageal reflux disease (GERD), and GERD is strongly associated with obstructive sleep apnea (OSA). Gender and ethnic differences in the prevalence and clinical presentation of these often overlapping sleep disorders have not been well documented. Our aim was to examine the associations between, and the symptoms associated with, nocturnal GERD and sleep bruxism in patients with OSA, and to examine the influence of gender and ethnicity. Methods : A retrospective chart review was performed of patients diagnosed with OSA at an academic sleep center. The patients completed a sleep questionnaire prior to undergoing polysomnography. Patients with confirmed OSA were evaluated based on gender and ethnicity. Associations were determined between sleep bruxism and nocturnal GERD, and daytime sleepiness, insomnia, restless legs symptoms, and markers of OSA severity in each group. Results : In these patients with OSA, the prevalence of nocturnal GERD (35%) and sleep bruxism (26%) were higher than the general population. Sleep bruxism was more common in Caucasians than in African Americans or Hispanics; there was no gender difference. Nocturnal GERD was similar among all gender and ethnic groups. Bruxism was associated with nocturnal GERD in females, restless legs symptoms in all subjects and in males, sleepiness in African Americans, and insomnia in Hispanics. Nocturnal GERD was associated with sleepiness in males and African Americans, insomnia in females, and restless legs symptoms in females and in Caucasians. Conclusion : Patients with OSA commonly have comorbid sleep bruxism and nocturnal GERD, which may require separate treatment. Providers should be aware of differences in clinical presentation among different ethnic and gender groups. PMID:25352924

Dynamic leg length asymmetry during gait is not a valid method for estimating mild anatomic leg length discrepancy.

PubMed

Leporace, Gustavo; Batista, Luiz Alberto; Serra Cruz, Raphael; Zeitoune, Gabriel; Cavalin, Gabriel Armondi; Metsavaht, Leonardo

2018-03-01

The purpose of this study was to test the validity of dynamic leg length discrepancy (DLLD) during gait as a radiation-free screening method for measuring anatomic leg length discrepancy (ALLD). Thirty-three subjects with mild leg length discrepancy walked along a walkway and the dynamic leg length discrepancy (DLLD) was calculated using a motion analysis system. Pearson correlation and paired Student t -tests were applied to calculate the correlation and compare the differences between DLLD and ALLD (α = 0.05). The results of our study showed DLLD is not a valid method to predict ALLD in subjects with mild limb discrepancy.

Leg stiffness and stride frequency in human running.

PubMed

Farley, C T; González, O

1996-02-01

When humans and other mammals run, the body's complex system of muscle, tendon and ligament springs behaves like a single linear spring ('leg spring'). A simple spring-mass model, consisting of a single linear leg spring and a mass equivalent to the animal's mass, has been shown to describe the mechanics of running remarkably well. Force platform measurements from running animals, including humans, have shown that the stiffness of the leg spring remains nearly the same at all speeds and that the spring-mass system is adjusted for higher speeds by increasing the angle swept by the leg spring. The goal of the present study is to determine the relative importance of changes to the leg spring stiffness and the angle swept by the leg spring when humans alter their stride frequency at a given running speed. Human subjects ran on treadmill-mounted force platform at 2.5ms-1 while using a range of stride frequencies from 26% below to 36% above the preferred stride frequency. Force platform measurements revealed that the stiffness of the leg spring increased by 2.3-fold from 7.0 to 16.3 kNm-1 between the lowest and highest stride frequencies. The angle swept by the leg spring decreased at higher stride frequencies, partially offsetting the effect of the increased leg spring stiffness on the mechanical behavior of the spring-mass system. We conclude that the most important adjustment to the body's spring system to accommodate higher stride frequencies is that leg spring becomes stiffer.

Protection against high intravascular pressure in giraffe legs.

PubMed

Petersen, Karin K; Hørlyck, Arne; Ostergaard, Kristine H; Andresen, Joergen; Broegger, Torbjoern; Skovgaard, Nini; Telinius, Niklas; Laher, Ismael; Bertelsen, Mads F; Grøndahl, Carsten; Smerup, Morten; Secher, Niels H; Brøndum, Emil; Hasenkam, John M; Wang, Tobias; Baandrup, Ulrik; Aalkjaer, Christian

2013-11-01

The high blood pressure in giraffe leg arteries renders giraffes vulnerable to edema. We investigated in 11 giraffes whether large and small arteries in the legs and the tight fascia protect leg capillaries. Ultrasound imaging of foreleg arteries in anesthetized giraffes and ex vivo examination revealed abrupt thickening of the arterial wall and a reduction of its internal diameter just below the elbow. At and distal to this narrowing, the artery constricted spontaneously and in response to norepinephrine and intravascular pressure recordings revealed a dynamic, viscous pressure drop along the artery. Histology of the isolated median artery confirmed dense sympathetic innervation at the narrowing. Structure and contractility of small arteries from muscular beds in the leg and neck were compared. The arteries from the legs demonstrated an increased media thickness-to-lumen diameter ratio, increased media volume, and increased numbers of smooth muscle cells per segment length and furthermore, they contracted more strongly than arteries from the neck (500 ± 49 vs. 318 ± 43 mmHg; n = 6 legs and neck, respectively). Finally, the transient increase in interstitial fluid pressure following injection of saline was 5.5 ± 1.7 times larger (n = 8) in the leg than in the neck. We conclude that 1) tissue compliance in the legs is low; 2) large arteries of the legs function as resistance arteries; and 3) structural adaptation of small muscle arteries allows them to develop an extraordinary tension. All three findings can contribute to protection of the capillaries in giraffe legs from a high arterial pressure.

Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome.

PubMed

Saeki, J; Nakamura, M; Nakao, S; Fujita, K; Yanase, K; Ichihashi, N

2018-01-01

Previous history of medial tibial stress syndrome (MTSS) is a risk factor for MTSS relapse, which suggests that there might be some physical factors that are related to MTSS development in runners with a history of MTSS. The relationship between MTSS and muscle stiffness can be assessed in a cross-sectional study that measures muscle stiffness in subjects with a history of MTSS, who do not have pain at the time of measurement, and in those without a history of MTSS. The purpose of this study was to compare the shear elastic modulus, which is an index of muscle stiffness, of all posterior lower leg muscles of subjects with a history of MTSS and those with no history and investigate which muscles could be related to MTSS. Twenty-four male collegiate runners (age, 20.0±1.7 years; height, 172.7±4.8 cm; weight, 57.3±3.7 kg) participated in this study; 14 had a history of MTSS, and 10 did not. The shear elastic moduli of the lateral gastrocnemius, medial gastrocnemius, soleus, peroneus longus, peroneus brevis, flexor hallucis longus, flexor digitorum longus, and tibialis posterior were measured using shear wave elastography. The shear elastic moduli of the flexor digitorum longus and tibialis posterior were significantly higher in subjects with a history of MTSS than in those with no history. However, there was no significant difference in the shear elastic moduli of other muscles. The results of this study suggest that flexor digitorum longus and tibialis posterior stiffness could be related to MTSS. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Spanish Translation and Cross-Language Validation of a Sleep Habits Questionnaire for Use in Clinical and Research Settings

PubMed Central

Baldwin, Carol M.; Choi, Myunghan; McClain, Darya Bonds; Celaya, Alma; Quan, Stuart F.

2012-01-01

Study Objectives: To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings. Methods: Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated. Results: All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively. Conclusions: The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples. Citation: Baldwin CM

Nephrotic syndrome presenting as deep vein thrombosis or pulmonary embolism.

PubMed

Ambler, Bill; Irvine, Sharon; Selvarajah, Vik; Isles, Chris

2008-04-01

A patient presenting with a swollen left leg and pleuritic chest pain was shown to have deep vein thrombosis (DVT) by Doppler studies. He was anticoagulated but required two further admissions with swelling of both legs before a diagnosis of nephrotic syndrome was considered and confirmed. Renal biopsy showed that this was caused by membranous nephropathy. Two audits were subsequently conducted. The first was of diagnostic discharge codes for nephrotic syndrome and venous thromboembolism in south west Scotland (population 147,000) from 1997 to 2006. A diagnosis of nephrotic syndrome was confirmed in 32 patients, four (12.5%) of whom (including the index case) had presented with DVT (two) or pulmonary embolus (PE) (two). A second audit of 98 consecutive patients with Doppler-positive lower limb DVT presenting to A&E in Dumfries from July 2005 to July 2006 showed that the urine had been tested for protein in one case only. Although nephrotic syndrome remains an uncommon cause of DVT or PE, it is complicated by venous thromboembolism sufficiently frequently for the diagnosis to be considered in all patients with DVT or PE, for whom the take-home message should simply be-Don't forget to dip the urine or ignore a low serum albumin.

The Restless Universe - Understanding X-Ray Astronomy in the Age of Chandra and Newton

NASA Astrophysics Data System (ADS)

Schlegel, Eric M.

2002-10-01

Carl Sagan once noted that there is only one generation that gets to see things for the first time. We are in the midst of such a time right now, standing on the threshold of discovery in the young and remarkable field of X-ray astronomy. In The Restless Universe , astronomer Eric Schlegel offers readers an informative survey of this cutting-edge science. Two major space observatories launched in the last few years--NASA's Chandra and the European Newton --are now orbiting the Earth, sending back a gold mine of data on the X-ray universe. Schlegel, who has worked on the Chandra project for seven years, describes the building and launching of this space-based X-ray observatory. But the book goes far beyond the story of Chandra . What Schlegel provides here is the background a nonscientist would need to grasp the present and follow the future of X-ray astronomy. He looks at the relatively brief history of the field, the hardware used to detect X-rays, the satellites--past, present, and future--that have been or will be flown to collect the data, the way astronomers interpret this data, and, perhaps most important, the insights we have already learned as well as speculations about what we may soon discover. And throughout the book, Schlegel conveys the excitement of looking at the universe from the perspective brought by these new observatories and the sharper view they deliver. Drawing on observations obtained from Chandra, Newton , and previous X-ray observatories, The Restless Universe gives a first look at an exciting field which significantly enriches our understanding of the universe.

A new leg voxel model in two different positions for simulation of the non-uniform distribution of (241)Am in leg bones.

PubMed

Khalaf, Majid; Brey, Richard R; Meldrum, Jeff

2013-01-01

A new leg voxel model in two different positions (straight and bent) has been developed for in vivo measurement calibration purposes. This voxel phantom is a representation of a human leg that may provide a substantial enhancement to Monte Carlo modeling because it more accurately models different geometric leg positions and the non-uniform distribution of Am throughout the leg bones instead of assuming a one-position geometry and a uniform distribution of radionuclides. This was accomplished by performing a radiochemical analysis on small sections of the leg bones from the U.S. Transuranium and Uranium Registries (USTUR) case 0846. USTUR case 0846 represents an individual who was repeatedly contaminated by Am via chronic inhalation. To construct the voxel model, high resolution (2 mm) computed tomography (CT) images of the USTUR case 0846 leg were obtained in different positions. Thirty-six (36) objects (universes) were segmented manually from the CT images using 3D-Doctor software. Bones were divided into 30 small sections with an assigned weight exactly equal to the weight of bone sections obtained from radiochemical analysis of the USTUR case 0846 leg. The segmented images were then converted into a boundary file, and the Human Monitoring Laboratory (HML) voxelizer was used to convert the boundary file into the leg voxel phantom. Excluding the surrounding air regions, the straight leg phantom consists of 592,023 voxels, while the bent leg consists of 337,567 voxels. The resulting leg voxel model is now ready for use as an MCNPX input file to simulate in vivo measurement of bone-seeking radionuclides.

Proteus syndrome: a case report.

PubMed

Pangkanon, S; Limpongsanurak, W; Sangtawesin, V

2001-05-01

Proteus syndrome is a rare genetic disorder, characterized by partial gigantism of the hands and/or feet, asymmetry of the limbs, plantar hyperplasia, multiple hamartomatous subcutaneous tumors, hyperostoses, and long bone overgrowth. A one day old Thai male infant is reported with macrosomia, hemihypertrophy of the left side of the face and left leg, large feet, macrodactyly of toes, plantar hyperplasia, large subcutaneous mass with a violet-red surface over the left side of the chest wall and a large port-wine stain involving the lateral aspect of the right chest wall. The clinical findings, diagnostic criteria, differential diagnosis, and management of the Proteus syndrome are reviewed.

Ocean Drilling Program: Completed Legs

Science.gov Websites

. Austin Leg summary Repository Wolfgang Schlager 102 14-Mar-85 25-Apr-85 Miami, Florida 418 Bermuda Rise Lisbon, Portugal 902-906 New Jersey Sea-Level Transect Peter Blum Gregory Mountain Leg summary Repository , Nova Scotia 1071-1073 Continuing the New Jersey Sea-Level Transect Mitchell J. Malone James A. Austin

RELAP5 Analyses of OECD/NEA ROSA-2 Project Experiments on Intermediate-Break LOCAs at Hot Leg or Cold Leg

NASA Astrophysics Data System (ADS)

Takeda, Takeshi; Maruyama, Yu; Watanabe, Tadashi; Nakamura, Hideo

Experiments simulating PWR intermediate-break loss-of-coolant accidents (IBLOCAs) with 17% break at hot leg or cold leg were conducted in OECD/NEA ROSA-2 Project using the Large Scale Test Facility (LSTF). In the hot leg IBLOCA test, core uncovery started simultaneously with liquid level drop in crossover leg downflow-side before loop seal clearing (LSC) induced by steam condensation on accumulator coolant injected into cold leg. Water remained on upper core plate in upper plenum due to counter-current flow limiting (CCFL) because of significant upward steam flow from the core. In the cold leg IBLOCA test, core dryout took place due to rapid liquid level drop in the core before LSC. Liquid was accumulated in upper plenum, steam generator (SG) U-tube upflow-side and SG inlet plenum before the LSC due to CCFL by high velocity vapor flow, causing enhanced decrease in the core liquid level. The RELAP5/MOD3.2.1.2 post-test analyses of the two LSTF experiments were performed employing critical flow model in the code with a discharge coefficient of 1.0. In the hot leg IBLOCA case, cladding surface temperature of simulated fuel rods was underpredicted due to overprediction of core liquid level after the core uncovery. In the cold leg IBLOCA case, the cladding surface temperature was underpredicted too due to later core uncovery than in the experiment. These may suggest that the code has remaining problems in proper prediction of primary coolant distribution.

Shaggy aorta syndrome after acute arterial macroembolism: report of a case.

PubMed

Hayashida, Naoki; Murayama, Hirokazu; Pearce, Yoko; Asano, Souichi; Ohashi, Yukio; Kohno, Hiroki; Handa, Takemi; Matsuo, Kozo; Nakagawa, Yasutsugu; Tatsuno, Katsuhiko

2004-01-01

We report the case of a patient who underwent treatment for a macroembolism in the right lower leg, which led to shaggy aorta syndrome. Anticoagulant therapy for the macroembolism and intra-aortic catheterization exacerbated the patient's renal function and triggered another massive microembolization of the visceral arteries, with a fatal outcome. To minimize the incremental complications inherent to this syndrome, awareness and prompt diagnosis with enhanced computed tomography or intravenous digital subtraction aortography are essential. Axillo-bifemoral bypass with bilateral external iliac artery ligations, performed with optimal timing, could save patients with shaggy aorta syndrome.

Famous people with Gilles de la Tourette syndrome?

PubMed

Monaco, Francesco; Servo, Serena; Cavanna, Andrea Eugenio

2009-12-01

Virtually no neurologist nor psychiatrist today can be unaware of the diagnosis of Gilles de la Tourette syndrome (GTS). Although the eponymous description by Dr. Georges Gilles de la Tourette was published in 1885, familiarity with this syndrome has been achieved only recently. In this article, the two most renown accounts of exceptional individuals retrospectively diagnosed with GTS are critically analyzed: British lexicographer Samuel Johnson and Austrian musician Wolfgang Amadeus Mozart. In both cases, clinical descriptions have been retrieved from written documents predating Gilles de la Tourette's original publication. The case for Samuel Johnson having GTS is strong, mainly based on Boswell's extensive biographical account. Johnson was reported to have a great range of tics and compulsions, including involuntary utterances, repetitive ejaculations, and echo-phenomena. On the other hand, there is circumstantial evidence that Mozart may have had hyperactivity, restlessness, sudden impulses, odd motor behaviors, echo/palilalia, love of nonsense words, and scatology, the latter being documented in autograph letters ("coprographia"). However, the evidence supporting the core features of GTS, i.e., motor and vocal tics, is rather inconsistent. Thus, GTS seems to be an implausible diagnosis in Mozart's medical history and completely unrelated to his undisputed musical genius.

Acne in Klinefelter Syndrome-46XY/47XXY Mosaicism?

PubMed

Lakshmi, Chembolli; Swarnalakshimi, Selvaraj

2015-01-01

Klinefelter syndrome (KFS) is the most common non-heritable sex chromosome anomaly caused by nondisjunction during cell division and contains two or more X chromosomes. More than two third of all cases are homogenous (47XXY) and the remaining are mosaic (46XY/47XXY). Lower limb ulcers are frequently observed and attributed to impaired fibrinolysis. A case of KFS with post acne scars and leg ulcers is presented. The rarity of acne in this syndrome is explained by the phenomenon of mosaicism.

Not letting the left leg know what the right leg is doing: limb-specific locomotor adaptation to sensory-cue conflict.

PubMed

Durgin, Frank H; Fox, Laura F; Hoon Kim, Dong

2003-11-01

We investigated the phenomenon of limb-specific locomotor adaptation in order to adjudicate between sensory-cue-conflict theory and motor-adaptation theory. The results were consistent with cue-conflict theory in demonstrating that two different leg-specific hopping aftereffects are modulated by the presence of conflicting estimates of self-motion from visual and nonvisual sources. Experiment 1 shows that leg-specific increases in forward drift during attempts to hop in place on one leg while blindfolded vary according to the relationship between visual information and motor activity during an adaptation to outdoor forward hopping. Experiment 2 shows that leg-specific changes in performance on a blindfolded hopping-to-target task are similarly modulated by the presence of cue conflict during adaptation to hopping on a treadmill. Experiment 3 shows that leg-specific aftereffects from hopping additionally produce inadvertent turning during running in place while blindfolded. The results of these experiments suggest that these leg-specific locomotor aftereffects are produced by sensory-cue conflict rather than simple motor adaptation.

Loading and performance of the support leg in kicking.

PubMed

Ball, Kevin

2013-09-01

The punt kick is important in many football codes and support leg kinematics and ground reaction forces have been implicated in injury and performance in kicking. To evaluate ground reaction forces and support leg kinematics in the punt kick. Cross sectional study. Seven elite Australian football players performed maximal kicks into a net using both the preferred and non-preferred legs. A force plate measured ground reaction forces and an optical motion capture system (200Hz) collected kinematic data during the stance phase of the kick. Preferred and non-preferred legs were compared and performance was evaluated by correlating parameters with foot speed at ball contact. Vertical forces were larger than running at a similar speed but did not reach levels that might be considered an injury risk. Braking forces were directed solely posteriorly, as for soccer kicks, but lateral force patterns varied with some players experiencing greater forces medially and others laterally. A more extended support leg, larger peak vertical and braking force during the stance phase and a shorter stance contact time was associated with larger kick leg foot speed at ball contact. No difference existed between the preferred and non-preferred legs for ground reaction forces or support leg mechanics. To punt kick longer, a straighter support leg, less time on the ground and stronger braking should be encouraged. Conditioning the support leg to provide stronger braking potential is recommended. Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Towards a Comparative Measure of Legged Agility

DTIC Science & Technology

2014-06-01

body movement with change of velocity or direction in response to a stimulus” [18]. Notwithstanding the many informative and inspiring studies of legged...specific power (watts per kilogram taken over a gait cycle of leg power output relative to leg muscle mass or body mass) [22, 26–28] but it is not scale...closest to the body mass normalized mea- sure we will introduce below. In contrast, characterizing directional aspects of agility performance seems

Motion of the center of mass in children with spastic hemiplegia: balance, energy transfer, and work performed by the affected leg vs. the unaffected leg.

PubMed

Feng, Jing; Pierce, Rosemary; Do, K Patrick; Aiona, Michael

2014-01-01

Asymmetry between limbs in people with spastic hemiplegic cerebral palsy (HEMI) adversely affects limb coordination and energy generation and consumption. This study compared how the affected leg and the unaffected leg of children with HEMI would differ based on which leg trails. Full-body gait analysis data and force-plate data were analyzed for 31 children (11.9 ± 3.8 years) with HEMI and 23 children (11.1 ± 3.1 years) with typical development (TD). Results showed that peak posterior center of mass-center of pressure (COM-COP) inclination angles of HEMI were smaller than TD when the affected leg trailed but not when the unaffected leg trailed. HEMI showed greater peak medial COM-COP inclination angles and wider step width than TD, no matter which leg trailed. More importantly, when the affected leg of HEMI trailed, it did not perform enough positive work during double support to propel COM motion. Consequently, the unaffected leg had to perform additional positive work during the early portion of single support, which costs more energy. When the unaffected leg trailed, the affected leg performed more negative work during double support; therefore, more positive work was still needed during early single support, but energy efficiency was closer to that of TD. Energy recovery factor was lower when the affected leg trailed than when the unaffected leg trailed; both were lower than TD. These findings suggest that the trailing leg plays a significant role in propelling COM motion during double support, and the 'unaffected' side of HEMI may not be completely unaffected. It is important to strengthen both legs. Copyright © 2013 Elsevier B.V. All rights reserved.

Parkinson's Disease and Sleep/Wake Disturbances

PubMed Central

Swick, Todd J.

2012-01-01

Parkinson's disease (PD) has traditionally been characterized by its cardinal motor symptoms of bradykinesia, rigidity, resting tremor, and postural instability. However, PD is increasingly being recognized as a multidimensional disease associated with myriad nonmotor symptoms including autonomic dysfunction, mood disorders, cognitive impairment, pain, gastrointestinal disturbance, impaired olfaction, psychosis, and sleep disorders. Sleep disturbances, which include sleep fragmentation, daytime somnolence, sleep-disordered breathing, restless legs syndrome (RLS), nightmares, and rapid eye movement (REM) sleep behavior disorder (RBD), are estimated to occur in 60% to 98% of patients with PD. For years nonmotor symptoms received little attention from clinicians and researchers, but now these symptoms are known to be significant predictors of morbidity in determining quality of life, costs of disease, and rates of institutionalization. A discussion of the clinical aspects, pathophysiology, evaluation techniques, and treatment options for the sleep disorders that are encountered with PD is presented. PMID:23326757

Unraveling the Neurobiology of Sleep and Sleep Disorders Using Drosophila.

PubMed

Chakravarti, L; Moscato, E H; Kayser, M S

2017-01-01

Sleep disorders in humans are increasingly appreciated to be not only widespread but also detrimental to multiple facets of physical and mental health. Recent work has begun to shed light on the mechanistic basis of sleep disorders like insomnia, restless legs syndrome, narcolepsy, and a host of others, but a more detailed genetic and molecular understanding of how sleep goes awry is lacking. Over the past 15 years, studies in Drosophila have yielded new insights into basic questions regarding sleep function and regulation. More recently, powerful genetic approaches in the fly have been applied toward studying primary human sleep disorders and other disease states associated with dysregulated sleep. In this review, we discuss the contribution of Drosophila to the landscape of sleep biology, examining not only fundamental advances in sleep neurobiology but also how flies have begun to inform pathological sleep states in humans. © 2017 Elsevier Inc. All rights reserved.

Sleep disorders in pregnancy

PubMed Central

Bourjeily, Ghada

2009-01-01

Sleep complaints are a common occurrence in pregnancy that are in part due to pregnancy-associated anatomic and physiological changes but may also be due to pathological causes. In the non-pregnant population, sleep deprivation has been associated with physical and cognitive issues; poor sleep may even be associated with adverse maternal outcomes. Maternal obesity, one of the most prevalent risk factors in obstetric practices, together with physiologic changes of pregnancy predispose to the development of sleep disordered breathing. Symptoms of sleep disordered breathing have also been associated with poor maternal outcomes. Management options of restless legs syndrome and narcolepsy pose a challenge in pregnancy; benefits of therapy need to be weighed against the potential harm to the fetus. This article briefly reviews the normal changes in pregnancy affecting sleep, gives an overview of certain sleep disorders occurring in pregnancy, and suggests management options specific for this population. PMID:27582822

Human hopping on damped surfaces: strategies for adjusting leg mechanics.

PubMed

Moritz, Chet T; Farley, Claire T

2003-08-22

Fast-moving legged animals bounce along the ground with spring-like legs and agilely traverse variable terrain. Previous research has shown that hopping and running humans maintain the same bouncing movement of the body's centre of mass on a range of elastic surfaces by adjusting their spring-like legs to exactly offset changes in surface stiffness. This study investigated human hopping on damped surfaces that dissipated up to 72% of the hopper's mechanical energy. On these surfaces, the legs did not act like pure springs. Leg muscles performed up to 24-fold more net work to replace the energy lost by the damped surface. However, considering the leg and surface together, the combination appeared to behave like a constant stiffness spring on all damped surfaces. By conserving the mechanics of the leg-surface combination regardless of surface damping, hoppers also conserved centre-of-mass motions. Thus, the normal bouncing movements of the centre of mass in hopping are not always a direct result of spring-like leg behaviour. Conserving the trajectory of the centre of mass by maintaining spring-like mechanics of the leg-surface combination may be an important control strategy for fast-legged locomotion on variable terrain.

[How to characterize and treat sleep complaints in bipolar disorders?

PubMed

Geoffroy, P A; Micoulaud Franchi, J-A; Lopez, R; Poirot, I; Brion, A; Royant-Parola, S; Etain, B

2017-08-01

Sleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD. We examined the international scientific literature in June 2016 and performed a literature search with PubMed electronic database using the following headings: "bipolar disorder" and ("sleep" or "insomnia" or "hypersomnia" or "circadian" or "apnoea" or "apnea" or "restless legs"). Patients with BD suffer from sleep and circadian rhythm abnormalities during major depressive episodes (insomnia or hypersomnia, nightmares, nocturnal and/or early awakenings, non-restorative sleep) and manic episodes (insomnia, decreased need for sleep without fatigue), but also some of these abnormalities may persist during remission. These remission phases are characterized by a reduced quality and quantity of sleep, with a longer sleep duration, increased sleep latency, a lengthening of the wake time after sleep onset (WASO), a decrease of sleep efficiency, and greater variability in sleep/wake rhythms. Patients also present frequent sleep comorbidities: chronic insomnia, sleepiness, sleep phase delay syndrome, obstructive sleep apnea/hypopnea syndrome (OSAHS), and restless legs syndrome (RLS). These disorders are insufficiently diagnosed and treated whereas they are associated with mood relapses, treatment resistance, affect cognitive global functioning, reduce the quality of life, and contribute to weight gain or metabolic syndrome. Sleep and circadian rhythm abnormalities have been also associated with suicidal behaviors. Therefore, a clinical exploration with characterization of these abnormalities and disorders is essential. This exploration should be

Rapid eye movement sleep behaviour disorder symptomatic of a brain stem cavernoma.

PubMed

Felix, Sandra; Thobois, Stephane; Peter-Derex, Laure

2016-04-01

A 75-year-old man complained of excessive daytime sleepiness (EDS), difficulty falling asleep and nocturnal agitation during sleep. Restless legs syndrome (RLS) was diagnosed and treated. Because of persistent EDS, snoring and nycturia, a nocturnal polysomnography (PSG) was performed. PSG showed high sleep fragmentation related to a moderate to severe obstructive sleep apnea syndrome. Continuous positive airway pressure treatment (CPAP) was proposed. Because of the persistence of abnormal nocturnal behaviours, characterized by screaming, punching and falling out of bed, a video-PSG with CPAP treatment was performed. The recording showed typical chin electromyography (EMG) activity increase associated with violent movements during rapid eye movement (REM) sleep, suggesting REM sleep behaviour disorders (RBD). Clinical neurological examination found no parkinsonian syndrome, no dysautonomic sign and no neurological focal sign. Dopamine transporter imaging [123I-FP-CIT single photon emission computed tomography (SPECT)] did not find any presynaptic dopaminergic pathways degeneration. Brain magnetic resonance imaging showed a vascular lesion suggestive of cavernoma located in the pons. The present case illustrates the complexity of sleep disturbance diagnosis with a possible entanglement of aetiologies responsible for nocturnal agitation, and confirms that an isolated pons cavernoma should be considered among the rare causes of RBD. © 2016 European Sleep Research Society.

Which diagnostic findings in disorders with excessive daytime sleepiness are really helpful? A retrospective study.

PubMed

Kretzschmar, Ute; Werth, Esther; Sturzenegger, Christian; Khatami, Ramin; Bassetti, Claudio L; Baumann, Christian R

2016-06-01

Due to extensive clinical and electrophysiological overlaps, the correct diagnosis of disorders with excessive daytime sleepiness is often challenging. The aim of this study was to provide diagnostic measures that help discriminating such disorders, and to identify parameters, which don't. In this single-center study, we retrospectively identified consecutive treatment-naïve patients who suffered from excessive daytime sleepiness, and analyzed clinical and electrophysiological measures in those patients in whom a doubtless final diagnosis could be made. Of 588 patients, 287 reported subjective excessive daytime sleepiness. Obstructive sleep apnea is the only disorder that could be identified by polysomnography alone. The diagnosis of insufficient sleep syndrome relies on actigraphy as patients underestimate their sleep need and the disorder shares several clinical and electrophysiological properties with both narcolepsy type 1 and idiopathic hypersomnia. Sleep stage sequencing on MSLT appears helpful to discriminate between insufficient sleep syndrome and narcolepsy. Sleep inertia is a strong indicator for idiopathic hypersomnia. There are no distinctive electrophysiological findings for the diagnosis of restless legs syndrome. Altogether, EDS disorders are common in neurological sleep laboratories, but usually cannot be diagnosed based on PSG and MSLT findings alone. The diagnostic value of actigraphy recordings can hardly be overestimated. © 2016 European Sleep Research Society.

Musculo-Skeletal Abnormalities in Patients with Marfan Syndrome

PubMed Central

Al Kaissi, Ali; Zwettler, Elisabeth; Ganger, Rudolf; Schreiner, Simone; Klaushofer, Klaus; Grill, Franz

2013-01-01

Background A leptosomic body type is tall and thin with long hands. Marfanoid features may be familial in nature or pathological, as occurs in congenital contractual arachnodactyly (Beal’s syndrome) and Shprintzen-Goldberg syndrome mimicking some of the changes of Marfan syndrome, although not accompanied by luxation of lens and dissecting aneurysm of aorta. Methods In this article we collected eight patients who were consistent with the diagnosis of Marfan syndrome via phenotypic and genotypic characterization. Results Our patients manifested a constellation of variable presentations of musculo-skeletal abnormalities ranging from developmental dysplasia of the hip, protrusio acetabuli, leg length inequality, patellar instability, scoliosis, to early onset osteoarthritis. Each abnormality has been treated accordingly. Conclusion This is the first paper which includes the diagnosis and the management of the associated musculo-skeletal abnormalities in patients with Marfan syndrome, stressing that patients with Marfan syndrome are exhibiting great variability in the natural history and the severity of musculo-skeletal abnormalities. PMID:23399831

Acute compartment syndrome caused by uncontrolled hypothyroidism.

PubMed

Modi, Anar; Amin, Hari; Salzman, Matthew; Morgan, Farah

2017-06-01

Acute compartment syndrome is increased tissue pressure exceeding perfusion pressure in a closed compartment resulting in nerve and muscle ischemia. Common precipitating causes are crush injuries, burns, substance abuse, osseous or vascular limb trauma. This is a case of 42year old female with history of hypothyroidism who presented to emergency room with acute onset of severe pain and swelling in right lower extremity. Physical examination was concerning for acute compartment syndrome of right leg which was confirmed by demonstration of elevated compartmental pressures. No precipitating causes were readily identified. Further laboratory testing revealed uncontrolled hypothyroidism. Management included emergent fasciotomy and initiating thyroid hormone replacement. This case represents a rare association between acute compartment syndrome and uncontrolled hypothyroidism. We also discuss the pathogenesis of compartment syndrome in hypothyroid patients and emphasize the importance of evaluating for less common causes, particularly in setting of non-traumatic compartment syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

Sympathetic adaptations to one-legged training

NASA Technical Reports Server (NTRS)

Ray, C. A.

1999-01-01

The purpose of the present study was to determine the effect of leg exercise training on sympathetic nerve responses at rest and during dynamic exercise. Six men were trained by using high-intensity interval and prolonged continuous one-legged cycling 4 day/wk, 40 min/day, for 6 wk. Heart rate, mean arterial pressure (MAP), and muscle sympathetic nerve activity (MSNA; peroneal nerve) were measured during 3 min of upright dynamic one-legged knee extensions at 40 W before and after training. After training, peak oxygen uptake in the trained leg increased 19 +/- 2% (P < 0.01). At rest, heart rate decreased from 77 +/- 3 to 71 +/- 6 beats/min (P < 0.01) with no significant changes in MAP (91 +/- 7 to 91 +/- 11 mmHg) and MSNA (29 +/- 3 to 28 +/- 1 bursts/min). During exercise, both heart rate and MAP were lower after training (108 +/- 5 to 96 +/- 5 beats/min and 132 +/- 8 to 119 +/- 4 mmHg, respectively, during the third minute of exercise; P < 0.01). MSNA decreased similarly from rest during the first 2 min of exercise both before and after training. However, MSNA was significantly less during the third minute of exercise after training (32 +/- 2 to 22 +/- 3 bursts/min; P < 0.01). This training effect on MSNA remained when MSNA was expressed as bursts per 100 heartbeats. Responses to exercise in five untrained control subjects were not different at 0 and 6 wk. These results demonstrate that exercise training prolongs the decrease in MSNA during upright leg exercise and indicates that attenuation of MSNA to exercise reported with forearm training also occurs with leg training.

Sjogren's syndrome presenting as remitting seronegative symmetric synovitis with pitting edema (RS3PE).

PubMed Central

Choi, Young Mi; Sheen, Dong Hyuk; Lee, Yun Jong; Lee, Eun Bong; Song, Yeong Wook

2003-01-01

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical and acute synovitis, pitting edema, the absence of rheumatoid factor, increased acute phase reactants, lack of bony erosions on radiography, and benign and short clinical course. Half of all patients with Sjogren's syndrome experience arthritis during the disease course. We here describe the first case of Sjogren's syndrome presenting as RS3PE. She had swelling in knees, ankles, and wrists. After then the swelling spread to her lower legs, feet, face, and both hands. She was admitted to another hospital and was suspected of lupus or rheumatoid arthritis. Three months later, she had dry mouth and had lower lip biopsy. She was admitted to this hospital due to development of swelling in face and lower legs for 3 days. On physical examination, she had pitting edema in both hands and feet dorsum. Laboratory test showed elevated erythrocyte sedimentation rate, positivity of rheumatoid factor, anti-nuclear antibody, and anti-Ro antibody. There was no erosion in the hands radiography. Schirmer's test and lip biopsy was compatible with Sjogren's syndrome. She was diagnosed RS3PE and Sjogren's syndrome. She was begun with prednisolone and her symptoms improved gradually. PMID:12923344

Sjogren's syndrome presenting as remitting seronegative symmetric synovitis with pitting edema (RS3PE).

PubMed

Choi, Young Mi; Sheen, Dong Hyuk; Lee, Yun Jong; Lee, Eun Bong; Song, Yeong Wook

2003-08-01

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical and acute synovitis, pitting edema, the absence of rheumatoid factor, increased acute phase reactants, lack of bony erosions on radiography, and benign and short clinical course. Half of all patients with Sjogren's syndrome experience arthritis during the disease course. We here describe the first case of Sjogren's syndrome presenting as RS3PE. She had swelling in knees, ankles, and wrists. After then the swelling spread to her lower legs, feet, face, and both hands. She was admitted to another hospital and was suspected of lupus or rheumatoid arthritis. Three months later, she had dry mouth and had lower lip biopsy. She was admitted to this hospital due to development of swelling in face and lower legs for 3 days. On physical examination, she had pitting edema in both hands and feet dorsum. Laboratory test showed elevated erythrocyte sedimentation rate, positivity of rheumatoid factor, anti-nuclear antibody, and anti-Ro antibody. There was no erosion in the hands radiography. Schirmer's test and lip biopsy was compatible with Sjogren's syndrome. She was diagnosed RS3PE and Sjogren's syndrome. She was begun with prednisolone and her symptoms improved gradually.

Acne in Klinefelter Syndrome-46XY/47XXY Mosaicism?

PubMed Central

Lakshmi, Chembolli; Swarnalakshimi, Selvaraj

2015-01-01

Klinefelter syndrome (KFS) is the most common non-heritable sex chromosome anomaly caused by nondisjunction during cell division and contains two or more X chromosomes. More than two third of all cases are homogenous (47XXY) and the remaining are mosaic (46XY/47XXY). Lower limb ulcers are frequently observed and attributed to impaired fibrinolysis. A case of KFS with post acne scars and leg ulcers is presented. The rarity of acne in this syndrome is explained by the phenomenon of mosaicism. PMID:26538700

ODYSSEUS autonomous walking robot: The leg/arm design

NASA Technical Reports Server (NTRS)

Bourbakis, N. G.; Maas, M.; Tascillo, A.; Vandewinckel, C.

1994-01-01

ODYSSEUS is an autonomous walking robot, which makes use of three wheels and three legs for its movement in the free navigation space. More specifically, it makes use of its autonomous wheels to move around in an environment where the surface is smooth and not uneven. However, in the case that there are small height obstacles, stairs, or small height unevenness in the navigation environment, the robot makes use of both wheels and legs to travel efficiently. In this paper we present the detailed hardware design and the simulated behavior of the extended leg/arm part of the robot, since it plays a very significant role in the robot actions (movements, selection of objects, etc.). In particular, the leg/arm consists of three major parts: The first part is a pipe attached to the robot base with a flexible 3-D joint. This pipe has a rotated bar as an extended part, which terminates in a 3-D flexible joint. The second part of the leg/arm is also a pipe similar to the first. The extended bar of the second part ends at a 2-D joint. The last part of the leg/arm is a clip-hand. It is used for selecting several small weight and size objects, and when it is in a 'closed' mode, it is used as a supporting part of the robot leg. The entire leg/arm part is controlled and synchronized by a microcontroller (68CH11) attached to the robot base.

Links between sleep and daytime behaviour problems in children with Down syndrome.

PubMed

Esbensen, A J; Hoffman, E K; Beebe, D W; Byars, K C; Epstein, J

2018-02-01

In the general population, sleep problems have an impact on daytime performance. Despite sleep problems being common among children with Down syndrome, the impact of sleep problems on daytime behaviours in school-age children with Down syndrome is an understudied topic. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports of daytime behaviour problems among school-age children with Down syndrome. Thirty school-age children with Down syndrome wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Their parent and teacher completed a battery of measures to assess daytime behaviour. Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire, but not actigraph-measured sleep efficiency, was predictive of parent and teacher behavioural concerns on the Nisonger Child Behaviour Rating Form and the Vanderbilt ADHD Rating Scales. Actigraph-measured sleep period and parent-reported sleep duration on the Children's Sleep Habits Questionnaire was predictive of daytime parent-reported inattention. Actigraph-measured sleep period was predictive of parent-reported hyperactivity/impulsivity. The study findings suggest that sleep problems have complex relationships to both parent-reported and teacher-reported daytime behaviour concerns in children with Down syndrome. These findings have implications for understanding the factors impacting behavioural concerns and their treatment in school-age children with Down syndrome. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Human hopping on damped surfaces: strategies for adjusting leg mechanics.

PubMed Central

Moritz, Chet T; Farley, Claire T

2003-01-01

Fast-moving legged animals bounce along the ground with spring-like legs and agilely traverse variable terrain. Previous research has shown that hopping and running humans maintain the same bouncing movement of the body's centre of mass on a range of elastic surfaces by adjusting their spring-like legs to exactly offset changes in surface stiffness. This study investigated human hopping on damped surfaces that dissipated up to 72% of the hopper's mechanical energy. On these surfaces, the legs did not act like pure springs. Leg muscles performed up to 24-fold more net work to replace the energy lost by the damped surface. However, considering the leg and surface together, the combination appeared to behave like a constant stiffness spring on all damped surfaces. By conserving the mechanics of the leg-surface combination regardless of surface damping, hoppers also conserved centre-of-mass motions. Thus, the normal bouncing movements of the centre of mass in hopping are not always a direct result of spring-like leg behaviour. Conserving the trajectory of the centre of mass by maintaining spring-like mechanics of the leg-surface combination may be an important control strategy for fast-legged locomotion on variable terrain. PMID:12965003

Night Leg Cramps

MedlinePlus

... feet or thighs might cramp as well. Forcefully stretching the contracted muscle relieves the pain. Most of ... include Drinking plenty of fluids to avoid dehydration Stretching your leg muscles or riding a stationary bicycle ...

Leg MRI scan

MedlinePlus

... anything that contains metal into the scanner room. Considerations Tests that may be done instead of an ... Magnetic resonance imaging - ankle; MRI - femur; MRI - leg Patient Instructions Femur fracture repair - discharge Hip fracture - discharge ...

A load-based mechanism for inter-leg coordination in insects

PubMed Central

2017-01-01

Animals rely on an adaptive coordination of legs during walking. However, which specific mechanisms underlie coordination during natural locomotion remains largely unknown. One hypothesis is that legs can be coordinated mechanically based on a transfer of body load from one leg to another. To test this hypothesis, we simultaneously recorded leg kinematics, ground reaction forces and muscle activity in freely walking stick insects (Carausius morosus). Based on torque calculations, we show that load sensors (campaniform sensilla) at the proximal leg joints are well suited to encode the unloading of the leg in individual steps. The unloading coincides with a switch from stance to swing muscle activity, consistent with a load reflex promoting the stance-to-swing transition. Moreover, a mechanical simulation reveals that the unloading can be ascribed to the loading of a specific neighbouring leg, making it exploitable for inter-leg coordination. We propose that mechanically mediated load-based coordination is used across insects analogously to mammals. PMID:29187626

Cystinosis Presenting with Findings of Bartter Syndrome

PubMed Central

Özkan, Behzat; Çayır, Atilla; Koşan, Celalettin; Alp, Handan

2011-01-01

A five-year-old boy was referred to our pediatric clinic for evaluation of failure to thrive, headache, intermittent high fever, restlessness, polyuria, and polydipsia. His weight and height measurements were under the 3rd percentile. Clinical findings consisted of frontal bossing, carious teeth, O-bain deformity of the lower extremities, and moderate dehydration. The presence of metabolic alkalosis, hypokalemia, hypochloremia, and high renin and aldosterone levels were suggestive of Bartter syndrome and a treatment regimen for Bartter syndrome was started. At follow-up, the polyuria and hyponatremia were found to persist. A reassessment of the patient revealed findings consistent with proximal renal tubular acidosis such as metabolic acidosis with a high urinary pH, proteinuria, aminoaciduria with phosphaturia and hypercalciuria. Based on the presence of parental consanguinity as well as polyuria, proteinuria, low tubular reabsorption of phosphorus, generalized aminoaciduria, light yellow skin and hair color, the probable diagnosis of cystinosis was established and was confirmed by slit-lamp examination of the cornea showing cystine crystal deposition. Our case is a good example demonstrating that development of metabolic alkalosis does not exclude cystinosis and that all findings of the patient should be thoroughly evaluated. Conflict of interest:None declared. PMID:21750641

Cystinosis presenting with findings of Bartter syndrome.

PubMed

Özkan, Behzat; Çayır, Atilla; Koşan, Celalettin; Alp, Handan

2011-01-01

A five-year-old boy was referred to our pediatric clinic for evaluation of failure to thrive, headache, intermittent high fever, restlessness, polyuria, and polydipsia. His weight and height measurements were under the 3rd percentile. Clinical findings consisted of frontal bossing, carious teeth, O-bain deformity of the lower extremities, and moderate dehydration. The presence of metabolic alkalosis, hypokalemia, hypochloremia, and high renin and aldosterone levels were suggestive of Bartter syndrome and a treatment regimen for Bartter syndrome was started. At follow-up, the polyuria and hyponatremia were found to persist. A reassessment of the patient revealed findings consistent with proximal renal tubular acidosis such as metabolic acidosis with a high urinary pH, proteinuria, aminoaciduria with phosphaturia and hypercalciuria. Based on the presence of parental consanguinity as well as polyuria, proteinuria, low tubular reabsorption of phosphorus, generalized aminoaciduria, light yellow skin and hair color, the probable diagnosis of cystinosis was established and was confirmed by slit-lamp examination of the cornea showing cystine crystal deposition. Our case is a good example demonstrating that development of metabolic alkalosis does not exclude cystinosis and that all findings of the patient should be thoroughly evaluated. ©Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.

Frustrated S = 1/2 Two-Leg Ladder with Different Leg Interactions

NASA Astrophysics Data System (ADS)

Tonegawa, Takashi; Okamoto, Kiyomi; Hikihara, Toshiya; Sakai, Tôru

2017-04-01

We explore the ground-state phase diagram of the S = 1/2 two-leg ladder. The isotropic leg interactions J1,a and J1,b between nearest neighbor spins in the legs a and b, respectively, are different from each other. The xy and z components of the uniform rung interactions are denoted by Jr and ΔJr, respectively, where Δ is the XXZ anisotropy parameter. This system has a frustration when J1,aJ1,b < 0 irrespective of the sign of Jr. The phase diagrams on the Δ (0≤Δ<1) versus J1,b plane in the cases of J1,a = - 0.2 and J1,a = 0.2 with Jr = -1 are determined numerically. We employ the physical consideration, the level spectroscopy analysis of the results obtained by the exact diagonalization method and also the density-matrix renormalization-group method. It is found that the non-collinear ferrimagnetic (NCFR) state appears as the ground state in the frustrated region of the parameters. Furthermore, the direct-product triplet-dimer (TD) state in which all rungs form the TD pair is the exact ground state, when J1,a + J1,b = 0 and 0≤ Δ ≲ 0.83. The obtained phase diagrams consist of the TD, XY and Haldane phases as well as the NCFR phase.

A Biomechanical Comparison of Single-Leg Landing and Unplanned Sidestepping.

PubMed

Chinnasee, Chamnan; Weir, Gillian; Sasimontonkul, Siriporn; Alderson, Jacqueline; Donnelly, Cyril

2018-06-14

Unplanned sidestepping and single-leg landing have both been used to screen athletes for injury risk in sport. The aim of this study was to directly compare the lower limb mechanics of three single-leg landing tasks and an unplanned sidestepping task. Thirteen elite female team sport athletes completed a series of non-contact single-leg drop landings, single-leg countermovement jumps, single-leg jump landings and unplanned sidestepping in a randomized counterbalanced design. Three dimensional kinematics (250 Hz) and ground reaction force (2,000 Hz) data with a participant specific lower limb skeletal model were used to calculate and compare hip, knee and ankle joint kinematics, peak joint moments, instantaneous joint power and joint work during the weight acceptance phase of each sporting task (α=0.05). Peak knee joint moments and relevant injury risk thresholds were used to classify each athlete's anterior cruciate ligament injury risk during unplanned sidestepping and single-leg jump landing. Results showed that peak joint moments, power and work were greater during the single-leg jump landing task when compared to the single-leg drop landings and single-leg countermovement jumps tasks. Peak frontal and sagittal plane knee joint moments, knee joint power, as well as hip and knee joint work were greater during unplanned sidestepping when compared to the landing tasks. Peak ankle joint moments, power and work were greater during the landing tasks when compared to unplanned sidestepping. For 4 of the 13 athletes tested, their anterior cruciate ligament injury risk classification changed depending on whether they performed an unplanned sidestepping or single-leg jump landing testing procedure. To summarize, a single-leg jump landing testing procedure places a larger mechanical on the ankle joint when compared to single-leg drop landings, single-leg countermovement jumps and unplanned sidestepping. An unplanned sidestepping testing procedure places a larger

Sensitivity of sensor-based sit-to-stand peak power to the effects of training leg strength, leg power and balance in older adults.

PubMed

Regterschot, G Ruben H; Folkersma, Marjanne; Zhang, Wei; Baldus, Heribert; Stevens, Martin; Zijlstra, Wiebren

2014-01-01

Increasing leg strength, leg power and overall balance can improve mobility and reduce fall risk. Sensor-based assessment of peak power during the sit-to-stand (STS) transfer may be useful for detecting changes in mobility and fall risk. Therefore, this study investigated whether sensor-based STS peak power and related measures are sensitive to the effects of increasing leg strength, leg power and overall balance in older adults. A further aim was to compare sensitivity between sensor-based STS measures and standard clinical measures of leg strength, leg power, balance, mobility and fall risk, following an exercise-based intervention. To achieve these aims, 26 older adults (age: 70-84 years) participated in an eight-week exercise program aimed at improving leg strength, leg power and balance. Before and after the intervention, performance on normal and fast STS transfers was evaluated with a hybrid motion sensor worn on the hip. In addition, standard clinical tests (isometric quadriceps strength, Timed Up and Go test, Berg Balance Scale) were performed. Standard clinical tests as well as sensor-based measures of peak power, maximal velocity and duration of normal and fast STS showed significant improvements. Sensor-based measurement of peak power, maximal velocity and duration of normal STS demonstrated a higher sensitivity (absolute standardized response mean (SRM): ≥ 0.69) to the effects of training leg strength, leg power and balance than standard clinical measures (absolute SRM: ≤ 0.61). Therefore, the presented sensor-based method appears to be useful for detecting changes in mobility and fall risk. Copyright © 2013 Elsevier B.V. All rights reserved.

Microgravity, Mesh-Crawling Legged Robots

NASA Technical Reports Server (NTRS)

Behar, Alberto; Marzwell, Neville; Matthews, Jaret; Richardson, Krandalyn; Wall, Jonathan; Poole, Michael; Foor, David; Rodgers, Damian

2008-01-01

The design, fabrication, and microgravity flight-testing are part of a continuing development of palm-sized mobile robots that resemble spiders (except that they have six legs apiece, whereas a spider has eight legs). Denoted SpiderBots (see figure), they are prototypes of proposed product line of relatively inexpensive walking robots that could be deployed in large numbers to function cooperatively in construction, repair, exploration, search, and rescue activities in connection with exploration of outer space and remote planets.

Promethus Hot Leg Piping Concept

DOE Office of Scientific and Technical Information (OSTI.GOV)

AM Girbik; PA Dilorenzo

2006-01-24

The Naval Reactors Prime Contractor Team (NRPCT) recommended the development of a gas cooled reactor directly coupled to a Brayton energy conversion system as the Space Nuclear Power Plant (SNPP) for NASA's Project Prometheus. The section of piping between the reactor outlet and turbine inlet, designated as the hot leg piping, required unique design features to allow the use of a nickel superalloy rather than a refractory metal as the pressure boundary. The NRPCT evaluated a variety of hot leg piping concepts for performance relative to SNPP system parameters, manufacturability, material considerations, and comparison to past high temperature gas reactormore » (HTGR) practice. Manufacturability challenges and the impact of pressure drop and turbine entrance temperature reduction on cycle efficiency were discriminators between the piping concepts. This paper summarizes the NRPCT hot leg piping evaluation, presents the concept recommended, and summarizes developmental issues for the recommended concept.« less

Skipping on uneven ground: trailing leg adjustments simplify control and enhance robustness.

PubMed

Müller, Roy; Andrada, Emanuel

2018-01-01

It is known that humans intentionally choose skipping in special situations, e.g. when descending stairs or when moving in environments with lower gravity than on Earth. Although those situations involve uneven locomotion, the dynamics of human skipping on uneven ground have not yet been addressed. To find the reasons that may motivate this gait, we combined experimental data on humans with numerical simulations on a bipedal spring-loaded inverted pendulum model (BSLIP). To drive the model, the following parameters were estimated from nine subjects skipping across a single drop in ground level: leg lengths at touchdown, leg stiffness of both legs, aperture angle between legs, trailing leg angle at touchdown (leg landing first after flight phase), and trailing leg retraction speed. We found that leg adjustments in humans occur mostly in the trailing leg (low to moderate leg retraction during swing phase, reduced trailing leg stiffness, and flatter trailing leg angle at lowered touchdown). When transferring these leg adjustments to the BSLIP model, the capacity of the model to cope with sudden-drop perturbations increased.

Managing leg ulceration in intravenous drug users.

PubMed

Geraghty, Jemell

2015-09-01

Chronic venous leg ulceration is a long-term condition commonly associated with lower-limb injecting and chronic venous hypertension caused by collapsed veins, incompetent valves, deep vein thrombosis and reflux. It is not usually a medical emergency, but intravenous (IV) drug users with leg ulcers can attend emergency departments (EDs) with a different primary complaint such as pain or because they cannot access local primary care or voluntary services. Leg ulceration might then be identified during history taking, so it is important that ED nurses know how to assess and manage these wounds. This article explains how to assess and manage chronic venous leg ulcers in patients with a history of IV drug use, and highlights the importance of referral to specialist services when required, and to local primary care or voluntary services, before discharge to prevent admission and re-attendance.

[Acute compartment syndrome of the lower leg after ankle joint sprain. A case report].

PubMed

Angermann, P; Hoser, C; Lutz, M; Fink, C; Seykora, P

1998-03-01

In the field of traumatology, compartment syndromes of the lower extremity are often seen after fractures and direct injuries, or after ischaemia. Other causes include over-exertion and non-traumatic causes such as acute rhabdomyolysis, drug-induced myositis and eosinophilic myositis. This paper describes the clinical and MR course of a compartment syndrome following an ankle sprain.

Experimental-clinical study on the effects of hydromassage with Thermae Oasis's salsobromoiodine water in chronic venous stasis disease of the lower extremities.

PubMed

Ippolito, E; De Luca, S; Sommaruga, S; Grassellino, V; Nappi, G

2008-08-01

The aim of this study was to evaluate the efficacy of thermal therapy, in particular hydromassage therapy with the ''Ca' Rossa'' salsobromoiodic water of the Thermae Oasis (Ferrara, Italy), in patients with chronic venous insufficiency (CVI) of the inferior limbs. Fourty-four patients with primary varices of the legs were enrolled. The anamnestic symptomatologic indicators of disease were: pain, perception of heaviness or paresthesias, nocturnal cramps, ''restless leg'' syndrome, pruritus. The symptoms were evaluated for both intensity and frequency. An additional clinical indicator was the centimetric measurement of the leg diameters at 3 levels: supramalleolar, mid-calf and mid-thigh. The patients were subdivided in two groups: patients submitted to a cycle of hydromassage with salsobromoiodic water and patients treated with compressive elastic stocking (12 mmHg). At the end of the treatment cycle, symptomatologic and clinical data were reassessed, in addition to morphological and velocimetric parameters related to the function of the peripheral vascular system. The results showed in Group A (thermal water hydromassage) an improved reduction of subjective and objective symptoms as compared to the control Group B, demonstrating a superior efficacy of thermal therapy. The efficacy of hydromassage therapy is due not only to the favourable action of hydrostatic pressure upon venous flow of the inferior limbs, but also to the peculiar chemical and physical characteristics of the thermal water utilized in this study. The elevated osmotic power of hydromassage is responsible for the significant intrinsic antiedematous properties.

Lower Limb Symmetry: Comparison of Muscular Power Between Dominant and Nondominant Legs in Healthy Young Adults Associated With Single-Leg-Dominant Sports.

PubMed

Vaisman, Alex; Guiloff, Rodrigo; Rojas, Juan; Delgado, Iris; Figueroa, David; Calvo, Rafael

2017-12-01

Achieving a symmetrical power performance (difference <15%) between lower limbs is generally recommended during sports rehabilitation. However, athletes in single-leg-dominant sports, such as professional soccer players, could develop significant asymmetry between their dominant and nondominant legs, such that symmetry does not act as a viable comparison. To (1) compare maximal muscular power between the dominant and nondominant legs in healthy young adults, (2) evaluate the effect of a single-leg-dominant sport activity performed at the professional level, and (3) propose a parameter of normality for maximal power difference in the lower limbs of this young adult population. Controlled laboratory study. A total of 78 healthy, male, young adults were divided into 2 groups according to sport activity level. Group 1 consisted of 51 nonathletes (mean ± SD age, 20.8 ± 1.5 years; weight, 71.9 ± 10.5 kg) who participated in less than 8 hours a week of recreational physical activity with nonspecific training; group 2 consisted of 27 single-leg-dominant professional soccer players (age, 18.4 ± 0.6 years; weight, 70.1 ± 7.5 kg) who specifically trained and competed at their particular activity 8 hours or more a week. For assessment of maximal leg power, both groups completed the single-leg squat jump test. Dominance was determined when participants completed 2 of 3 specific tests with the same extremity. Statistical analysis included the Student t test. No statistical difference was found for maximal power between dominant and nondominant legs for nonathletes ( t = -1.01, P = .316) or single-leg-dominant professional soccer players ( t = -1.10, P = .281). A majority (95%) of participants studied showed a power difference of less than 15% between their lower extremities. Among young healthy adults, symmetrical power performance is expected between lower extremities independent of the existence of dominance and difference in sport activity level. A less than 15

[The Activation of Interlimb Interactions Increase the Motor Output in Legs in Healthy Subjects under the Conditions of Arm and Leg Unloading].

PubMed

Selionov, V A; Solopova, I A; Zhvansky, D S

2016-01-01

We studied the effect of arm movements and movements of separate arm joints on the electrophysiological and kinematic characteristics of voluntary and vibration-triggered stepping-like leg movements under the conditions of horizontal support of upper and lower limbs. The horizontal support of arms provided a significantly increase in the rate of activation of locomotor automatism by non-invasive impact on tonic sensory inputs. The addition of active arm movements during involuntary rhytmic stepping-like leg movements led to an increase in EMG activity of hip muscles and was accompanied by an increase in the amplitude of hip and shin movements. Passive arm movements had the same effect on induced leg movements. The movement of the shoulder joints led to an increase in the activity of hip muscles and an increase in the amplitude of movements of the knee and hip joints. At the same time, the movement of forearms. and wrists had similar facilitating effect on electrophysiological and kinematic characteristics of rhytmic stepping-like movements, but influenced the distal segments of legs to a greater extent. Under the conditions of sub-threshold vibration of leg muscles, voluntary arm movements led to the activation of involuntary rhytmic stepping movements. During voluntary leg movements, the addition of arm movements had a significantly smaller impact on the parameters of rhytmic stepping than during involuntary leg movements. Thus, the simultaneous movements of upper and lower limbs are an effective method of activation of neural networks connecting the rhythm generators of arms and legs. Under the conditions of arm and leg unloading, the interactions between the cervical and lumbosacral segments of the spinal cord seem to play the major role in the impact of arm movements on the patterns of leg movements. The described methods of activation of interlimb interactions can be used in the rehabilitation of post-stroke patients and patients with spinal cord injuries

Leg pairs as virtual wheels

NASA Astrophysics Data System (ADS)

Howe, Russel; Duttweiler, Mark; Khanlian, Luke; Setrakian, Mark

2005-05-01

We propose the use of virtual wheels as the starting point of a new vehicle design. Each virtual wheel incorporates a pair of simple legs that, by simulating the rotary motion and ground contact of a traditional wheel, combine many of the benefits of legged and wheeled motion. We describe the use of virtual wheels in the design of a robotic mule, presenting an analysis of the mule's mobility the results of our efforts to model and build such a device.

Plan for Living on a Restless Planet Sets NASA's Solid Earth Agenda

NASA Astrophysics Data System (ADS)

Solomon, Sean C.; Baker, Victor R.; Bloxham, Jeremy; Booth, Jeffrey; Donnellan, Andrea; Elachi, Charles; Evans, Diane; Rignot, Eric; Burbank, Douglas; Chao, Benjamin F.; Chave, Alan; Gillespie, Alan; Herring, Thomas; Jeanloz, Raymond; LaBrecque, John; Minster, Bernard; Pittman, Walter C., III; Simons, Mark; Turcotte, Donald L.; Zoback, Mary Lou C.

What are the most important challenges facing solid Earth science today and over the next two decades? And what is the best approach for NASA, in partnership with other agencies, to address those challenges? A new report, Living on a Restless Planet, provides a blueprint for answering these questions. The top priority for a new spacecraft mission in the area of solid Earth science over the next 5 years, according to this report, is a satellite dedicated to Interferometric Synthetic Aperture Radar (InSAR). At the request of NASA, the Solid Earth Science Working Group (SESWG) developed a strategy for the highest priority objectives in solid Earth science for the space agency over the next 25 years. The strategy addresses six challenges that are of fundamental scientific importance, have strong implications for society, and are amenable to substantial progress through a concerted series of scientific observations from space.

Fiber-type distribution in insect leg muscles parallels similarities and differences in the functional role of insect walking legs.

PubMed

Godlewska-Hammel, Elzbieta; Büschges, Ansgar; Gruhn, Matthias

2017-10-01

Previous studies have demonstrated that myofibrillar ATPase (mATPase) enzyme activity in muscle fibers determines their contraction properties. We analyzed mATPase activities in muscles of the front, middle and hind legs of the orthopteran stick insect (Carausius morosus) to test the hypothesis that differences in muscle fiber types and distributions reflected differences in their behavioral functions. Our data show that all muscles are composed of at least three fiber types, fast, intermediate and slow, and demonstrate that: (1) in the femoral muscles (extensor and flexor tibiae) of all legs, the number of fast fibers decreases from proximal to distal, with a concomitant increase in the number of slow fibers. (2) The swing phase muscles protractor coxae and levator trochanteris, have smaller percentages of slow fibers compared to the antagonist stance muscles retractor coxae and depressor trochanteris. (3) The percentage of slow fibers in the retractor coxae and depressor trochanteris increases significantly from front to hind legs. These results suggest that fiber-type distribution in leg muscles of insects is not identical across leg muscles but tuned towards the specific function of a given muscle in the locomotor system.

ORTHOPEDIC LEG BRACE

NASA Technical Reports Server (NTRS)

Myers, William Neil (Inventor)

2005-01-01

Knee braces generally have been rigid in both the knee bending direction and in the knee straightening direction unless a manually operated release is incorporated in them to allow the knee to bend. Desirably a braced knee joint should effectively duplicate the compound, complex, actions of a normal knee. The key to knee braces is the knee joint housing. The housing herein carries a number of cam action pawls. with teeth adapted to engage the internal teeth of a ratchet ring mounted in the housing. Cam action return springs and the shape of the cam action pawl teeth allow rotation of the ratchet ring in a leg straightening direction while still supporting a load. The leg can then be extended during walking while at the same time being prevented by the cam action pawls from buckling in the knee bending direction.

[Surgical treatment of acute deep leg and pelvic vein trombosis].

PubMed

Gall, F; Husfeldt, K J

1977-08-25

In the last 3 years 93 cases of iliofermoral trombosis were treated by surgery. We prefer the method used by Brunner, but under general anaesthesia and using a Bentley-Autotransfusion-System (ATS). The average age of our patients was 55 years (age ranged between 17 and 87 years). No lethal pulmonary embolism was observed. 2, 1 percent of the patients died following apoplex or acute heart failure. Of 67 patients who were operated on 6 months ago or more 70 percent have no further complaints, 28 percent still have some residual edema and only 2 patients have a severe postthrombotic syndrome. 50 percent of 40 control-phlebograms demonstrated patency of all veins. 20 percent had short segmentary occlusions with definite signs of recanalisation, while in 27 percent of the cases occlusions of the lower leg and thigh were found, the iliac veins being free. Only 2 postoperative phlebograms showed a complete iliofemoral venous occlusion. Our results prove, that the operative thrombectomy is a successful method, with which the main complications of the iliofemoral thrombosis-pulmonary embolisation and postthrombotic syndrome-can difinitely be reduced. Also because of better long term results, the operative therapy of acute ilofemoral thrombosis should be generally prefered instead of conservative treatment.

Popliteal Artery Entrapment or Chronic Exertional Compartment Syndrome?

PubMed Central

Gaunder, Christopher; Rivera, Jessica

2017-01-01

Diagnosis of lower limb pain in an athlete can be a challenging task due to the variety of potential etiologies and ambiguity of presenting symptoms. Five of the most commonly encountered causes of limb pain in athletes are chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), tibial stress fractures, soleal sling syndrome, and popliteal artery entrapment syndrome (PAES). Of these, the least frequent but potentially most serious of the pathologies is PAES. With an incidence of less than 1% seen in living subject studies, the condition is rare. However, a missed diagnosis will likely lead to progression of the disease and potential for unnecessary invasive procedures (McAree et al. 2008). In this paper, we present a young athlete misdiagnosed and treated for chronic exertional compartment syndrome. In both descriptive and a quick-reference table format, we review current literature and discuss how best to distinguish functional PAES from other causes of activity-related leg pain. PMID:28890727

Injury due to leg bands in willow flycatchers

USGS Publications Warehouse

Sedgwick, J.A.; Klus, R.J.

1997-01-01

We report an apparently unusually high incidence of leg injury in Willow Flycatchers (Empidonax traillii) as a result of banding and color banding. Color bands and U.S. Fish and Wildlife Service (USFWS) bands applied to Willow Flycatchers from 1988-1995 resulted in an overall leg injury rate of 9.6% to birds returning to our study areas in subsequent years. Most injuries occurred on legs with only color band(s) (58.3%) or on legs with both a USFWS band and a color band (35%); only 6.7% of injuries (4/60) were due to USFWS bands alone, yielding an overall USFWS band injury rate of only 0.6%. Injuries ranged from severe (swollen, bleeding legs; a missing foot) to relatively minor (irritations on the tarsus). Amputation of the foot occurred in 33.9% of the cases. Return rates of adult injured birds in the year(s) following injury were significantly lower than for the population at large.

The effect of leg preference on postural stability in healthy athletes.

PubMed

Huurnink, Arnold; Fransz, Duncan P; Kingma, Idsart; Hupperets, Maarten D W; van Dieën, Jaap H

2014-01-03

In research regarding postural stability, leg preference is often tested and controlled for. However, leg preference may vary between tasks. As athletes are a group of interest for postural stability testing, we evaluated the effect of five leg preference tasks categorization (step up, hop, ball kick, balance, pick up) on single-leg postural stability of 16 field hockey athletes. The 'center of pressure speed' was calculated as the primary outcome variable of single-leg postural stability. Secondary variables were 'mean length of the GRF vector in the horizontal plane', 'mean length of the ankle angular velocity vector', and 'mean length of the hip angular velocity vector', as well as the separate outcomes per degree of freedom. Results showed that leg preference was inconsistent between leg preference tasks. Moreover, the primary and secondary variables yielded no significant difference between the preferred and non-preferred legs, regardless of the applied leg preference task categorization (p>0.05). The present findings do not support the usability of leg preference tasks in controlling for bias of postural stability. In conclusion, none of the applied leg preference tasks revealed a significant effect on postural stability in healthy field hockey athletes. © 2013 Published by Elsevier Ltd.

DTI and VBM reveal white matter changes without associated gray matter changes in patients with idiopathic restless legs syndrome

PubMed Central

Belke, Marcus; Heverhagen, Johannes T; Keil, Boris; Rosenow, Felix; Oertel, Wolfgang H; Stiasny-Kolster, Karin; Knake, Susanne; Menzler, Katja

2015-01-01

Background and Purpose We evaluated cerebral white and gray matter changes in patients with iRLS in order to shed light on the pathophysiology of this disease. Methods Twelve patients with iRLS were compared to 12 age- and sex-matched controls using whole-head diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) techniques. Evaluation of the DTI scans included the voxelwise analysis of the fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD). Results Diffusion tensor imaging revealed areas of altered FA in subcortical white matter bilaterally, mainly in temporal regions as well as in the right internal capsule, the pons, and the right cerebellum. These changes overlapped with changes in RD. Voxel-based morphometry did not reveal any gray matter alterations. Conclusions We showed altered diffusion properties in several white matter regions in patients with iRLS. White matter changes could mainly be attributed to changes in RD, a parameter thought to reflect altered myelination. Areas with altered white matter microstructure included areas in the internal capsule which include the corticospinal tract to the lower limbs, thereby supporting studies that suggest changes in sensorimotor pathways associated with RLS. PMID:26442748

The relationship of hip muscle performance to leg, ankle and foot injuries: a systematic review.

PubMed

Steinberg, Nili; Dar, Gali; Dunlop, Martin; Gaida, James Edmund

2017-02-01

Hip control affects movement and muscle firing patterns in the leg, ankle and foot, and may contribute to overuse injuries. Muscle performance can be measured as strength, endurance or muscle activation patterns. Our objective was to systematically review whether hip muscle performance is associated with leg, ankle and foot injuries. A structured and comprehensive search of six medical literature databases was combined with forward and backward citation tracking (AMED, CINAHL, EMBASE, Medline, Scopus and SportDiscus). Eligible studies measured hip muscle performance in individuals with musculoskeletal injuries below the tibial tuberosity, using dynamometry or electromyography (EMG). All studies compared an injured group with a control group or compared the injured and non-injured limb in the same individual. Data was extracted from each study independently by two authors. Twenty case-control and four prospective studies (n = 24) met the inclusion criteria. Injury classifications included chronic ankle instability (n = 18), Achilles tendinopathy (n = 2), medial tibial stress syndrome and tibial stress fracture (n = 1), posterior tibial tendon dysfunction (n = 1), and exertional medial tibial pain (n = 2). Eleven of the studies revealed differences in hip muscle performance indicating less strength, delayed onset activation and decreased duration of activation in the injured groups. Two studies found evidence for differences between groups only in some of their measurements. Three out of the four prospective studies revealed that hip muscle performance was not a risk factor for leg, ankle and foot injuries. This review provides limited evidence that hip muscle performance variables are related to leg, ankle and foot injuries. Emerging evidence indicates this might be a result of the injury rather than a contributor to the injury.

Anatomical popliteal artery entrapment syndrome.

PubMed

Kwon, Yong Jae; Kwon, Tae-Won; Gwon, Jun Gyo; Cho, Yong-Pil; Hwang, Seung-Jun; Go, Ki-Young

2018-05-01

The aim of this study was to analyze anatomical popliteal artery entrapment syndrome (PAES) and to individualize the treatment of this condition according to the anatomical status of the artery and the adjacent structure. A total of 35 anatomical PAES legs in 23 consecutive patients treated within the Asan Medical Center, Seoul, Korea between 1995 and 2011 were analyzed retrospectively. Anatomical PAES was diagnosed by MRI and/or CT scans of the knee joint, and CT or conventional transfemoral arteriography of the lower extremities. We noted a type II gastrocnemius medial head (GNM) anomaly, a type III GNM anomaly, or an aberrant plantaris muscle in 51.4%, 20%, and 28.6% of PAES legs, respectively. In assessments of the arterial lesions, popliteal or tibial artery occlusion was noted in 19 of 26 symptomatic PAES legs. For cases without popliteal artery lesions, myotomy of the anatomically deranged muscle was performed in 5 of 7 symptomatic and 4 of 9 asymptomatic PAES legs. For occluded popliteal arteries, we performed ten direct repairs of the pathological popliteal artery and 4 femoro-below the knee popliteal bypass surgeries. As a result of the arterial Surgery, 9 direct procedures with myotomy yielded a patent artery, while 3 graft failures were noted in the bypass group. The median follow-up period was 84 months (range, 12-206 months). We recommend that treatment of PAES should be individualized based on pathology, symptoms, and various imaging studies.

Integrated system for single leg walking

NASA Astrophysics Data System (ADS)

Simmons, Reid; Krotkov, Eric; Roston, Gerry

1990-07-01

The Carnegie Mellon University Planetary Rover project is developing a six-legged walking robot capable of autonomously navigating, exploring, and acquiring samples in rugged, unknown environments. This report describes an integrated software system capable of navigating a single leg of the robot over rugged terrain. The leg, based on an early design of the Ambler Planetary Rover, is suspended below a carriage that slides along rails. To walk, the system creates an elevation map of the terrain from laser scanner images, plans an appropriate foothold based on terrain and geometric constraints, weaves the leg through the terrain to position it above the foothold, contacts the terrain with the foot, and applies force enough to advance the carriage along the rails. Walking both forward and backward, the system has traversed hundreds of meters of rugged terrain including obstacles too tall to step over, trenches too deep to step in, closely spaced obstacles, and sand hills. The implemented system consists of a number of task-specific processes (two for planning, two for perception, one for real-time control) and a central control process that directs the flow of communication between processes.

Agreement and correlation between the straight leg raise and slump tests in subjects with leg pain.

PubMed

Walsh, Jeremy; Hall, Toby

2009-01-01

The straight leg raise (SLR) and slump tests have traditionally been used to identify nerve root compression arising from disk herniation. However, they may be more appropriate as tests of lumbosacral neural tissue mechanosensitivity. The aim of this study was to determine agreement and correlation between the SLR and slump tests in a population presenting with back and leg pain. This was an observational, cross-sectional study design. Forty-five subjects with unilateral leg pain were recruited from an outpatient Back Pain Screening Clinic at a large teaching hospital in Ireland. The SLR and slump tests were performed on each side. In the event of symptom reproduction, the ankle was dorsiflexed. Reproduction of presenting symptoms, which were intensified by ankle dorsiflexion, was interpreted as a positive test. An inclinometer was used to measure range of motion (ROM). There was substantial agreement between SLR and slump test interpretation (kappa = 0.69) with good correlation in ROM between the 2 tests (r = 0.64) on the symptomatic side. In subjects who had positive results, ROM for both tests was significantly reduced compared to ROM on the contralateral side and ROM in subjects who had negative results. When the SLR and slump tests are interpreted as positive in the event of reproduction of presenting leg pain that are intensified by ankle dorsiflexion, these tests show substantial agreement and good correlation in the leg pain population. When interpreted in this way, these tests may be appropriate tests of neural tissue mechanosensitivity, but further criteria must be met before a definitive conclusion in relation to neural tissue mechanosensitivity may be drawn.

Compliant leg behaviour explains basic dynamics of walking and running

PubMed Central

Geyer, Hartmut; Seyfarth, Andre; Blickhan, Reinhard

2006-01-01

The basic mechanics of human locomotion are associated with vaulting over stiff legs in walking and rebounding on compliant legs in running. However, while rebounding legs well explain the stance dynamics of running, stiff legs cannot reproduce that of walking. With a simple bipedal spring–mass model, we show that not stiff but compliant legs are essential to obtain the basic walking mechanics; incorporating the double support as an essential part of the walking motion, the model reproduces the characteristic stance dynamics that result in the observed small vertical oscillation of the body and the observed out-of-phase changes in forward kinetic and gravitational potential energies. Exploring the parameter space of this model, we further show that it not only combines the basic dynamics of walking and running in one mechanical system, but also reveals these gaits to be just two out of the many solutions to legged locomotion offered by compliant leg behaviour and accessed by energy or speed. PMID:17015312

Refeeding syndrome in Southeastern Taiwan: our experience with 11 cases.

PubMed

Chen, Li-Ju; Chen, Huan-Lin; Bair, Ming-Jong; Wu, Chia-Hsien; Lin, I-Tsung; Lee, Yuan-Kai; Chu, Cheng-Hsin

2014-08-14

To present our experience with refeeding syndrome in southeastern Taiwan. We conducted a retrospective study during a 2-year period at the Mackay Memorial Hospital, Taitung Branch. We enrolled patients with very little or no nutrition intake for more than 10 d, a high risk group of refeeding syndrome, including those suffering from alcohol abuse, cancerous cachexia, chronic malnutrition, and prolonged starvation. A total of 11 patients (7 males, 4 females) with nasogastric feeding were included as having refeeding syndrome. Most of them had the symptoms of diarrhea, lethargy, and leg edema. The initial nutritional supplement was found to be relatively high in calories (1355.1 ± 296.2 kcal/d), high in protein (47.3 ± 10.4 gm/d), low in vitamin B1 (2.0 ± 0.5 mg/d), low in potassium (1260.4 ± 297.7 mg/d), and low in phosphorus (660.1 ± 151.8 mg/d). Furthermore, hypophosphatemia (2.4 ± 0.9 mg/dL) was noted during follow-up. Based on the suggestions of a dietician and a gastroenterologist, the clinical disorders of diarrhea, malaise and leg edema were significantly improved. The level of phosphate was also increased (3.3 ± 0.6 mg/dL). Refeeding syndrome is an overlooked and risky disorder that has some potentially fatal complications. Nasogastric feeding in nursing homes is an important risk factor for patients and deserves greater attention based on the initial results of this study.

Propulsion phase of the single leg triple hop test in women with patellofemoral pain syndrome: a biomechanical study.

PubMed

Bley, Andre Serra; Correa, João Carlos Ferrari; Dos Reis, Amir Curcio; Rabelo, Nayra Deise Dos Anjos; Marchetti, Paulo Henrique; Lucareli, Paulo Roberto Garcia

2014-01-01

Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.

Propulsion Phase of the Single Leg Triple Hop Test in Women with Patellofemoral Pain Syndrome: A Biomechanical Study

PubMed Central

Bley, Andre Serra; Correa, João Carlos Ferrari; Reis, Amir Curcio Dos; Rabelo, Nayra Deise Dos Anjos; Marchetti, Paulo Henrique; Lucareli, Paulo Roberto Garcia

2014-01-01

Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress. PMID:24830289

Swimming with stiff legs at low Reynolds number.

PubMed

Takagi, Daisuke

2015-08-01

Locomotion at low Reynolds number is not possible with cycles of reciprocal motion, an example being the oscillation of a single pair of rigid paddles or legs. Here, I demonstrate the possibility of swimming with two or more pairs of legs. They are assumed to oscillate collectively in a metachronal wave pattern in a minimal model based on slender-body theory for Stokes flow. The model predicts locomotion in the direction of the traveling wave, as commonly observed along the body of free-swimming crustaceans. The displacement of the body and the swimming efficiency depend on the number of legs, the amplitude, and the phase of oscillations. This study shows that paddling legs with distinct orientations and phases offers a simple mechanism for driving flow.

Dimensional synthesis of a leg mechanism

NASA Astrophysics Data System (ADS)

Pop, F.; Lovasz, E.-Ch; Pop, C.; Dolga, V.

2016-08-01

An eight bar leg mechanism dimensional synthesis is presented. The mathematical model regarding the synthesis is described and the results obtained after computation are verified with help of 2D mechanism simulation in Matlab. This mechanism, inspired from proposed solution of Theo Jansen, is integrated into the structure of a 2 DOF quadruped robot. With help of the kinematic synthesis method described, it is tried to determine new dimensions for the mechanism, based on a set of initial conditions. These are established by taking into account the movement of the end point of the leg mechanism, which enters in contact with the ground, during walking. An optimization process based on the results obtained can be conducted further in order to find a better solution for the leg mechanism.

Coordination of planar cell polarity pathways through Spiny-legs

PubMed Central

Ambegaonkar, Abhijit A; Irvine, Kenneth D

2015-01-01

Morphogenesis and physiology of tissues and organs requires planar cell polarity (PCP) systems that orient and coordinate cells and their behaviors, but the relationship between PCP systems has been controversial. We have characterized how the Frizzled and Dachsous-Fat PCP systems are connected through the Spiny-legs isoform of the Prickle-Spiny-legs locus. Two different components of the Dachsous-Fat system, Dachsous and Dachs, can each independently interact with Spiny-legs and direct its localization in vivo. Through characterization of the contributions of Prickle, Spiny-legs, Dachsous, Fat, and Dachs to PCP in the Drosophila wing, eye, and abdomen, we define where Dachs-Spiny-legs and Dachsous-Spiny-legs interactions contribute to PCP, and provide a new understanding of the orientation of polarity and the basis of PCP phenotypes. Our results support the direct linkage of PCP systems through Sple in specific locales, while emphasizing that cells can be subject to and must ultimately resolve distinct, competing PCP signals. DOI: http://dx.doi.org/10.7554/eLife.09946.001 PMID:26505959

[Locomotive syndrome and frailty. Concepts and methods of locomotion training].

PubMed

Ishibashi, Hideaki

2012-04-01

Locomotive syndrome means a condition of need for long-term care or a condition at the possible risk of it, due to weakening of locomotive organs, which is, in other words, frailty of mobility. Locomotion training is all exercises that help prevention or remediation from locomotive syndrome and the centerpieces of them consist of squats and single-leg standing exercises. This article explains the concepts of locomotion training and the actual manual of those two exercises. It will greatly help instructing patients or many other old people in communities or care facilities.

Sleep-Wake Cycle and Daytime Sleepiness in the Myotonic Dystrophies

PubMed Central

Romigi, A.; Albanese, M.; Liguori, C.; Placidi, F.; Marciani, M. G.; Massa, R.

2013-01-01

Myotonic dystrophy is the most common type of muscular dystrophy in adults and is characterized by progressive myopathy, myotonia, and multiorgan involvement. Two genetically distinct entities have been identified, myotonic dystrophy type 1 (DM1 or Steinert's Disease) and myotonic dystrophy type 2 (DM2). Myotonic dystrophies are strongly associated with sleep dysfunction. Sleep disturbances in DM1 are common and include sleep-disordered breathing (SDB), periodic limb movements (PLMS), central hypersomnia, and REM sleep dysregulation (high REM density and narcoleptic-like phenotype). Interestingly, drowsiness in DM1 seems to be due to a central dysfunction of sleep-wake regulation more than SDB. To date, little is known regarding the occurrence of sleep disorders in DM2. SDB (obstructive and central apnoea), REM sleep without atonia, and restless legs syndrome have been described. Further polysomnographic, controlled studies are strongly needed, particularly in DM2, in order to clarify the role of sleep disorders in the myotonic dystrophies. PMID:26316996

Myotonic dystrophytype 1 - report of non-24-h sleep-wake disorder with excessive daytime sleepiness.

PubMed

Filho, Lucio Huebra Pimentel; Gomes, Ana Carolina Dias; Gonçalves, Bruno; Tufik, Sergio; Coelho, Fernando Morgadinho

2018-05-15

Myotonic dystrophy (MD) is a neuromuscular disease with myotonia, progressive weakness, and involvement of CNS, heart, and gastrointestinal system. Excessive daytime sleepiness (EDS) in myotonic dystrophy type 1 (MD1) is related to sleep breathing diseases, restless leg syndrome, periodic limb movements during sleep and narcoleptic-like phenotype. However, authors highlight a central dysfunction of sleep regulation. We describe a 26-year-old, female, MD1 patient with EDS. Sleep diary/actigraphy evidenced two different circadian periods with values of 1442 and 1522 min. Agomelatine, 50 mg at night, was prescribed with improvement of the circadian rhythm and complaints of sleepiness. The identification of unanticipated causes of EDS, such as circadian rhythm disorders permits an appropriated treatment. As we know, it is the first relate of non-24-h sleep-wake disorder in patient with MD1. Sleep diary and actigraphy could be good options to investigate sleep-wake cycle disorder in patients with MD and EDS.

Quality improvement and practice-based research in neurology using the electronic medical record

PubMed Central