急性脑桥梗死继发不宁腿综合征4例报道并文献复习

目的 探讨急性脑桥梗死继发不宁腿综合征(RLS)的临床表现、发病机制、诊断及治疗。方法 回顾性分析4例脑桥梗死继发RLS患者的临床资料,分析临床表现和治疗过程,总结临床特征并进行文献复习。结果 4例患者均急性起病,有神经功能缺损的体征,明确诊断为急性脑桥梗死,在脑桥梗死后0～3 d出现单侧或双侧肢体不适感,需活动肢体以减轻不适,其中3例予吡贝地尔缓释片口服后肢体不适症状消失。结论 脑桥梗死是继发性RLS的非常见病因,易漏诊,其发病机制有待于进一步研究,钙通道α2δ配体和多巴胺受体激动剂是一线治疗方案,该病早期诊治预后良好。     

不宁腿综合征是卒中的危险因素

正不宁腿综合征(restless legs syndromeRLS)是临床常见的病因不明的感觉运动障碍性疾病,特征是小腿不适感或感觉异常,伴活动小腿的强烈愿望,也称为胫部不宁性焦虑(anxietastibiarum),常描述为一种深部的异常痛苦的、跳动的、烧灼样、蠕动样、挤压样撕裂样疼痛,症状呈昼夜规律变化,在夜间睡     

阻塞性睡眠呼吸暂停综合征致急性记忆障碍1例报道及相关文献复习

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)所致认知障碍的病因、诊断及治疗。方法分析1例由OSAS引起的急性记忆障碍患者的临床表现及其辅助检查结果与治疗经过,并复习相关文献。结果患者突然出现记忆障碍,无神经系统其他症状和体征,持续气道正压通气(CPAP)结合改善脑循环治疗有效。结论OSAS可引起全身各系统的多种疾病,神经元缺氧损伤及生化代谢紊乱是其引起认知障碍的主要病因,而由其导致的急性记忆障碍则需依据基础病史及相关辅助检查确诊。     

喹硫平缓释片致不宁臂综合征1例

不宁臂综合征(restless arms syndrome,RAS)是不宁腿综合征(restless legs syndrome,RLS)的上肢变异疾病,主要以上肢深部不适感及活动患肢的欲望为特征.抗精神病药已被报道可导致RLS的发生,但以手臂不适感作为唯一症状的RAS国内外鲜有报道.本文就1例精神分裂症患者在使用喹硫...     

不安腿综合征研究进展

不安腿综合征是一种夜间性四肢主要是下肢发生不愉快感觉而导致肢体发生运动异常的疾病。呈显性遗传但尚未分离出致病基因。病理特点表现为间脑(Ａ１１)及第三脑室旁(Ａ１４)多巴胺能神经元损害。铁缺乏可能影响中枢神经系统多巴胺代谢。本病常伴有睡眠性周期性肢体运动症及不自主性运动障碍。诊断主要依据其病史。小剂量多巴胺类药物治疗有效。     

加巴喷丁治疗奥氮平致不宁腿综合征1例

本文目的是提示临床使用奥氮平过程中加强对不宁腿综合征(RLS)的识别与治疗.本文报道1例精神分裂症患者服用奥氮平期间出现夜间双下肢不适、控制不住地想要活动双腿、无法入睡等RLS症状,服用加巴喷丁后,患者症状明显改善.     

不宁腿综合征23例临床分析

目的 探讨不宁腿综合征(RLS)的临床表现及可能的发病机制,观察多巴丝肼对RLS的治疗效果.方法 对符合原发性RLS诊断标准的23例患者进行回顾性分析.结果 23例患者均为中老年人,平均年龄56岁,平均发病年龄52岁.常以失眠和白日嗜睡为主诉,根据国际不宁腿综合征研究组(IRLSSG)的诊断标准,平均得分为25分,其中16例(69%)的患者为重度(21～30分).多导睡眠图(polysomnography,PSG)检查发现18例(78%)合并有周期性肢动,其中11例(61%)的患者周期性肢动指数为中度(25～49次);所有患者微觉醒指数均增高,其中16例(67%)的患者为中度.经多巴丝肼125 mg每晚睡前服用,治疗4周后,多数患者主观症状明显改善,IRLSSG评分明显减少(平均得分13分),其中5例恢复正常;合并周期性肢动的患者中,5例周期性肢动指数恢复正常,其余患者均为轻度;微觉醒指数明显减少,其中11例降为正常;19例患者睡眠潜伏期转为正常.6例(26%)患者出现一过性头痛、恶心、嗜睡.结论 对下肢不适感觉、活动后减轻、合并睡眠中腿动的患者,应尽早检查;多巴丝肼对治疗RLS有一定疗效.     

普拉克索治疗原发性不宁腿综合征的疗效和安全性观察

不宁腿综合征(RLS)是一种感觉运动性疾病,其主要特征是:患者在静息状态下出现难以名状的腿部不适感,迫使其活动肢体以缓解症状.疾病可引起入睡困难和睡眠中断,严重影响患者的睡眠质量,使患者在白天出现困倦、注意力不集中、记忆力下降,甚至使其生活缺乏动力,出现抑郁和焦虑[1].     

米氮平致不宁腿综合征1例

患者男性,31岁,农民。因少语、少动、忧愁3月余于2007年9月14日来诊。患者于3个月前无明显诱因地出现少语,忧愁,整日愁眉不展,唉声叹气,对任何事情均不感兴趣,有生不如死之感,但未见具体行动。在当地医院取“谷维素、维生素Bl”治疗,未见效果,于2007年9月14日来诊。发病来无兴奋话多、吹嘘等现象。     

Satoyoshi综合征1例报道及文献复习

目的：报道国内首例30岁Satoyoshi综合征女性患者的临床特征。方法：体格检查、血液生化检查和影像学检查。结果：本例患者除具有进行性发作性痛性痉挛、脱发、腹泻外，还有闭经、乳腺增生等。血液生化检查显示血皮质醇、甲状旁腺素水平降低。头颅MR显示双侧额顶深部小点状信号改变。结论：对临床表现为进行性痛性痉挛、脱发、腹泻的患者，要考虑Satoyoshi综合征的诊断。     

Restless legs syndrome and periodic limb movement disorder in the elderly

Restless legs syndrome (RLS) is a sensorimotor neurological disorder characterized by an urge to move the extremities, mostly the legs, caused or accompanied by unpleasant sensations in the affected limbs. Symptoms appear or increase in the evening or during the night and at rest. Sleep disturbances are the most frequent reason why patients seek medical aid. The diagnosis of periodic limb movement disorder (PLMD) requires polysomnographic confirmation and relies on the exclusion of other causes of sleep disturbances. The diagnosis of RLS is a clinical one and usually based on the patient's history. Diagnosis criteria should be applied in a modified form in the cognitively impaired elderly. The newly revised criteria emphasize behavioral indicators and supportive features in diagnosing RLS in this special population. Prevalence of both disorders increases strongly with age. Epidemiological studies revealed a 9% to 20% prevalence of RLS and an estimated 4% to 11% prevalence of PLMD in the elderly. Recent studies indicate RLS occurring approximately twice as often in older women than in older men. Treatment with dopaminergic drugs, opioids, anticonvulsants or hypnotics are usually well tolerated in the elderly. However, interaction with other medications and the possibility of severe sedation due to slower metabolism in the elderly should be considered.     

Pediatric restless legs syndrome diagnostic criteria: an update by the International Restless Legs Syndrome Study Group

BackgroundSpecific diagnostic criteria for pediatric restless legs syndrome (RLS) were published in 2003 following a workshop at the National Institutes of Health. Due to substantial new research and revision of the adult RLS diagnostic criteria, a task force was chosen by the International Restless Legs Syndrome Study Group (IRLSSG) to consider updates to the pediatric diagnostic criteria.MethodsA committee of seven pediatric RLS experts developed a set of 15 consensus questions to review, conducted a comprehensive literature search, and extensively discussed potential revisions. The committee recommendations were approved by the IRLSSG executive committee and reviewed by the IRLSSG membership.ResultsThe pediatric RLS diagnostic criteria were simplified and integrated with the newly revised adult RLS criteria. Specific recommendations were developed for pediatric application of the criteria, including consideration of typical words used by children to describe their symptoms. Pediatric aspects of differential diagnosis, comorbidity, and clinical significance were then defined. In addition, the research criteria for probable and possible pediatric RLS were updated and criteria for a related condition, periodic limb movement disorder (PLMD), were clarified.ConclusionsRevised diagnostic criteria for pediatric RLS have been developed, which are intended to improve clinical practice and promote further research.     

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

IntroductionLittle 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.MethodsEx-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.ResultsIn 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.ConclusionsChildren 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.     

French Consensus: How to diagnose restless legs syndrome

Correct diagnosis of restless legs syndrome (RLS) is essential to patient care and treatment. Diagnosis is most often clinical and based on diagnostic criteria: the need to move the legs accompanied to varying degrees by unpleasant sensations, predominantly during the evening and improved by movement. In rare cases, clinical examination is insufficient and a polysomnography is necessary. Once a positive diagnosis has been made, a neurological examination and an assessment of iron status are required. The severity of the RLS must be evaluated to determine whether a specific treatment is necessary. Before treatment, it is essential to ensure that a definite diagnosis of RLS has been made and the phenotype characterised. This enables a personal treatment plan and limits the risk of augmentation syndrome.     

Pediatric restless legs syndrome and periodic limb movement disorder: Parent–child pairs

ObjectiveAlthough recent publications have reported the occurrence of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) in children and adolescents, the literature is relatively limited. The goals of this retrospective study were to (1) apply the recent International Classification of Sleep Disorders 2nd edition (ICSD-2) diagnostic criteria for RLS and PLMD in pediatric cases where periodic limb movements in sleep (PLMS) ?5 per hour were found; (2) review parental history of RLS; and (3) further define the clinical characteristics of RLS and PLMD in a pediatric subgroup where each child had a parent with clinically assessed RLS.MethodsThis was a retrospective analysis of consecutive polysomnograms (PSGs) with PLMS >5 per hour in patients ?19 years of age from a single pediatric sleep/neurology practice over 11 years. Excluded were cases with sleep apnea, narcolepsy, or medication that might induce or aggravate PLMS or RLS. ICSD-2 diagnostic criteria for definite RLS and PLMD were applied to the pediatric cases, and parental history for RLS was assessed. A subset of cases was included for detailed review if the child or adolescent had RLS or PLMD and a biological parent met RLS criteria and had a formal sleep evaluation.ResultsThere were 204 cases that met the initial inclusion criteria. A positive parental history of RLS was found in 53% of pediatric RLS cases and in 52% of pediatric PLMD cases. A subset of 37 children or adolescents and 36 biological parents, from 33 different families, met full inclusion criteria and are presented in detail. Of these 37, 10 had a diagnosis of RLS and 27 a diagnosis of PLMD. Over this same period of time, PLMS >5 per hour were found in 74% of pediatric definite RLS cases assessed by PSG.ConclusionsThis case series adds to the growing literature describing RLS and PLMD in children and adolescents using recently revised diagnostic criteria. The similar prevalence of parental RLS in both pediatric RLS and pediatric PLMD cases suggests a close association between PLMD and RLS in some cases. This supports the emerging view that PLMS may be a marker or endophenotype for a specific, common RLS genotype.     

Restless legs syndrome in patients with sequelae of poliomyelitis

BackgroundNo 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.MethodsA 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.ResultThe 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).DiscussionRLS occurs frequently in patients with PM, both in those with and without pPS, and responds well to treatment with dopaminergic drugs.     

Restless legs syndrome: diagnosis and review of management options

Restless legs syndrome (RLS) is one of the commonest movement disorders affecting sleep and also daytime functioning. The prevalence may be 8%–10% of the white Caucasian population. The diagnosis is simple and is based on a well-validated clinical questionnaire, yet misdiagnosis is common and the condition remains underdiagnosed and consequently inappropriately treated, often causing great distress to the sufferers. In spite of robust evidence for effective treatment of RLS, patients may often be told to “put up with the symptoms” and suffer the consequence of years of poor sleep which may lead to major lifestyle changes. This review addresses the diagnostic issues, the differential diagnosis, and the evidence base for treatment of the common condition.     

Restless legs syndrome and pregnancy: A review

Restless legs syndrome (RLS) is a common sensorimotor neurological disorder that is diagnosed according to the revised criteria of the International RLS Study Group (IRLSSG). The pathophysiology of RLS is still unknown and its prevalence is influenced by ethnicity, age, and gender. RLS is divided into two types by etiology: primary or idiopathic and secondary. Primary RLS is strongly influenced by a genetic component while secondary RLS is caused by other associated conditions such as end-stage renal disease or peripheral neuropathy. Another common condition associated with RLS is pregnancy. The prevalence of RLS during pregnancy is two to three times higher than in the normal population and is influenced by the trimester and the number of parity. The main mechanisms that may contribute to the pathophysiology of RLS during pregnancy are hormonal changes and iron and folate status. Standard medications for treating RLS during pregnancy are not established. Most medications have been used according to the evidence from non-pregnant patients. Therefore, consideration of the medical treatment for treating RLS during pregnancy should be balanced between the benefit of relieving the symptoms and maternal and fetal risk. In general, the prognosis of RLS during pregnancy is good and symptoms are usually relieved after delivery.     

Prevalence of restless legs syndrome and periodic limb movement disorder in the general population

BACKGROUND: Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are two sleep disorders characterized by abnormal leg movements and are responsible for deterioration in sleep quality. However, the prevalence of these disorders is not well known in the general population. This study aims to document the prevalence of RLS and PLMD in the general population and to identify factors associated with these conditions. METHODS: Cross-sectional studies were performed in the UK, Germany, Italy, Portugal and Spain. Overall, 18,980 subjects aged 15 to 100 years old representative of the general population of these five European countries underwent telephone interviews with the Sleep-EVAL system. A section of the questionnaire assessed leg symptoms during sleep. The diagnoses of PLMD and RLS were based on the minimal criteria provided by the International Classification of Sleep Disorders. RESULTS: The prevalence of PLMD was 3.9% and RLS was 5.5%. RLS and PLMD were higher in women than in men. The prevalence of RLS significantly increased with age. In multivariate models, being a woman, the presence of musculoskeletal disease, heart disease, obstructive sleep apnea syndrome, cataplexy, doing physical activities close to bedtime and the presence of a mental disorder were significantly associated with both disorders. Factors specific to PLMD were: being a shift or night worker, snoring, daily coffee intake, use of hypnotics and stress. Factors solely associated with RLS were: advanced age, obesity, hypertension, loud snoring, drinking at least three alcoholic beverages per day, smoking more than 20 cigarettes per day and use of SSRI. CONCLUSIONS: PLMD and RLS are prevalent in the general population. Both conditions are associated with several physical and mental disorders and may negatively impact sleep. Greater recognition of these sleep disorders is needed.