Restless leg syndrome: a risk factor of higher prevalence of anxiety and depression in Parkinson’s disease patients

Background: Many studies have assessed the relationship of depression and anxiety with Parkinson’s disease (PD), as well as examining restless leg syndrome (RLS) with depression and anxiety. Nonetheless, there has not been an extensive effort to show how the prevalence of RLS affects both depression and anxiety in PD patients. The objective of this study was to examine how the prevalence of RLS in PD patients affects the prevalence and severity of depression and anxiety and how they compare with each other. This study is the first of its kind that examines the effects of the combination of the two neurological conditions with depression and anxiety as well as comparing their prevalence and severity to each other.

Methods: The study included 27 PD patients who also suffered from RLS, 27 PD patients not suffering from RLS, and 27 gender-matched healthy individuals. All were evaluated for caseness and severity of both anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); HADS-A and HADS-D, respectively.

Results: PD patients with RLS reported having the highest prevalence of both anxiety and depression. The least reported cases for both anxiety and depression were in the control group. In comparison, the results for severity of anxiety and depression within the three groups showed that PD patients with and without RLS had significantly higher severity scores for both anxiety and depression than the control group, but the scores did not significantly differ between the two PD patient groups.

Conclusion: The presence of RLS in PD patients may increase the occurrence of both anxiety and depression, but the severity of the symptoms is not significant in the two groups of the PD patients.     

The Impact of Subthalamic Deep Brain Stimulation on Restless Legs Syndrome in Parkinson's Disease

IntroductionThe study aimed at evaluating the effect of subthalamic deep brain stimulation (DBS-STN) on restless legs syndrome (RLS) in Parkinson's disease (PD) patients.Materials and MethodsWe assessed the presence of RLS before and 6 and 12 months after surgery in 36 patients. Differences between patients with RLS, without RLS, and with remission of RLS in terms of sleep measures (interview and validated questionnaires) and nonmotor symptoms (NMS). Polysomnography (PSG) was performed in 24 patients. Simple and multiple regression models were used to identify potential predictors of RLS outcome after DBS-STN.ResultsBefore DBS-STN 14 of the 36 patients (39%) were diagnosed with RLS. DBS-STN resulted in the resolution of RLS in 43% (n = 6) and the emergence of RLS in 2 (9%) patients. During the study, 20 patients remained without RLS and the patients with unremitting RLS (n = 8) experienced alleviation of symptoms. At baseline patients with RLS had higher Non-Motor Symptoms Scale (NMSS) total and sleep domain, Unified Parkinson's Disease Rating Scale (UPDRS) part IV and lower Parkinson's Disease Sleep Scale (PDSS) scores. There were no differences between the groups without and with RLS in terms of PSG recordings.ConclusionDBS-STN provided relief of symptoms in most of the patients with PD and RLS. We found that RLS was associated with worse subjective sleep quality, more severe NMS, and complications of levodopa therapy. DBS-STN may have direct impact on RLS rather than related indirectly through post-surgery change in medications.     

Random dominance and childhood migraine: a new marker? A controlled study of laterality in children with migraine

We assessed various aspects of laterality by direct observation in children with migraine and peer controls, with special reference to the frequency of random dominance. This frequency varied with the test battery used, being lower on the Edinburgh and Oldfield inventories which measure hand-use preference, and higher on the Handedness index and Spontaneous gestural index, which explore "genetic laterality". Random dominance would seem to be a new marker of migraine in childhood, for use alongside the hyperreactivity marker found in a previous study.     

Decline of immune responsiveness: a pathogenetic factor in Alzheimer's disease?

The involvement of immunological alterations in the pathogenesis of Alzheimer’s disease (AD) is widely discussed. Hitherto, findings on systemic immunological alterations are inconsistent. We measured the concentrations of the pro-inflammatory cytokines IL-1β, IL-2, IL-6, and TNF-α, and of the soluble receptors sIL-2r, sIL-6r, and sTNF-αr, in cerebrospinal fluid (CSF) and serum of 20 Alzheimer patients and 21 controls. Moreover, we studied levels of the pro-inflammatory IL-6, Il-12, IFN-γ, and TNF-α, and of the anti-inflammatory IL-5 and IL-13 in stimulated blood cell cultures from 27 AD patients and 25 controls. The levels in CSF and serum were diminished in AD or under detection limit. In mitogen-stimulated blood cultures we found a significant decrease of pro- and anti-inflammatory cytokines in the AD group. Our data suggest a general decline of immune responsiveness in AD. Based on the recent research, an impaired immune response may be considered as a pathogenetically relevant factor in AD. With respect to the putative role of ageing in AD, we assume a premature immunosenescence contributing to the Alzheimer’s pathology.     

Restless legs syndrome in narcolepsy: a side effect of sodium oxybate?

Gamma-hydroxybutyrate (GHB) has re-emerged as a major treatment for narcolepsy. As dopaminergic transmission is clearly involved in the pathophysiology of restless legs syndrome (RLS), and GHB reduces dopamine release, one may hypothesize that RLS may occur in narcolepsy in the presence of GHB. We report a case of narcolepsy with a severe occurrence of typical RLS with GHB, symptoms never previously experienced by the subject and reversible after withdrawal.     

Platelet–leukocyte interaction and platelet activation in migraine: a link to ischemic stroke?

OBJECTIVES: Migraine has been identified as an independent risk factor for ischemic stroke. Both neurogenic inflammation and platelet activation have been linked to the pathophysiology of migraine. Increased platelet activation results in up-regulation of specific binding to leukocytes which promotes pro-inflammatory leukocyte secretion and their tethering to endothelium, a mechanism that has been demonstrated in stroke and which could provide a link to migraine. We aimed to determine whether platelet-leukocyte aggregation is increased in migraine patients outside an acute attack. METHODS: Seventy two patients with migraine according to IHS criteria were compared to a control group (n = 72). Whole blood flow cytometry was used to quantify the activation dependent P selectin on the platelet, and to assess the fraction of platelets bound to the different leukocyte subsets. RESULTS: Migraine patients showed significantly more platelet-leukocyte aggregates compared to the control subjects (p = 0.003). This effect was driven by an increased polymorphonuclear cell-platelet aggregation (p = 0.003) whereas platelet aggregation with monocytes and lymphocytes was not. Platelet activation was also increased (p = 0.001). CONCLUSIONS: In migraine pro-inflammatory platelet adhesion to leukocytes occurs during the headache free interval similar to that seen in acute coronary and cerebrovascular syndromes. This may suggest a link between migraine and stroke on a cellular level.     

What's in a smile?: Quantification of the vertical smile of patients with myasthenia gravis

Many patients with myasthenia gravis who experience bulbar symptoms show a vertical smile, which may have a considerable, and often underestimated, impact on social life. Peri-oral muscle function can be quantified by calculating lip-length and snout indices, which indicate the degree to which a person is capable of smiling and of pursing the lips, respectively. In the present study patients with bulbar myasthenia gravis were compared to patients with ocular myasthenia gravis, patients now in remission (but previously suffering from bulbar myasthenia gravis), and healthy subjects. The lip-length and snout indices of patients with bulbar myasthenia gravis were significantly lower than those of the other groups. The facial impairments were no longer detectable in patients with bulbar myasthenia gravis in remission and no subclinical impairments in lip-length and snout indices were found in the ocular myasthenia gravis group. These findings were consistent with the patients' reports of impairment of smiling and other oral functions. The patients suffering from a vertical smile or other oral impairments were well aware of their condition, most probably because of the social consequences of being unable to smile. The indices could be of importance in the longitudinal evaluation of therapy in individual patients and in pharmacotherapeutical research. We found a low correlation between the lip-length and snout indices, which reflects the capricious pattern of involvement of separate muscles in myasthenia gravis. Therefore both indices deserve special attention if they are used for monitoring myasthenic symptoms.     

Relationships with patients in oncology: can a clinician be a friend?

Encounters with patients who are experiencing a life crisis such as cancer can be profoundly meaningful to both patients and those caring for them. Intense emotional involvement with patients can also lead to difficulties including "burnout" (Davitz and Davitz 1975), interstaff conflict (Burnham 1966; Pollack and Battle 1963; Robinson 1984; Weintraub 1964), and violation of professional boundaries (Applebaum 1990; Gartrell et al. 1986; Gutheil 1989a, 1989b). Nicholi (1988) has reviewed the challenges that psychotherapists face in maintaining relationships with patients that are both close and therapeutic. However, there has been little research into the relationships that clinicians in other medical disciplines have with their patients. This report describes both the stresses and rewards of relationships with oncology patients in a comprehensive sample of 192 staff members at a regional cancer center, interviewed about factors affecting their job satisfaction.     

Arylsulphatase A activity in familial parkinsonism: a pathogenetic role?

Cellular mechanism leading to Parkinson Disease (PD) is still unknown, but impairment of lysosomal degradation of aberrant proteins seems to play a crucial role. The most known lysosomal disease associated with PD is Gaucher Disease. However, actually a number of different lysosomal disorders have been linked with PD. We report three families with Arylsulphatase A partial deficit in which we can find a high recurrence of parkinsonism among the siblings. The pedigree members show as well some atypical signs and symptoms among the PD spectrum features. Arylsulphatase A plays a crucial role in protein degradation. Even if a possibly casual association cannot be excluded, it can be speculated that Arylsulphatase A partial deficit can act as a cofactor for neurodegeneration in subjects with other genetic or environmental predispositions to PD or to other neurodegenerative disease.     

Aggregation of social deficits and psychiatric disorders in parents of children with autism: toward a temperamental link?

Background

Autism is a group of neurodevelopmental disorders with heterogeneous phenotypic expression. Twin and family-based studies have demonstrated the importance of genetic factors in the etiology of these disorders. The pioneering work of Folstein and Rutter (1977) [16], showing concordance – 82 % in non affected monozygotic twins and 10 % in non affected dizygotic twins – for cognitive deficits (mostly affecting language), has directed work towards family-based studies aiming at demonstrating the existence of a “broad autism phenotype” (BAP), corresponding to the extension of the “autistic” phenotype in the relatives of affected children (Bailey et al., 1998 [5]). This notion of a broad phenotype makes it possible to take into account abnormalities in one or more of the three domains of the syndrome: communication, socialization and restrained and obsessive interest in a succession of subjects, with qualitatively similar but quantitatively smaller difficulties observed in the relatives.

Literature findings

We review here previous studies investigating the broad phenotype in the relatives of children with autism. We focus specifically on the hypothesis of a link between the aggregation of social deficits and of psychopathological problems, such problems being more frequently observed in these families than in families with other types of handicap (Abbeduto et al., 2004 [1]). Although the difficulties observed in these families may be partly explained by the stress of having to raise a heavily disabled child, genetic susceptibility factors may play a role in the occurrence of these problems in the families of autistic children. Constantino and Todd (2003) [14] support the hypothesis that a single factor is transmitted in families – social reciprocity – and may be responsible for the overall dysfunction in the various domains of the syndrome in affected individuals. However, this susceptibility factor may be linked to other deficits observed in certain psychiatric disorders (e.g., attention deficit in ADHD), consistent with the hypothesis that there is a link between the broad phenotype and psychopathological problems.

Conclusion

This paper reviews this issue in the two domains of study described and presents a hypothesis to account for the possible link between the presence of the broad phenotype – or more specifically, of social deficits – and the more frequent occurrence of psychological problems in the families of autistic individuals. The notion of temperament (Garon et al., 2009 [17]) is proposed and considered to present essential characteristics that might account for this relationship: indeed, temperament is associated with notions of IQ, psychopathology and social function and could potentially be used as a predictive variable in affected individuals. Finally, the link between temperament and psychopathology in the relatives of affected individuals may be reflected in the presence of cognitive peculiarities more specifically linked to socioemotional dysfunction (Losh and Piven, 2007 [22]).     

Restless legs syndrome: a rarity in the Nigerian pregnant population?

ObjectivesThe prevalence of RLS in pregnancy is higher when compared with the general population however it remains unknown among indigenous black Africans. Available data indicate that RLS is uncommon in sub-Saharan Africa. We embarked on this study to determine the prevalence and characteristics of RLS in an antenatal clinic sample of Nigerian pregnant women compared with a primary care sample of non-pregnant women.MethodsA total of 310 pregnant women and non-pregnant women filled out a questionnaire which incorporated the 2014 minimal criteria of the International Restless Legs Syndrome Study Group. Demographic and clinical data, including sleep duration and samples for blood hemoglobin concentration and urinalysis were obtained.ResultsThe mean ages of the pregnant and non-pregnant women were 24.9 ± 5.6 years and 23.6 + 5.4 years, respectively (p = 0.003). There was no case of RLS found among pregnant women while five (1.6%) of the non-pregnant women fulfilled the criteria for RLS. Overall, the prevalence report of RLS symptoms was associated with lower mean habitual nocturnal sleep duration (p < 0.05) coffee (p = 0.013) and kola nut (0.023) consumption, report of leg cramps (p < 0.001) and proteinuria (p = 0.047), Report of leg cramps and proteinuria were independently associated with RLS.ConclusionThe prevalence of restless legs syndrome is low among women of child-bearing age in the Nigerian population and may be lower in pregnancy. Report of leg cramps and proteinuria are independently associated with RLS.