不宁腿综合征与卒中

不宁腿综合征（restless legs syndrome,RLS）与卒中均为神经系统常见疾病。研究提示RLS 增加卒中的发病风险,而且卒中患者RLS发病率也明显升高。急性缺血性卒中合并RLS可能与梗死部 位相关,病灶部位的铁含量异常、多巴胺功能障碍可能与RLS相关。另外,RLS患者交感神经过度兴奋、 副交感神经被抑制、下丘脑-垂体-肾上腺轴（hypothal ami c-pituitary-adrenal axis,HPA）活动增加,心率 增快,血压升高,引发心房颤动等各种心律失常,可增加脑血管病的发病风险。有研究表明,RLS患者 的不良睡眠质量可能导致的睡眠剥夺、抑郁及不良睡眠习惯均能增加卒中的风险。正确认识两者之 间的关系,有助于我们在临床上更好地进行卒中和RLS诊断以及防治工作。     

不宁腿综合征与卒中相关性的临床证据和可能机制

近年来临床报道的不宁腿综合征（restless legs syndrome,RLS）与卒中相关联的临床病例 层出不穷,RLS患者罹患卒中的比例增加,卒中后出现RLS亦较常见。近年来频繁报道的RLS与卒中相 关性临床研究,也认证了上述的结论。推测RLS发病机制与卒中的多项危险因素相关或重叠存在,重 度的RLS增加了卒中,尤其缺血性卒中的风险,并可能成为缺血性卒中的危险因素,但RLS与卒中之间 的因果关系尚需要进一步探讨。     

急性脑梗死后不宁腿综合征的临床特征

目的  了解急性脑梗死后不宁腿综合征（restless legs syndrome,RLS）的临床特征,以及其对急性脑梗死预后的影响。 方法  按照国际不宁腿工作组（International Restless Legs Syndrome Study Group,IRLSSG）定义标准,连续筛查住院治疗的急性脑梗死患者中RLS患者,选择年龄、性别、梗死部位匹配的同时期住院的非RLS脑梗死患者为对照组,比较2组的临床特征及预后。 结果  研究筛查275例急性脑梗死患者,其中RLS患者19例,患病率为6.91%（19/275）。RLS组年龄（62.89±10.26）岁;非RLS组19例,年龄（62.63±9.96）岁。与对照组比较,RLS组Epworth嗜睡量表（Epworth Sleepiness Scale,ESS）>10分的比例更高（57.9% vs 21.1%,P=0.020）,匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index,PSQI）>15分的比例也更高（47.4% vs 15.8%,P=0.040）。脑梗死后90?d和180?d,RLS组Barthel指数（Barthel Index,BI）低于非RLS组（P值分别是＜0.001和＜0.001）,改良Rankin量表（modified Rankin Scale,mRS）评分高于非RLS组（P值分别是0.64和0.04）。RLS组14例（73.68%）患者合并周期性腿动,15例（78.9%）患者合并阻塞性睡眠呼吸障碍。 结论  急性脑梗死后RLS患者较无RLS患者睡眠质量及预后更差。     

Acute-Withdrawal Restless Legs Syndrome Following Abrupt Cessation of Short-Term Tramadol

We report a young man who had received tramadol for pain control and experienced an uncomfortable sensation in both legs immediately after tramadol withdrawal that worsened at rest and at night, and which could be relieved only by moving the legs. He suffered from insomnia and paced up and down in his house every night. Readministration of tramadol dramatically resolved his symptoms of restless legs syndrome (RLS), but they reappeared after tramadol withdrawal. Tramadol was therefore replaced with ropinirole, which was discontinued after several weeks, and there was no recurrence of his RLS symptoms. This patient appeared to have developed tramadol-withdrawal-induced RLS, and this case report emphasizes the importance of monitoring for withdrawal-type symptoms like RLS when tramadol intake is being stopped.     

MEIS1, a Promising Candidate Gene,Is Not Associated with the Core Symptoms of Antipsychotic-Induced Restless Legs Syndrome in Korean Schizophrenia Patients

ObjectiveRestless legs syndrome (RLS) is a distressing sleep disorder to which individuals appear to be genetically predisposed. In the present study, we assumed that antipsychotic-induced RLS symptoms were attributable to differences in individual genetic susceptibility, and investigated whether MEIS1, a promising candidate gene, was associated with antipsychotic-induced RLS symptoms in schizophrenia patients.MethodsAll subjects were diagnosed with schizophrenia by board-certified psychiatrists using the Korean version of the Structured Clinical Interview for DSM-IV. We assessed antipsychotic-induced RLS symptoms in 190 Korean schizophrenic patients using the diagnostic criteria of the International Restless Legs Syndrome Study Group. Genotyping was performed for the rs2300478 and rs6710341 polymorphisms of the MEIS1 gene.ResultsWe divided subjects into RLS symptom (n=96) and non-symptom (n=94) groups. There was no significant between-group difference in the genotype or allele frequencies of the two polymorphisms investigated, nor in the frequency of the rs2300478-rs6710341 haplotype.ConclusionOur data do not suggest that the rs2300478 and rs6710341 polymorphisms of the MEIS1 gene are associated with the core symptoms of antipsychotic-induced RLS in schizophrenia; different genetic mechanisms may underlie antipsychotic-induced vs. primary RLS.     

No Evidence for Association between Tyrosine Hydroxylase Gene Val81Met Polymorphism and Susceptibility to Tardive Dyskinesia in Schizophrenia

Objective

Tyrosine hydroxylase (TH) is the rate-limiting enzyme in dopamine biosynthesis. Because the TH Val81Met polymorphism is located in the amino-terminal regulatory domain of the tetrameric enzyme, it is a candidate marker for susceptibility to dopamine-related traits. We investigated the hypothesis that TH Val81Met polymorphism can influence susceptibility to tardive dyskinesia (TD) in schizophrenia.

Methods

TH Val81Met polymorphism was analyzed by PCR-based methods in 83 schizophrenic patients with TD and 126 schizophrenic patients without TD, matched for antipsychotic drug exposure and other relevant variables.

Results

There was no significant association of the genotype and allele frequencies determined by the TH Val81Met polymorphism between TD and non-TD patients. In addition, there was no significant difference in terms of total Abnormal Involuntary Movement Scale scores among the three genotype groups.

Conclusion

Within the limitations imposed by the size of the clinical sample, these findings suggest that the Val81Met polymorphism of the TH gene does not contribute significantly to the risk for TD.     

Resolution of Pregabalin and Mirtazapine Associated Restless Legs Syndrome by Bupropion in a Patient with Major Depressive Disorder

Bupropion is a selective norepinephrine and dopamine reuptake inhibitor with no serotonergic activity, and is therefore an antidepressant with unique pharmacological properties. There are some reports that selective serotonin reuptake inhibitors (SSRIs) or mirtazapine can induce adverse effects including restless legs syndrome (RLS) and that bupropion can reverse these adverse effects. Here, we report about a patient with a major depressive disorder who exhibited RLS after being treated with pregabalin and mirtazapine. This adverse effect disappeared after having switched from mirtazapine to bupropion. Bupropion inhibits the reuptake of dopamine and increases dopamine neurotransmission in both the nucleus accumbens and the prefrontal cortex. This pharmacological profile can be effective in patients with RLS related to dopamine hypoactivity. However, the limitations of this single case report mean that further investigations with larger samples are needed.     

Demographic and Clinical Characteristics of Patients with Restless Legs Syndrome in Spine Clinic

Objective

The restless legs syndrome (RLS) is a common disorder affecting up to 5% to 15% of the general population, in which the incidence increases with age, and includes paresthesia in the legs. The purpose of this study is to investigate the incidence of RLS in spine center and to review clinical manifestations of this syndrome and its current treatments.

Methods

Over a period of a year, retrospective medical record review and lumbar magnetic resonance images were performed on 32 patients with RLS in spine clinic who were diagnosed by National Institutes of Health criteria. Affected limbs were classified as five. Two grading systems were used in the evaluation of neural compromises.

Results

The incidence of RLS was 5.00% (32/639). There were 16 males (50%) and 16 females (50%). The median age at diagnosis was 55.4 years (range, 25-93 years). There are no correlation between the affected limbs of RLS and neural compromises on the lumbar spine.

Conclusion

The RLS is a clearly common neurologic disorder of the limbs, usually the legs. The awareness of this syndrome can help reduce diagnostic error; thereby, avoiding the morbidity and expense associated with unnecessary studies or inappropriate treatments in RLS patients.     

加巴喷丁治疗不安腿综合征的疗效观察

目的：探讨加巴喷丁治疗不安腿综合征（RLS）的疗效。方法：回顾性分析10例应用加巴喷丁治疗RLS患者的临床资料，以2RLS病情严重程度评定量表（IRLS）及匹兹堡睡眠质量指数（PSQI）评估疗效。结果：RLS患者用药前后IRLS及PSQI评分差异有统计学意义（P〈0．05）；在主观睡眠质量、入睡时间、睡眠时间、睡眠效率、日间功能障碍及总分评定差异有统计学意义（P〈0．05），疗效与病程成正相关（P〈0．05）。结论：加巴喷丁用于治疗RLS有效。     

Pergolide: treatment of choice in Restless Legs Syndrome (RLS) and Nocturnal Myoclonus Syndrome (NMS). Longterm follow up on pergolide

Summary. Pergolide has proven significantly superior to L-dopa plus peripheral decarboxylase inhibitor in short-term therapy of RLS/NMS. We now first present long-term follow-up sleep data showing its lastingly good effects after averagely 517 treatment days. Accepted December 15, 1997; received November 5, 1997     

不安腿综合征的主观睡眠质量评估及多导睡眠图研究

目的了解不安腿综合征(RLS)患者的主、客观睡眠质量,以及RLS严重程度量表评分与睡眠质量的相关性。方法选取30例RLS患者(RLS组)和30名年龄、性别匹配的健康正常人(对照组),通过BECK抑郁量表、BECK焦虑量表、Chalder疲惫量表、匹兹堡睡眠质量指数量表、Epworth嗜睡量表、RLS生活质量量表评估RLS患者主观睡眠质量及生活质量。运用多导睡眠图分析患者客观睡眠质量情况。对RLS严重程度与睡眠质量进行相关性分析。结果与对照组比较,RLS组抑郁量表评分、Chalder疲惫量表评分、匹兹堡睡眠质量指数量表评分均增高。RLS严重程度量表评分(IRLS)与Chalder疲惫量表评分、匹兹堡睡眠质量指数量表评分及RLS生活质量量表评分具有显著相关性。多导睡眠图检测:RLS组总睡眠时间减少,睡眠效率下降;N1期睡眠比例、入睡后清醒时间及微觉醒指数增高;RLS组睡眠期周期性肢体运动(PLMS)指数显著增高(P0.001)。IRLS评分与PLMS指数具有相关性(r=0.371,P=0.044),而与其他客观睡眠参数无相关性。结论 RLS显著影响患者睡眠质量及生活质量,且主观睡眠质量、生活质量及PLMS指数与IRLS具有相关性。     

Alterations of Functional Connectivity in Patients With Restless Legs Syndrome

Restless legs syndrome (RLS) is a common neurological illness marked by a strong desire to move one’s legs, usually in association with uncomfortable sensations. Recent studies have investigated brain networks and connectivity in RLS. The advent of network analysis has greatly improved our understanding of the brain and various neurological disorders. A few studies have investigated alterations in functional connectivity in patients with RLS. This article reviews functional connectivity studies of patients with RLS, which have identified significant alterations relative to healthy controls in several brain networks including thalamic, salience, default-mode, and small-world networks. In addition, network changes related to RLS treatment have been found, including to repetitive transcranial magnetic stimulation, transcutaneous spinal cord direct-current stimulation, and dopaminergic drugs. These findings suggest that the underlying pathogenesis of RLS includes alterations in the functional connectivity in the brain and that RLS is a network disorder.     

Effects of Transcutaneous Spinal Direct Current Stimulation in Idiopathic Restless Legs Patients

BackgroundTranscutaneous spinal direct current stimulation (tsDCS) is a new non-invasive technique to modulate spinal cord activity. The pathophysiological concept of primary RLS proposes increased spinal excitability.ObjectiveThis pilot study used tsDCS to reduce pathologically enhanced spinal excitability in RLS patients and to thereby ameliorate clinical symptoms.Methods20 patients with idiopathic RLS and 14 healthy subjects participated in this double-blinded, placebo-controlled study. All participants received one session of cathodal, anodal and sham stimulation of the thoracic spinal cord for 15 min (2.5 mA) each, in randomized order during their symptomatic phase in the evening. The soleus Hoffmann-reflex with Hmax/Mmax-ratio and seven different H2/H1-ratios (of two H-reflex responses to double stimuli) were measured. The RLS symptoms were assessed by a visual analogue scale (VAS). All parameters were measured before and twice after tsDCS.ResultsRLS patients showed increased H2/H1-ratios during their symptomatic phase in the evening. Application of anodal stimulation led to a decreased H2/H1-ratio for 0.2 and 0.3 s interstimulus intervals in patients. Furthermore, application of anodal and cathodal stimulation led to a reduction in restless legs symptoms on the VAS, whereas application of sham stimulation had no effects on either the VAS or on the H2/H1-ratio in patients. VAS changes did not correlate with changes of H2/H1-ratios.ConclusionsThis is the first tsDCS study in idiopathic RLS, which resulted in short-lasting clinical improvement. Furthermore, our results support the pathophysiological concept of spinal cord hyperexcitability in primary RLS and provide the basis for a new non-pharmacological treatment tool.