Transcranial brain sonography in Parkinson's disease with restless legs syndrome

Substantia nigra (SN) hyperechogenicity assessed by transcranial brain sonography (TCS) is a characteristic finding in idiopathic Parkinson's disease (PD). In contrast, SN hypoechogenicity on TCS has been recently demonstrated in restless legs syndrome (RLS). RLS is one of the most common sleep problems in PD, but the pathophysiologic relationship between these two disorders has not been thoroughly elucidated. We compared the SN echogenicities of PD patients with and without RLS to investigate whether comorbid RLS in PD affects SN echogenicity and to explain the echogenic differences between idiopathic RLS (iRLS) and secondary PD–related RLS (pRLS). Sixty‐three PD patients (median age 64.6 ± 10.6 years), 40 iRLS patients (53.1 ± 11.7 years), and 40 healthy controls (69.1 ± 2.3 years) were enrolled in our study. All subjects answered a sleep questionnaire and underwent TCS. PD patients were subdivided into two groups, PD with RLS (PD+RLS, n = 26) and PD without RLS (PD‐RLS, n = 37), and the sonographic findings of each group were compared. Although significant hyperechogenicity was detected in both the SN and SN/midbrain ratios in both PD subgroups compared with the controls and the iRLS group (P < 0.001), there were no significant differences in SN echogenicity between the PD+RLS and PD‐RLS groups. Meanwhile, iRLS patients showed significant SN hypoechogenicity. In conclusion, comorbid RLS in PD did not have an impact on the sonographic SN findings. These results suggest that the pathogenesis of pRLS and iRLS involve different mechanisms. Further study will be required to clarify the association between RLS and PD. © 2010 Movement Disorder Society     

Characterizing restless legs syndrome and leg motor restlessness in patients with Parkinson's disease: A multicenter case-controlled study

BackgroundWe investigated the prevalence and impact of restless legs syndrome (RLS) and leg motor restlessness (LMR) in patients with Parkinson's disease (PD) in a multicenter study.MethodsA total of 436 PD patients and 401 age- and sex-matched controls were included in this study. RLS was diagnosed based on four essential features. LMR was diagnosed when a participant exhibited the urge to move his or her legs but did not meet the four essential features of RLS.ResultsThe RLS prevalence did not differ between PD patients and controls (3.4% vs. 2.7%), while LMR prevalence was significantly higher in PD patients than in controls (12.8% vs. 4.5%). PD patients with RLS or LMR had a higher prevalence of excessive daytime sleepiness (EDS) (50.7%, vs. 6.9%), probable REM sleep behavior disorder (38.0% vs. 3.4%) and PD-related sleep problems (49.3% vs. 20.7%) than controls with RLS or LMR. RLS/LMR preceding PD onset was related to an older age of PD onset.ConclusionOur study revealed an increased prevalence of LMR but not RLS in PD patients. LMR could be an early manifestation of PD; however, whether LMR is within the range of RLS or whether LMR and RLS constitute different entities in PD requires further studies.     

Restless legs syndrome in Friedreich ataxia: A polysomnographic study

Friedreich ataxia (FA) is the most common type of hereditary ataxia. Frataxin deficiency due to a GAA expansion in the first intron of chromosome 9 results in intramitochondrial iron accumulation. On the basis of the patients' complaints about sleep disturbance and pathophysiological considerations, we systematically assessed sleep history and polysomnography in FA. We included 16 consecutive FA patients (11 men, 5 women; mean age, 35.4 ± 11.1 years) with a mean disease duration of 16.5 ± 7.0 years. All patients underwent a standardized protocol including a detailed sleep history and polysomnographic recordings. Eight out of 16 patients were diagnosed with restless legs syndrome (RLS). In seven patients, RLS onset was after the onset of FA. Interestingly, FA patients with RLS had significantly lower serum ferritin levels than FA patients without RLS (76.3 ± 56.0 μg/L vs. 176.3 ± 100.7 μg/L; P = 0.043 after correction for sex and age). Moreover, periodic leg movements in wakefulness (PLMW) indices were significantly higher in FA patients with RLS than FA patients without RLS (FA with RLS, 118.1 ± 50.7; FA without RLS, 65.6 ± 44.2; P = 0.028). There was an inverse correlation between serum ferritin levels and PLMW indices obtained in all FA patients (rho ?0.538, P = 0.039). RLS is common in FA. Its frequency in this primarily spinal ataxia appears consistent with the concept of dysfunctional spinal sensorimotor integration in the pathophysiology of RLS. The finding that RLS is more frequent in the context of lower serum ferritin levels in FA is interesting, but requires further investigation in larger patient samples. © 2009 Movement Disorder Society.     

Restless legs syndrome,a predictor of subcortical stroke: a prospective study in 346 stroke patients

ObjectiveThe objective of this study was to assess the prevalence of restless legs syndrome (RLS) among patients with stroke and to examine the anatomical correlation between location of stroke and RLS symptoms.MethodsWe administered a pre-structured sleep questionnaire to consecutive stroke patients seen in our neurology services department over a 3-year period. Unconscious (Glasgow Coma Scale score <15) or aphasic, renally impaired, or neuropathic patients were excluded. Diagnosis of RLS was established according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG), and polysomnography was conducted.ResultsOf 346 stroke patients, 35 (10.11%) fulfilled IRLSSG diagnostic criteria for RLS, which had existed for an average (±standard deviation) of 60 ± 40 months before stroke. The mean age of onset was 52.94 (±10.32) years. Twenty-four patients (68%) had RLS symptoms contralateral to the hemisphere involved in the stroke (eight with unilateral and 16 with grossly asymmetrical RLS). Twenty-nine of 35 patients (82.86%) had imaging evidence of subcortical (16 with hemorrhagic and 13 with ischemic) stroke. Patients with pre-stroke RLS differed from those without it only by subcortical location of the stroke (82.9% vs 31.5% respectively, p < 0.001). The most significant differentiating factor between patients with subcortical stroke and those with cortical stroke was pre-stroke RLS (22.83% vs 2.74%, p < 0.001), the others being history of hypertension and hemorrhagic stroke type.ConclusionRLS, especially unilateral or asymmetrical, might frequently pre-exist in patients presenting with subcortical stroke. The common laterality may suggest an important predictive value for RLS, and may form an important point for future research.     

Restless legs syndrome is a common feature of adult celiac disease

Restless legs syndrome (RLS) is a common neurological condition, frequently idiopathic, sometimes associated with specific disorders such as iron deficiency. We investigated RLS prevalence in celiac disease (CD), an autoimmune disease characterized by several features such as malabsorption‐related iron deficiency anemia and peripheral neuropathy. We screened a population of 100 adult CD patients for CD features, iron metabolism, clinical and neurological conditions, and enrolled 100 age‐ and sex‐matched controls in the general population. RLS was ascertained in CD patients and controls by both the presence of the four essential International RLS Study Group diagnostic criteria and neurological examination. The International RLS Study Group rating scale was used to measure RLS severity. We found a 31% prevalence of RLS in the CD population that was significantly higher than the prevalence in the control population (4%; P < 0.001). The average severity of RLS in CD population was moderate (17 ± 6.5). In the CD population, no significant correlation was found between RLS and either gluten‐free diet or iron metabolism, despite hemoglobin levels were significantly lower in CD patients with RLS than without RLS (P = 0.003). We found no correlation between RLS and other possible causes of secondary RLS, including signs of peripheral neuropathy, pregnancy, end‐stage renal disease, and pharmacological treatments.Our study broadens the spectrum of neurological disorders associated with CD and indicates that RLS should be sought for in all patients with CD. © 2010 Movement Disorder Society     

Family recurrence and oligo-anuria predict uremic restless legs syndrome

Pizza F, Persici E, La Manna G, Campieri C, Plazzi G, Carretta E, Cappuccilli ML, Ferri B, Stefoni S, Montagna P. Family recurrence and oligo‐anuria predict uremic restless legs syndrome.
Acta Neurol Scand: 2012: 125: 403–409.
© 2011 John Wiley & Sons A/S. Objectives – To determine clinical and laboratory predictors of restless legs syndrome (RLS) in patients with end‐stage kidney disease (ESKD) undergoing long‐term hemodialysis (HD). Materials and Methods – One hundred and sixty‐two consecutive patients were assessed. History of sleep disturbances, neurological examination, clinical, and laboratory data were collected. Patients with and without RLS were compared, and a logistic regression model described the relations between independent predictors and RLS. Results – Fifty‐one patients (32%) currently had RLS (RLS+). RLS+ vs RLS? patients were more frequently women (49% vs 29%, P = 0.012), had first‐degree relative with RLS (22% vs 6%, P = 0.004), insomnia (59% vs 36%, P = 0.007), peripheral neuropathy (41% vs 21%, P = 0.006), and low residual diuresis (92% vs 68% with below 500 ml/24 h, P = 0.001). Low (OR = 8.71, CI = 2.27–33.41; P = 0.002) and absent (OR = 4.96, CI = 1.52–16.20; P = 0.008) residual diuresis, peripheral neuropathy (OR = 4.00, CI = 1.44–11.14; P = 0.008), and first‐degree relative with RLS (OR = 3.82, CI = 1.21–12.13; P = 0.023) significantly predicted RLS in ESKD patients undergoing HD. Conclusion – Positive family history for RLS together with reduced/absent residual renal function and peripheral neuropathy predicts the risk for RLS in ESKD patients undergoing HD. Longitudinal studies are warranted to correlate RLS occurrence with genetic and environmental factors.     

Restless legs syndrome in Iranian patients with multiple sclerosis

Restless legs syndrome (RLS) is a common neurological movement disorder that is often seen in multiple sclerosis patients. However, the association between RLS and multiple sclerosis (MS) is still unclear and RLS is not considered as one of the MS symptoms. This study was conducted to assess the frequency of RLS and its associated factors in patients with MS. This was a cross-sectional study conducted during January and April 2010. A total of 205 patients diagnosed with multiple sclerosis (164 females, 41 males, mean age 32.8 ± 8.9 years) were enrolled in the study and underwent a medical history interview and a neurological examination. The diagnosis of RLS was based on International Restless Legs Syndrome Study Group Criteria. 57 patients (27.8 %) met the RLS diagnostic criteria. In 90.1 % of the patients, the onset of RLS was simultaneous with or followed by MS onset. There was no significant difference between patients with and without RLS in respect of age, gender, disease duration, and MS pattern. There was an increased incidence of leg jerks before sleep in patients with RLS (P = 0.04). In patients suffering from RLS, there is greater complaint of insomnia (P = 0.03). Body mass index, history of anemia, excessive day-time somnolence, consuming caffeine-containing beverages, pregnancy numbers, smoking, and alcohol consumption were not associated with the presence of RLS. This study revealed high prevalence of RLS in MS patients. Screening of RLS in these patients should always be considered to improve management of MS.     

Restless legs syndrome in Parkinson's disease.

The present study explores the frequency of RLS in PD and focuses on the clinical differences between patients with and without restless legs syndrome (RLS). A cross-sectional study was designed, comprising 114 patients diagnosed with PD. Those patients positive for RLS were assessed for intensity of the syndrome (IRLS). We compared the clinical characteristics of the patients with and without RLS, using specific scales: Unified Parkinson's Disease Rating Scale (UPDRS I-IV), quality of life (Parkinson's Disease Questionnaire, PDQ 39), sleep symptoms (Parkinson's Disease Sleep Scale, PDSS), and diurnal hypersomnia (Epworth Sleepiness Scale). Twenty-five patients (21.9%) out of a total of 114 subjects diagnosed with PD met the RLS diagnostic criteria. RLS was more frequent in women (68%). The patients with RLS showed poorer scores on the PDSS (PD-RLS+: 102.4 +/- 15.1 vs PD-RLS-: 113.2 +/- 16.4) (P = 0.005) and in the bodily discomfort dimension of the PDQ-39 (PD-RLS+ 6.1 +/- 3.4 vs PD-RLS- 3.8 +/- 2.6) (P = 0.002). Analysis of the subscales of the PDSS showed significant differences (P < 0.001) between both groups of patients in items 4 and 10, and to a lesser degree in items 5 (P = 0.01) and 11 (P = 0.02) There was no increased incidence of diurnal hypersomnia in the group of patients with RLS. There were no differences in the rest of the variables. RLS is frequent in patients with PD, though this condition doesn't apparently affect quality of life or lead to an increased presence of diurnal hypersomnia. It would be advisable to validate the diagnostic criteria of RLS in this specific group of patients.     

Restless legs syndrome in Parkinson's disease

INTRODUCTION: Recent clinical and functional imaging data suggest impaired central dopaminergic transmission in restless legs syndrome (RLS). As RLS responds to dopaminergic medications, an etiologic link between RLS and Parkinson's disease (PD) has been proposed. However, few studies have examined this association. OBJECTIVE: To investigate the prevalence of RLS amongst PD outpatient population. METHOD: The prevalence of RLS was determined by the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Consecutive PD patients (n=125) were prospectively evaluated in our clinic. RESULTS: There were 77 (61.6%) males and 48 (38.4%) females with a mean age of 65.1+/-9.3 (SD) years (range 34-83), and mean age of onset of disease at 59.6 years+/-10.7 (SD) years (range 30-81). Nineteen (15.2%) patients had motor restlessness. Of these, one (0.8%) patient had RLS-like symptoms closely correlated to wearing "off" effect of levodopa. None of the patients satisfied the IRLSSG diagnostic criteria of RLS. This was not significantly different compared to the 0.6% and 0.1% RLS prevalence in our general population and clinic population. CONCLUSIONS: Our study demonstrates that motor restlessness was present in 15.2% of our PD patients. However, prevalence of RLS in our PD patients was not significantly different from our general population or clinic population, suggesting that these two diseases may not share the same pathophysiologic mechanism.     

High false-positive rate of questionnaire-based restless legs syndrome diagnosis in multiple sclerosis

Background/ObjectivesRestless legs syndrome (RLS) is diagnosed by self-reported symptoms. Multiple sclerosis (MS) patients have disease-related symptoms which could mimic RLS. This study assessed the: (1) false-positive rate for questionnaire-based RLS diagnosis in MS patients and (2) utility of periodic leg movements during wakefulness (PLMW) on overnight polysomnography (PSG) in identifying true-positive RLS patients.MethodsAmbulatory MS patients without known sleep disorders were recruited. Subjects completed the International RLS Study Group (IRLSG) diagnostic questionnaire (IRLDQ) and underwent full overnight PSG. IRLDQ-positive patients underwent clinical evaluation to confirm the diagnosis and completed the RLS severity scale (IRLS).ResultsSeventy-one MS patients (mean age 46.8 ± 10.4 years) were evaluated. Thirty-eight had a positive IRLDQ. RLS diagnosis was confirmed in 22, yielding a false-positive rate of 42% [95% confidence interval (CI) 26–59%], predominantly attributable to paresthesiae (n = 7), and cramps and/or muscle spasms (n = 4). IRLS scores were not significantly different between subjects with confirmed and nonconfirmed RLS. The PLMW index was significantly higher in patients with confirmed RLS (55.4 ± 41.9 vs. 29.7 ± 18.8, p = 0.03). The sensitivity of a PLMW index >70/h for true-positive IRLDQ was 8/22 = 36%, 95% CI: 17.2–59.3, and the specificity was 16/16 = 100%, 95% CI: 79.4–100.ConclusionsMS patients have a high false-positive rate of RLS diagnosis using a standardized questionnaire largely attributable to MS-related sensorimotor symptoms. While detailed clinical evaluation is essential for confirming RLS diagnosis, the PLMW index may provide useful adjunctive information.     

A case‐control study on restless legs syndrome in nondialyzed patients with chronic renal failure

Restless legs syndrome (RLS) is a possible consequence of end‐stage renal disease. However, conclusive data on the association between RLS and chronic renal failure (CRF) in nondialyzed patients are still lacking. The aims of this study were: (1) to look for an association between RLS and CRF in nondialyzed patients; (2) to analyze the characteristics of RLS and its consequences on nocturnal rest in nondialyzed patients with CRF; (3) to identify possible predictors of RLS occurrence in nondialyzed patients with CRF. We recruited 138 nondialyzed patients with CRF (mean age: 69.8 ± 11.7 years; male: 61.6%) and 151 controls (mean age: 60.2 ± 18.6 years; male: 42.4%). An expert in sleep medicine investigated the presence of RLS by means of a face‐to‐face interview. Fifteen nondialyzed CRF patients and five controls were diagnosed as RLS affected. A multivariate analysis confirmed that RLS was independently associated with CRF in nondialyzed patients (P = 0.004). CRF patients RLS⁺ were more commonly women and showed the presence of an iron deficiency compared with the RLS^? ones. Independent predictors of RLS in nondialyzed CRF patients were: female sex (OR: 10.7, 95% CI: 2.2–31.3; P = 0.004) and percentage of transferrin saturation (OR: 0.6, 95% CI: 0.4–0.9; P = 0.04). This is the first case‐control study able to recognize an association between RLS and CRF in patients not yet on dialysis. Nephrologists should investigate and treat RLS in their nondialyzed patients with CRF. In particular, physicians should carefully investigate women and patients with iron deficiency in the presence of RLS symptoms. © 2010 Movement Disorder Society     

Restless legs syndrome in Parkinson's disease: a case-controlled study.

Restless legs syndrome (RLS) is a disorder of motor activity with a circadian pattern, occurring frequently in patients with Parkinson's disease (PD). We sought to estimate the prevalence of RLS in Indian PD patients. One hundred twenty-six consecutive PD patients and 128 healthy age- and sex-matched controls were evaluated using a predesigned questionnaire. RLS was present in 10 of 126 cases of PD (7.9%) and 1 of 128 controls (0.8%, P = 0.01). PD patients with RLS were older than those without RLS (63.70 +/- 7.80 years vs. 57.37 +/- 10.04 years; P = 0.05) and had higher prevalence of depression (40% vs. 10.3%; P = 0.023). No demographic factors or factors related to PD correlated with the presence or severity of RLS. RLS is more common among patients with PD than controls. A greater medical recognition of this disorder is needed in view of available effective treatment.     

Nocturnal eating is part of the clinical spectrum of restless legs syndrome and an underestimated risk factor for increased body mass index

ObjectivesWe aimed to investigate the prevalence of night eating syndrome (NES) in a large cohort of patients with restless legs syndrome (RLS).MethodsOur cross-sectional study included 120 patients examined at the University of Bologna Centre for Sleep Disorders, Bologna, Italy, and met all four International RLS criteria for the diagnosis of RLS. Each patient underwent a semistructured telephone interview investigating demographic data and general health status, RLS features and severity, presence of excessive daytime sleepiness, and presence of NES.ResultsThe sample included 37 men and 83 women with a mean age of 63.8 ± 11.5 years. There were 31% of patients who reported episodes of nocturnal eating (NE); among them, 17% fulfilled the new diagnostic criteria for NES. Comparing RLS patients with and without NE, there were no differences in RLS features. However, RLS patients with NE were older (67.2 ± 11.6 vs 62.4 ± 11; P = .038), were in a higher body mass index (BMI) range (27.7 ± 3.8 vs 26.1 ± 4.1 kg/m²; P = .023), were taking more drugs for concomitant diseases (89% vs 72%; P = .031), were more likely to report insomnia (40% vs 23%; P = .041), and were using more hypnotic agents (37.8% vs 19.3%; P = .050) and dopaminergic drugs (65% vs 46%; P = .041). When comparing those RLS patients with NES diagnostic criteria and those without NES, no differences emerged in demographic, clinical, and RLS features; however, NES patients were in a higher BMI range (28.3 ± 4.1 vs 26.2 ± 3.9 kg/m², P = .037), were more frequently smokers (43% vs 17%; P = .027), and were more frequently using hypnotic agents (30% vs 24%; P = .025). Lastly, no differences were found when comparing patients with a NES diagnosis and those with NE not fitting the diagnostic criteria for NES, except for a higher use of benzodiazepine drugs (BDZ) in this latter subgroup (29% vs zero; P = .014).ConclusionsA nocturnal compulsion to eat seems to be an intrinsic part of the clinical spectrum of RLS manifestations and an odd risk factor for increases in BMI in RLS patients. However, it is still not clear if NE in RLS would fit in one of the two known categorized syndromes of NE (i.e., sleep-related eating disorder [SRED] or NES) or if it represents a different strictly RLS-related eating behavior.     

Prevalence and clinical characteristics of restless legs syndrome in diabetic peripheral neuropathy: comparison with chronic osteoarthritis

BackgroundThe prevalence of restless legs syndrome (RLS) in patients with peripheral neuropathy has been reported to be higher than that of the general population in some studies, which suggests an association between neuropathy and RLS, but not all studies show increased RLS with neuropathy. These differences may reflect adequacy of the diagnosis, effects of chronic pain complicating the diagnosis, or population differences. Moreover, if there is increased risk for RLS with neuropathy, it may reflect consequences of the chronic pain rather than other aspects of diabetes mellitus (DM). Therefore, we investigated the effects of diagnosis rigor on the estimated prevalence of RLS in patients with diabetic peripheral neuropathy (DPN) and those with chronic leg pain from osteoarthritis (OA), and then we compared the RLS prevalence in these two populations with each other and with population prevalence for Korea.MethodsOur study is a prospective case-control study of 199 patients with DPN and 220 patients with OA. After evaluating the presence of RLS in these subjects using the diagnostic criteria of the International RLS Study Group, we confirmed the diagnosis of RLS through face-to-face interviews using the 18-item Hopkins Diagnostic Questionnaire, which removes RLS mimics; and through independent examinations by two neurologists.ResultsOf the 199 subjects with DPN, 44 (22%) appeared to have RLS from their answers on the 4-item RLS diagnostic questionnaire compared to 8 (3.6%) of 220 subjects with OA. However, the prevalence of RLS in the DPN group dropped to 16 (8%) subjects but stayed at 8 (3.6%) OA subjects when using the Hopkins Telephone Diagnostic Interview (HTDI) adapted for clinical interview. The RLS prevalence determined by HTDI remained significantly higher (P = .042) in the DPN group compared to the OA group and was twice that reported for the general Korean population (8% vs 3.9%). Among subjects with DPN, those with RLS were older (68.06 ± 8.43 years vs 62.46 ± 11.05 years; P = .049) and had higher pain scores (visual analog scale [VAS], 4.69 ± 2.52 vs 2.72 ± 2.12; P = .002). The quality of sleep (MOS [Medical Outcomes Study] sleep scale) and health-related quality of life (QoL) (total score on the 36-Item Short-Form Health Survey [SF-36]) showed no significant difference between the two groups.ConclusionsThe prevalence of RLS in patients with DPN cannot be accurately assessed with only the four diagnostic criteria interview, but the prevalence was higher than expected for Koreans from the general population prevalence and also was higher than occurred with OA patients with chronic leg pains when accurately assessed with a structured interview. Chronic leg pain from OA does not significantly complicate RLS diagnosis, and chronic pain itself does not explain the increased RLS prevalence in diabetic neuropathy.     

Prevalence and clinical profile of restless legs syndrome in Parkinson's disease

Parkinson's disease (PD) and restless legs syndrome (RLS) have a dopaminergic link. More insight in the clinical profile of RLS in patients with PD may benefit our understanding of this link. The aims of this study were to evaluate the frequency and clinical profile of RLS in a large cohort of PD patients. In 269 nondemented Caucasian PD patients, the four diagnostic criteria for RLS were administered by a RLS trained researcher. In patients with definite RLS, the severity of these symptoms was assessed. Furthermore, in all patients, relevant motor and nonmotor symptoms in PD were evaluated. Definite RLS was present in 11% of the patients. RLS patients were more often female (69% vs. 32%, P < 0.001), but no other significant differences existed between PD patients with and without RLS. Within the PD patients with RLS, severity of RLS correlated positively with PD severity, motor fluctuations, depressive symptoms, daytime sleepiness, cognitive problems, autonomic symptoms, and psychotic symptoms. This study in a large PD cohort shows that prevalence of RLS is similar to that in the general population, which might be caused by underestimation of RLS due to dopaminergic treatment. No relations were found between the presence of RLS and PD symptoms, but the severity of RLS was related to the severity of PD‐related, mainly nondopaminergic, symptoms. It is hypothesized that, nondopaminergic systems, such as the noradrenergic system may play a role in the possible link between PD and RLS. © 2010 Movement Disorder Society     

Exploring the relationship between Parkinson disease and restless legs syndrome

BACKGROUND: Restless legs syndrome (RLS) and Parkinson disease (PD) are common neurological conditions that respond to dopaminergic therapy. To our knowledge, the relationship between the two has not been thoroughly explored. METHODS: We consecutively queried 303 patients with PD seen in our clinic for the presence of RLS symptoms, and evaluated their condition with the Epworth Sleepiness Scale and other demographic and sleep measures. We then looked for predictors of RLS in these patients with PD. We also compared a larger group of patients with PD/RLS with a group of patients with RLS alone. RESULTS: Of 303 patients with PD, 63 (20.8%) had symptoms of RLS. Neither PD patient demographics nor PD treatments could reliably predict the development of RLS symptoms; however, lower serum ferritin levels were associated with RLS symptoms in our patients with PD (P =.01). In 54 (68%) of the 79 total patients with PD/RLS (including additional patients with PD/RLS seen in the clinic) with reliable age-at-onset data, the PD symptoms preceded the RLS symptoms (chi(2) test, P<.001). Compared with patients with idiopathic RLS (N = 146), patients with PD/RLS (N = 109) were older at RLS onset (P<.001), were less likely to have a family history of RLS (P<.001), and had lower serum ferritin levels (P =.01). CONCLUSIONS: Symptoms of RLS are common in patients with PD; however, except in patients with a family history of RLS, they seem to reflect a secondary phenomenon, perhaps in relation with lower ferritin levels. There is no evidence that RLS symptoms early in life predispose to the subsequent development of PD.     

Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease

Anxiety disorders are common in Parkinson's disease (PD), but are not well characterized. This study determined the prevalence and clinical correlates of all DSM‐IV‐TR anxiety disorder diagnoses in a sample of 127 subjects with idiopathic PD who underwent comprehensive assessments administered by a psychiatrist and neurologist. A panel of six psychiatrists with expertise in geriatric psychiatry and/or movement disorders established by consensus all psychiatric diagnoses. Current and lifetime prevalence of at least one anxiety disorder diagnosis was 43% (n = 55) and 49% (n = 63), respectively. Anxiety disorder not otherwise specified, a DSM diagnosis used for anxiety disturbances not meeting criteria for defined subtypes, was the most common diagnosis (30% lifetime prevalence, n = 38). Compared with nonanxious subjects, panic disorder (n = 13) was associated with earlier age of PD onset [50.3 (12.2) vs. 61.0 (13.7) years, P < 0.01], higher rates of motor fluctuations [77% (10/13) vs. 39% (25/64), P = 0.01] and morning dystonia [38% (5/13) vs. 13% (8/62), P < 0.03]. This high prevalence of anxiety disorders, including disturbances often not meeting conventional diagnostic criteria, suggests that anxiety in PD is likely underdiagnosed and undertreated and refined characterization of anxiety disorders in PD is needed. In addition, certain anxiety subtypes may be clinically useful markers associated with disease impact in PD. © 2009 Movement Disorder Society     

Beneficial effect of transcranial magnetic stimulation on sleep in Parkinson's disease

Sleep disorders are common in Parkinson's disease (PD) and have profound negative influences on quality of life. Sleep structure in healthy participants can be changed by repetitive transcranial magnetic stimulation (rTMS), but this has never been studied systematically in PD. Therefore, we characterized sleep in PD patients and examined effects of rTMS using a combination of actigraphy and a pressure sensitive pad. Thirteen PD patients received 5 Hz rTMS over the motor or parietal cortex. Actigraphic sleep estimates were obtained before, during and after rTMS, as well as compared with 8 healthy, age‐matched controls. Motor symptoms and mood were evaluated before and after rTMS. Mixed‐model regression analyses indicated that PD patients slept shorter (350 ± 17 vs. 419 ± 24 min., P = 0.02), more fragmented (fragmentation index 41 ± 4 vs. 22 ± 2, P = 0.0004) and had a lower sleep efficiency (77 ± 2 vs. 86 ± 2%, P = 0.002) and longer nocturnal awakenings (3.4 ± 0.2 vs. 2.3 ± 0.2 min., P = 0.003) than healthy controls. rTMS over the parietal, but not over the motor cortex improved sleep fragmentation (P = 0.0002) and sleep efficiency (P = 0.0002) and reduced the average duration of nocturnal awakenings (P = 0.02). No change of motor symptoms or mood was observed. Disturbed sleep in PD patients may partly be reversed by parietal rTMS, without affecting motor symptoms or mood. © 2009 Movement Disorder Society     

中国帕金森病患者不宁腿综合征患病率的meta分析

目的为了研究不宁腿综合征(RLS)在中国帕金森病(PD)患者中的患病率,以及其与一般人群中RLS患病率的比较。方法通过在万方医学网、中国知网(CNKI)、维普网、Pubmed和Web of Science数据库中检索关于中国PD患者RLS的患病率相关的横断面研究和病例﹣对照研究。经过筛选后的文献采用Stata 12.0来分析RLS在中国PD患者中的患病率。结果总共纳入了34项研究,其中按照诊断标准可分为IRLSSG组(n=7)、NMS问卷组(n=16)、PDSS组(n=4)以及自定标准的其他组(n=7)。meta分析结果提示,总的RLS患病率为33%;IRLSSG组RLS的患病率为23%;NMS问卷组的患病率为44%;PDSS组为13%;其他组为28%。RLS在PD组的患病率明显高于一般人群(OR=4.65,95%CI:2.39~9.03,P0.001)。结论 RLS在中国PD人群中的患病率为33%;依据不同的诊断标准得出的患病率有所差异。NMS问卷作为RLS的初筛具有一定作用,而对于PD中RLS患者的诊断则推荐采用IRLSSG。此外,中国PD人群中的RLS患病率要明显高于一般人群。     

Restless legs syndrome in patients with amyotrophic lateral sclerosis

We aimed to evaluate the frequency and determinants of restless legs syndrome (RLS) in a group of 76 patients with amyotrophic lateral sclerosis (ALS) and 100 control subjects. A diagnosis of RLS was made according to the criteria of the International RLS Study Group, and severity was assessed by the RLS severity scale. RLS was significantly more frequent in patients with ALS (ALS/RLS⁺) than in control subjects (25% vs. 8%; P = 0.002). Compared with control subjects, patients with ALS/RLS⁺ showed shorter history of RLS complaints and higher frequency of symptoms occurrence. Moreover, compared with those without RLS, patients with ALS/RLS⁺ showed increased functional impairment and more often reported sleep complaints. Multivariate logistic regression confirmed the association between RLS and functional impairment. Our findings suggest that RLS should be considered as a possible cause of disrupted sleep in patients with ALS and should be specifically investigated in these patients. © 2010 Movement Disorder Society.