Enfermedad de Willis-Ekbom a propósito de un caso / Willis-Ekbom's disease a case report

Los trastornos del sueño REM, son de alta prevalencia en nuestro medio, se manifiestan por lo general en comorbilidad con trastornos afectivos como la ansiedad y la depresión. Dependiendo de la sintomatología del paciente la afectación puede afectar su calidad de vida, en nuestro medio son frecuentes las crisis de pánico y trastornos del sueño reconocidos culturalmente como provenientes de embrujos o maleficios, que al no ser tratados con buenos resultados, buscan una respuesta en el ámbito médico postergando la intervención en el caso evaluado. El presente caso describe los síntomas experimentados por un adulto de sexo masculino, con un cuadro que impresiona por su descripción sintomatológica de origen netamente urológico, que fue valorado en integridad con sus respectivos resultados laboratoriales y de gabinete es referido a diferentes especialidades y finalmente a psiquiatría donde se llega a la conclusión diagnostica de enfermedad de Willis-Ekbom, trastorno del sueño REM y Trastorno de ansiedad generalizada con crisis de pánico, se realiza tratamiento específico, con resultados favorables y seguimientos periódicos. Se presenta el caso clínico de un paciente de sexo masculino de 61 años como se describe en la presentación.

REM sleep disorders, are of high prevalence in our environment, are usually manifested in comorbidity with affective disorders such as anxiety and depression. Depending on the symptomatology of the patient, the affectation can affect their quality of life, in our environment there are frequent panic crises and sleep disorders culturally recognized as coming from spells or curses, which, when not being treated with good results, seek an answer in the medical field postponing the intervention in the case evaluated. The present case describes the symptoms experienced by a male adult, with a picture that impresses with his symptomatic description of a purely urological origin, which was assessed in integrity with their respective laboratory and laboratory results. It refers to different specialties and finally to psychiatry. where the diagnostic conclusión of Willis-Ekbom disease, REM sleep disorder and generalized anxiety disorder with panic crisis is reached, specific treatment is performed, with favorable results and periodic follow-up.

Restless Legs Syndrome, and symptoms of Restless Syndrome in patients with Graves disease: a cross-sectional survey

OBJECTIVES: Restless legs syndrome (RLS) is a frequent comorbid condition associated with distinct unrelated diseases. While the incidence of RLS has not been definitively confirmed, RLS-like symptoms have been reported in a section of Asian population who also had hyperthyroidism. The prevalence of RLS is generally low in Asian populations. Under these circumstances, we hypothesized that in a population where RLS is common, such as in Brazil, RLS could manifest as a comorbid ailment alongside Graves' disease, a common hyperthyroid condition. METHODS: In a cross-sectional survey, 108 patients who presented with Graves' disease were analyzed for restless legs or associated symptoms. RESULTS: Twelve patients (11.1%) displayed symptoms of RLS prior to the incidence of Graves' disease. These patients experienced worsening of the symptoms during their hyperthyroid state. Six patients (5.6%) developed RLS, consequent upon the incidence of Graves' disease as per the consensus of the panel of the experts. Fifteen patients (13.9%) also presented with RLS-like symptoms without any discernible circadian feature of the syndrome. CONCLUSION: Our findings confirm that Graves' disease might trigger restless legs-like symptoms, while the condition of hyperthyroidism could also be complicated by definite RLS.

Association between Restless Legs Syndrome Symptoms and Self-Reported Hypertension: a Nationwide Questionnaire Study in Korea

BACKGROUND: The association between restless legs syndrome (RLS) and hypertension remains controversial. We investigated the relationship between RLS and hypertension in a nationwide sample of the Korean adult population. METHODS: This was a cross-sectional questionnaire-based study including 2,740 adults aged 19 years or more. Subjects who met the four essential International RLS Study Group criteria and reported symptoms occurring at least once a week were defined as the RLS group. The presence of hypertension was defined as a self-reported history of physician-diagnosed hypertension. We conducted multiple logistic regression analysis to determine the independent association between RLS symptoms and self-reported hypertension after adjusting for potential confounding factors. RESULTS: Among the 2,740 subjects, 68 (2.5%; 95% confidence interval [CI], 1.9%–3.1%) were found to have RLS with a symptom frequency of at least once a week. The prevalence of self-reported hypertension was 30.9% (95% CI, 20.5%–42.0%) in the RLS group, which was significantly higher than that in controls (12.4%; 95% CI, 11.2%–13.6%; P < 0.001). Multiple logistic regression analysis showed that the adjusted odds ratio for self-reported hypertension in the RLS group was 2.10 (95% CI, 1.12–3.93) compared to controls. In addition to RLS symptoms, old age, being overweight, low education level, diabetes mellitus, and short sleep duration were significantly associated with self-reported hypertension. CONCLUSION: RLS symptoms occurring at least once a week is independently associated with a higher prevalence of self-reported hypertension in the adult Korean population. Further research will confirm the clinical implication of the present results and the causal relationship between RLS and hypertension.

Exclusion of mimics does not influence Willis-Ekbom disease diagnosis among recent medical graduates / Exclusão de fatores confundidores não influencia o diagnóstico da doença de Willis-Ekbom entre recém-formados em Medicina

ABSTRACT In view of the diagnostic challenge posed by restless legs syndrome/Willis-Ekbom disease (RLS/WED) to health professionals and the challenge of its recognition by patients, the diagnostic criteria have been revised and updated to facilitate identification of this disease. However, in a previous study, we found that self-diagnosis of RLS/WED depends on the very name used to describe the condition. Objective: To ascertain whether the presence of the fifth diagnostic criterion of the International Restless Legs Syndrome Study Group (IRLSSG), is necessary for RLS/WED diagnosis when the term "Willis-Ekbom disease" is used. Methods: We randomly distributed 705 forms to recent medical graduates, asking them to self-assess whether they had "Willis-Ekbom disease" (WED). In one questionnaire model, we excluded the fifth criterion suggested by the IRLSSG, while in the other, all five criteria were included. No forms contained the term RLS; only WED was used throughout. Results: Seven hundred and five recent medical graduates participated in the study. Among the 332 who received the form without the fifth criterion, 8 (2.41%) self-diagnosed as having WED (95%CI: 0.8%-4.1%). Of the 373 who received the form with all five of the 2014 IRLSSG criteria, 9 (2.41%) self-diagnosed as having WED (95%CI: 0.8%-4.0%) (p > 0.05). Conclusion: Our data show that presence of the fifth IRLSSG criterion did not influence self-diagnosis of WED among recent medical graduates, suggesting that the name WED reduces the odds of mimics (confounding conditions) being misinterpreted as symptoms of this disease. This finding indicates that for the diagnosis of RLS/WED only four criteria and a systematic use of the name WED are necessary.

RESUMO Frente ao desafio diagnóstico da síndrome das pernas inquietas/doença de Willis-Ekbom (SPI/DWE) pelos profissionais de saúde e também seu reconhecimento pelos pacientes, os critérios de diagnóstico vêm sendo revisados e atualizados para facilitar a identificação dessa doença, porém, em estudo anterior, observamos que o autodiagnóstico da SPI/DWE depende do próprio nome utilizado para descrevê-la. Objetivo: Verificar se a presença do quinto critério do International Restless Legs Syndrome Study Group (IRLSSG) é necessária para o diagnóstico da SPI/DWE quando utilizamos apenas a expressão/denominação DWE. Métodos: Distribuímos aleatoriamente 705 formulários solicitando a médicos recém-formados que avaliassem se eles tinham DWE. Em um tipo de questionário, excluímos o quinto critério diagnóstico sugerido pelo IRLSSG e no outro mantivemos os cinco critérios. Em nenhum formulário apresentamos o termo SPI, apenas DWE. Resultados: Setecentos e cinco médicos recém-formados participaram do estudo. Dentre os 332 médicos que receberam o formulário sem o quinto critério, 8 (2,41%) autodiagnosticaram-se com DWE (IC 95%: 0,8%-4,1%). Trezentos e setenta e três médicos receberam o formulário com os 5 critérios do IRLSSG (2014) e 9 (2,41%) autodiagnosticaram-se como tendo DWE (IC 95%: 0,8%-4,0%) (p > 0.05). Conclusão: Nossos dados mostraram que a presença do quinto critério do IRLSSG não influenciou a realização do autodiagnóstico da DWE entre médicos recém-formados, sugerindo que a denominação DWE reduz a chance de condições confundidoras serem tomadas como sintomas desta doença. Este achado está de acordo com dados anteriores, onde mostramos que o autodiagnóstico da SPI/DWE é dependente da denominação utilizada para descrever a doença.

Trastornos de sueño en residentes de Atahualpa / Sleep disorders in Atahualpa residents

RESUMEN Es probable que los problemas de salud relacionados con los trastornos del sueño se encuentren en aumento en las zonas rurales de América Latina, en parte relacionados con los cambios en el estilo de vida, el trabajo con turnos nocturnos y otros factores. Sin embargo, poco se sabe sobre la prevalencia de estas condiciones en lugares rurales remotos. En el Proyecto Atahualpa, hemos investigado los trastornos del sueño utilizando instrumentos de campo estandarizados asociados con tecnología sofisticada como la polisomnografía. Una mala calidad del sueño se ha asociado con fragilidad y con la presencia de marcadores de neuroimagen de enfermedad de vasos cerebrales y atrofia cortical global. Por el contrario, la ingesta dietética de pescado oleoso se asoció con una mejor calidad del sueño. También se ha investigado la prevalencia y algunos correlatos del síndrome de las piernas inquietas (enfermedad de Willis-Ekbom) y se encontró una prevalencia relativamente superior a la descrita en la mayoría de las regiones tropicales, así como la asociación de esta afección con el estrés psicológico. Finalmente, un informe preliminar muestra una elevada prevalencia de apnea obstructiva moderada a severa en los residentes de Atahualpa de ≥60 años (27%) y su correlación con daño subcortical difuso de origen vascular. Se necesitan más estudios para comprender mejor las consecuencias de los síntomas relacionados con el sueño en dichas poblaciones.

ABSTRACT Health problems related to sleep disorders are likely on the rise in rural areas of Latin America, partly related to changes in life style, shift work, and other factors. However, little is known on the burden of these conditions in remote rural settings. In the Atahualpa Project, we have investigated sleep disorders using standardized field instruments associated with sophisticated technology such as polysomnography. A poor sleep quality has been associated with frailty and with the presence of neuroimaging markers of cerebral small vessel disease and global cortical atrophy. On the contrary, dietary intake of oily fish was associated with a better sleep quality. We have also investigated the prevalence and some correlates of the restless legs syndrome (Willis-Ekbom disease), and found a prevalence relatively higher than that described in most other tropical regions, as well as the association of this condition with psychological stress. Finally, a preliminary report shows a high prevalence of moderate-to-severe obstructive sleep apnea in Atahualpa residents aged ≥60 years (27%) and its correlation with diffuse subcortical damage of vascular origin. Further studies are needed to better understand consequences of sleep-related symptoms in underserved populations.

Saint John's wort, an herbal inducer of the cytochrome P4503A4 isoform, may alleviate symptoms of Willis-Ekbom's disease

OBJECTIVE: Certain drug classes alleviate the symptoms of Willis-Ekbom's disease, whereas others aggravate them. The pharmacological profiles of these drugs suggest that drugs that alleviate Willis-Ekbom's disease inhibit thyroid hormone activity, whereas drugs that aggravate Willis-Ekbom's disease increase thyroid hormone activity. These different effects may be secondary to the opposing actions that drugs have on the CYP4503A4 enzyme isoform. Drugs that worsen the symptoms of the Willis-Ekbom's disease inhibit the CYP4503A4 isoform, and drugs that ameliorate the symptoms induce CYP4503A4. The aim of this study is to determine whether Saint John's wort, as an inducer of the CYP4503A4 isoform, diminishes the severity of Willis-Ekbom's disease symptoms by increasing the metabolism of thyroid hormone in treated patients. METHODS: In an open-label pilot trial, we treated 21 Willis-Ekbom's disease patients with a concentrated extract of Saint John's wort at a daily dose of 300 mg over the course of three months. RESULTS: Saint John's wort reduced the severity of Willis-Ekbom's disease symptoms in 17 of the 21 patients. CONCLUSION: Results of this trial suggest that Saint John's wort may benefit some Willis-Ekbom's disease patients. However, as this trial was not placebo-controlled, the extent to which Saint John's wort is effective as a Willis-Ekbom's disease treatment will depend on future, blinded placebo-controlled studies. .