ABSTRACT
Abstract Objectives: To assess the presence of restless legs syndrome, periodic leg movement, and sleep disorders in female adolescents with idiopathic musculoskeletal pain through a sleep scale and polysomnography, and to compare these data in adolescents without pain history. Method: Twenty-six adolescents diagnosed with idiopathic musculoskeletal pain followed in a pain outpatient clinic and 25 healthy controls matched by age and education were recruited. The restless legs syndrome criteria were evaluated according to the International Restless Legs Syndrome Study Group, the Sleep Disturbance Scale for Children was completed, nocturnal polysomnography was performed, and anxiety symptoms were recorded. Results: The mean age of idiopathic musculoskeletal pain adolescents was 13.9 ± 1.6 years; in controls, it was 14.4 ± 1.4 years. One adolescent in the control group (4 %) and nine patients with idiopathic musculoskeletal pain (34.6 %) fulfilled the restless legs syndrome criteria (p = 0.011). The authors did not observe significant differences in Sleep Disturbance Scale for Children scores between the groups in all components: disorders of initiating and maintaining sleep (p = 0.290), sleep breathing disorders (p = 0.576), disorders of arousal (p = 0.162), sleep-wake transition disorders (p = 0.258), disorder of excessive daytime somnolence (p = 0.594), and sleep hyperhidrosis (p = 0.797). The neurophysiological, respiratory, and periodic leg movement parameters were similar in both groups. Having anxiety was not associated with restless legs syndrome (p = 0.11). Three patients with idiopathic musculoskeletal pain (11.5 %) presented restless legs syndrome and periodic leg movement simultaneously, which was absent in the control group. Conclusion: Female adolescents with idiopathic musculoskeletal pain present criteria for RLS more frequently than healthy adolescents. However, this study did not observe relevant changes in objective and subject sleep variables.
Resumo Objetivos: Avaliar a presença de síndrome das pernas inquietas, movimento periódico das pernas e distúrbios do sono em adolescentes do sexo feminino com dor musculoesquelética idiopática por meio da escala do sono e da polissonografia e comparar esses dados em adolescentes sem histórico de dor. Método: Foram recrutados 26 adolescentes diagnosticados com dor musculoesquelética idiopática acompanhados em um ambulatório de dor e 25 controles saudáveis pareados por idade e escolaridade. Avaliamos os critérios da síndrome das pernas inquietas de acordo com o Grupo Internacional de Estudos de Síndrome das Pernas Inquietas, a Escala de Distúrbios do Sono em Crianças, a polissonografia noturna e os sintomas de ansiedade. Resultados: A idade média dos adolescentes com dor musculoesquelética idiopática foi 13,9 ± 1,6 anos e dos controles foi 14,4 ± 1,4 anos. Um adolescente no grupo de controle (4%) e nove pacientes com dor musculoesquelética idiopática (34,6%) atenderam aos critérios da síndrome das pernas inquietas (p = 0,011). Não observamos diferenças significativas nos escores da Escala de Distúrbios do Sono em Crianças entre os grupos em todos os componentes: distúrbios do início e da manutenção do sono (p = 0,290), distúrbios respiratórios do sono (p = 0,576), distúrbios do despertar (p = 0,162), distúrbios da transição sono-vigília (p = 0,258), sonolência diurna excessiva (p = 0,594) e hiperidrose do sono (p = 0,797). Os parâmetros neurofisiológicos, respiratórios e o movimento periódico das pernas foram semelhantes nos dois grupos. Ansiedade não foi associada à síndrome das pernas inquietas (p = 0,11). Três pacientes com dor musculoesquelética idiopática (11,5%) apresentaram síndrome das pernas inquietas e movimento periódico das pernas simultaneamente, situação ausente no grupo de controle. Conclusão: As adolescentes do sexo feminino com dor musculoesquelética idiopática apresentaram critérios para síndrome das pernas inquietas com mais frequência do que as adolescentes saudáveis. Contudo, não observamos mudanças relevantes nas variáveis do sono objetivas e subjetivas.
Subject(s)
Humans , Female , Child , Adolescent , Restless Legs Syndrome/complications , Restless Legs Syndrome/epidemiology , Sleep Wake Disorders/complications , Musculoskeletal Pain , Sleep , PolysomnographyABSTRACT
Restless legs syndrome (RLS) is a disease characterized by the urge to move the legs and sleep disturbances. Similarly, chronic spontaneous urticaria (CSU) is a dermatological disease characterized by pruritus and sleep disorders. In this study, we aimed to determine the prevalence and severity of RLS in patients with chronic spontaneous urticaria (CSU) and to compare the quality of sleep of patients with and without RLS in the CSU group using the Pittsburgh Sleep Quality Index. A total of 130 patients with CSU and 100 healthy controls were included in this study. The frequency of RLS, frequency of sleep disturbances, and average score of RLS in patients with CSU were statistically significantly higher than control groups (respectively P = 0.008, P = 0.009, P = 0.004). Subjective sleep quality, sleep latency and habitual sleep efficiency scores in patients with RLS were statistically significantly higher than patients without RLS (respectively P = 0.016, P = 0.007, P = 0.035). We claimed that pruritus of urticaria may decrease the quality of sleep in patients with RLS and it may trigger and worsen the restless legs syndrome. Furthermore, RLS and CSU may share a common etiology.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Case-Control Studies , Cross-Sectional Studies , Prevalence , Restless Legs Syndrome/complications , Severity of Illness Index , Sleep Wake Disorders/etiology , Urticaria/complicationsABSTRACT
Restless legs syndrome (RLS) is a neurological disorder that responds to dopaminergic drugs, indicating a common pathophysiology with Parkinson's disease (PD). The prevalence of RLS was estimated in a group of PD patients and its clinical and biochemical characteristics were analysed. Forty-eight patients with PD were evaluated into two groups, with and without RLS. Clinical characteristics assessed in both groups were age, gender, duration of PD, Hoehn and Yahr, and Schwab and England scales. Laboratory variables such as hemoglobin, s-iron, s-ferritin and creatinine were obtained. The prevalence of RLS was 18.75 percent. No significant differences regarding clinical variables and biochemical parameters were observed. The high prevalence of RLS found in PD patients suggests the concept of a common etiological link and it seems that secondary causes did not play a central role in the pathophysiology of RLS in this group of parkinsonian patients.
A síndrome das pernas inquietas (SPI) é um distúrbio sensitivo-motor que responde aos agentes dopaminérgicos, demonstrando uma possível semelhança fisiopatológica com a doença de Parkinson (DP). Foi avaliada a prevalência da SPI em um grupo de pacientes com DP e suas características clínicas e laboratoriais. Quarenta e oito pacientes diagnosticados com DP foram divididos em dois grupos: com e sem SPI. Características clínicas como idade, sexo, duração da DP, escalas de Hoehn e Yahr, e Schwab e England e achados bioquímicos como hemoglobina, ferro sérico, ferritina sérica e creatinina foram obtidos. A freqüência da SPI foi de 18,75 por cento. Não se observaram diferenças estatisticamente significativas quanto às características clínicas e aos achados bioquímicos. A alta prevalência de SPI encontrada em pacientes com DP sugere associação entre essas duas doenças. É provável que causas secundárias não exerçam papel central na fisiopatologia da SPI nesse grupo de pacientes parkinsonianos.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Parkinson Disease/complications , Restless Legs Syndrome/complications , Ferritins/blood , Hemoglobins/analysis , Iron/blood , Parkinson Disease/blood , Parkinson Disease/physiopathology , Restless Legs Syndrome/blood , Restless Legs Syndrome/physiopathology , Urea/bloodABSTRACT
Introdução: A síndrome das pernas inquietas (SPI) tem sido relacionada a diversas doenças, entre elas doença renal e anemia. Objetivo: Descrever a prevalência da síndrome das pernas inquietas (SPI) nos pacientes em terapia de hemodiálise na região da Associação dos Municípios da Região de Laguna, Santa Catarina, Sul do Brasil (AMUREL). Métodos: 117 indivíduos submetidos à terapia de hemodiálise na região da AMUREL foram entrevistados para se avaliar a presença, o tipo (primária ou secundária) e a gravidade da SPI, creatinina, ureia, ferro e ferritina séricos. Resultados: A prevalência de SPI foi de 30,8% (n=36). Dos portadores, 33,3% tiveram o diagnóstico de SPI primária e 66,7% (n=24) o de SPI secundária .Quanto à gravidade, 58,3% foram classificados como intermitente, 16,7% em persistente leve, 8,3% em persistente moderada e 16,7% em ersistente grave. A maior parte dos casos de SPI não tinha sido diagnosticada anteriormente. Não foi encontrada correlação com os parâmetros bioquímicos nem diferenças significativas entre os sexos. Conclusão: A síndrome das pernas inquietas é comum e pouco diagnosticada. Sua prevalência é considerável e aumenta substancialmente em indivíduos urêmicos. Não encontramos nenhuma evidência de que anemia por deficiência de ferro e ferritina, nem índices altos de ureia e creatinina séricos possam desempenhar um importante papel patogênico.
Introduction: Restless legs syndrome (RLS) has been related to several diseases, including renal disease and anaemia. Aim: To determine the prevalence of restless legs syndrome in patients under haemodialysis therapy in the region of the Association of Municipalities of the Region of Laguna (AMUREL), in the state of Santa Catarina, South Brazil. Methods: 117 patients undergoing haemodialysis in the AMUREL region were interviewed in order to evaluate the presence, type (primary or secondary), and severity of RLS, as well as their serum creatinine, urea, iron, and ferritin levels. Results: The prevalence of RLS was 30.8% (n=36). Among the affected individuals, 33.3% were diagnosed with primary RLS and 66.7% (n=24) with secondary RLS. Concerning severity, 58.3% were rated as intermittent, 16.7% as mildly persistent, 8.3% as moderately persistent, and 16.7% as severely persistent. Most of the cases of RLS had not been diagnosed before. No correlation of RLS was detected with the biochemical measures, nor differences between the sexes. Conclusion: Restless legs syndrome is common and underdiagnosed. Its prevalence is considerable and increases significantly in uraemic individuals. We failed to find any evidence that iron and ferritin deficiency anaemia, or high serum urea and creatinine, can play an important pathogenic role.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Cross-Sectional Studies , Renal Dialysis/history , Renal Dialysis/methods , Renal Dialysis/psychology , Renal Dialysis , Restless Legs Syndrome/complications , Restless Legs Syndrome/diagnosis , Prevalence , Uremia/complications , Uremia/diagnosis , Uremia/pathologyABSTRACT
We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 ± 14) with disease from 0.4 to 23 years (6.7 ± 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 ± 2.0). RLS was detected in 12 cases (27 percent). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52 percent) and excessive daytime sleepiness in 3 cases (6.8 percent). Fatigue was present in 32 subjects (73 percent) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Disorders of Excessive Somnolence/etiology , Fatigue/etiology , Multiple Sclerosis/complications , Restless Legs Syndrome/complications , Cross-Sectional Studies , Disorders of Excessive Somnolence/diagnosis , Fatigue/diagnosis , Restless Legs Syndrome/diagnosis , Severity of Illness Index , Young AdultABSTRACT
Restless legs syndrome (RLS) is characterized by disturbing leg sensations associated to sleep complaints and excessive daytime somnolence. In the elderly, it affects 10 to 35 percent. Our objective was to determine the prevalence of RLS in institutionalized elderly, analyzing its relationship with clinical, laboratorial and neurophysiological features. We conducted a cross-sectional study of all the subjects under treatment on a chronic-care geriatric service by using face-to-face interviews, which include sleep complaints, the Epworth Sleepiness Scale and standardized questions addressing the four minimal criteria for RLS. The patients with RLS diagnosis received neurological examination, laboratorial tests and three of them, neurophysiological evaluation. The prevalence of RLS was 15.6 percent. Women were more affected and sleep complaints were frequent. There was no significance on other clinical, laboratorial or neurophysiological findings. We conclude that RLS is a prevalent condition in elderly, may lead to sleep complaints and is often underdiagnosed.
Síndrome de pernas inquietas (SPI) é um distúrbio caracterizado por sensações parestésicas nos membros, aliviadas à sua movimentação ativa. A patologia se associa freqüentemente a distúrbios do sono, sendo especialmente prevalente em idosos (10 a 35 por cento), e pode estar associada a outras condições clínicas. Nosso objetivo foi determinar a prevalência da SPI em idosos institucionalizados, analisando queixas do sono e outras condições clínicas, bioquímicas e neurofisiológicas. Nós entrevistamos os idosos em regime de internato no Instituto São Vicente de Paula (Campina Grande, PB), utilizando questionários específicos para o sono, escala de sonolência de Epworth e um questionário para critérios mínimos para o diagnóstico de SPI. Os pacientes com o diagnóstico de SPI submeteram-se a exame neurológico, laboratoriais, e três deles, a exame neurofisiológico. A prevalência de SPI foi 15,62 por cento, afetando especialmente o sexo feminino. Queixas de sono e patologias associadas foram freqüentes, embora os testes laboratoriais e neurofisiológicos não tenham acrescentado dados significativos. Nós concluímos que SPI é prevalente em idosos, relaciona-se a alterações do sono e é freqüentemente subdiagnosticada.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Homes for the Aged , Institutionalization , Restless Legs Syndrome/epidemiology , Analysis of Variance , Brazil/epidemiology , Cross-Sectional Studies , Geriatric Assessment , Prevalence , Restless Legs Syndrome/complications , Restless Legs Syndrome/diagnosis , Sex FactorsABSTRACT
The patient was a 44-yr-old man with end-stage renal disease who had developed chorea as a result of hypoglycemic injury to the basal ganglia and thalamus and who was subsequently diagnosed with depression and restless legs syndrome (RLS). For proper management, the presence of a complex medical condition including two contrasting diseases, chorea and RLS, had to be considered. Tramadol improved the pain and dysesthetic restlessness in his feet and legs, and this was gradually followed by improvements in his depressed mood, insomnia, lethargy, and feelings of hopelessness. This case suggests that the dopaminergic system participates intricately with the opioid, serotoninergic, and noradrenergic systems in the pathophysiology of RLS and pain and indirectly of depression and insomnia.
Subject(s)
Adult , Humans , Male , Analgesics, Opioid/therapeutic use , Anti-Dyskinesia Agents/therapeutic use , Chorea/complications , Citalopram/therapeutic use , Drug Therapy, Combination , Haloperidol/therapeutic use , Kidney Failure, Chronic/complications , Magnetic Resonance Imaging , Restless Legs Syndrome/complications , Selective Serotonin Reuptake Inhibitors/therapeutic use , Tramadol/therapeutic useABSTRACT
BACKGROUND & PURPOSE: The association of obstructive sleep apnea syndrome (OSAS) and restless legs syndrome (RLS) has been reported in the literature for many years. Both conditions may be responsible for fatigue and somnolence complaints secondary to nocturnal sleep disruption. The primary concern of this study is to evaluate the outcome of fatigue and daytime sleepiness symptoms at baseline and after continuous positive air pressure (CPAP) treatment in OSAS patients with and without RLS. METHOD: A prospective and comparative study between a group of 13 patients with OSAS and a group of 17 patients with OSAS+RLS. Laboratory blood tests and polysomnography were performed at baseline. The Epworth Sleepiness Scale (ESS) and the PichotÆs questionnaire of fatigue/depression (PIC) were applied before and after 3 months of CPAP treatment. Results were compared. RESULTS: No significant differences were found on PSG and laboratory results at baseline. Both groups had similar ESS and PIC scores at baseline (p=0.73 and 0.08, respectively). After n-CPAP, OSAS+RLS patients showed higher ESS and PIC scores (p=0.017 and 0.03, respectively). CONCLUSIONS: Despite a favorable general response, n-CPAP seemed less effective in treating fatigue and sleepiness in the OSAS+RLS group.
OBJETIVO: A associação síndrome de apnéia obstrutiva do sono / síndrome de pernas inquietas (SAOS-SPI) tem sido mencionada na literatura há muito. Ambas podem ser responsáveis por queixas de fadiga e sonolência secundárias à fragmentação do sono noturno. O objetivo deste estudo é avaliar a evolução dos sintomas de fadiga e sonolência diurna excessiva antes e após o tratamento com pressão aérea positiva contínua (CPAP) em pacientes portadores de SAOS, com e sem SPI. MÉTODO: Estudo prospectivo e comparativo entre um grupo de 13 pacientes com SAOS e um grupo de 17 com SAOS +SPI. Exames laboratoriais e polissonografia (PSG) foram realizados no início do estudo. A escala de sonolência de Epworth (ESE) e o questionário de fadiga/depressão de Pichot (PIC) foram aplicados antes do tratamento com CPAP e 3 meses após. Os resultados foram comparados. RESULTADOS: No início do estudo não foram encontradas diferenças significativas na avaliação laboratorial e PSG. Ambos os grupos apresentavam inicialmente pontuação semelhante na avaliação da ESE e PIC (p=0,73 e 0,08, respectivamente). Após CPAP, os pacientes SAOS+SPI apresentaram maiores ESE e PIC (p=0,017 e 0,03, respectivamente). CONCLUSÃO: Apesar de resposta inicial favorável em ambos os grupos, o CPAP foi aparentemente menos eficaz na redução das queixas de fadiga e sonolência nos pacientes apnéicos com associação a SPI.
Subject(s)
Female , Humans , Male , Middle Aged , Continuous Positive Airway Pressure , Disorders of Excessive Somnolence/etiology , Fatigue/etiology , Restless Legs Syndrome/complications , Sleep Apnea, Obstructive/complications , Disorders of Excessive Somnolence/therapy , Fatigue/therapy , Polysomnography , Prospective Studies , Severity of Illness Index , Surveys and Questionnaires , Sleep Apnea, Obstructive/therapy , Treatment OutcomeABSTRACT
O delírio parasitário (ou síndrome de Ekbom) é uma condição rara, onde o paciente apresenta uma forte convicção de que está infestado por pequenos parasitas ou organismos. Muitas vezes, os delírios são tão intensos que levam esses pacientes à automutilação. Relatamos aqui um caso de um senhor de 67 anos, isolado socialmente, solteiro, apresentando delírio parasitário em região perineal, culminando em lesões por automutilação.
Delusional parasitosis (or Ekbom's syndrome) is a rare condition, in which the patient has a strong conviction that he or she is infested by small parasites or organisms. These delusions are often so intense that they lead the patient to self-mutilation. We report a case of a 67-year-old man, socially isolated, single, with delusional parasitosis in the perineal area, culminating in self-mutilation lesions.
Subject(s)
Humans , Male , Aged , Self Mutilation , Restless Legs Syndrome/complications , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/pathology , Restless Legs Syndrome/psychology , Restless Legs Syndrome/therapy , Delusions , Paranoid DisordersABSTRACT
A síndrome de Ekbom, conhecida também como delírio de infestaçäo parasitária, acarofobia, "delusional parasitosis", parasitose psicogênica, é doença de rara ocorrência. Caracteriza-se pela firme convicçäo dos pacientes de que estäo infectados por vermes que saem pela pele, em geral do couro cabeludo ou até mesmo da boca, dos olhos e da regiäo genital. A maioria dos pacientes é idosa e do sexo feminino, freqüentemente com isolamento social. Alguns casos estäo associados a doenças orgânicas como hipertireoidismo, diabetes, lesöes corticais, intoxicaçöes medicamentosas. A comorbidade com torcicolo espasmódico, até onde vai nosso conhecimento, é um achado inédito na literatura. Relatamos caso de uma senhora de 72 anos de idade que se apresentou com torcicolo espasmódico associado ao quadro psiquiátrico