A case of restless legs syndrome with cold sensation successfully treated with acupuncture and moxibustion treatment / 全日本鍼灸学会雑誌

[Objective] We report a patient with restless legs syndrome (RLS) associated with chronic cold sensation in her lower legs. Both symptoms were successfully treated with acupuncture and moxibustion.[Patient] The patient was a 42-year-old female whose chief complaint was unpleasant abnormal sensation on the back of her lower legs that appeared when attempting to sleep. She had previously experienced the same sensation while she was pregnant, but it disappeared after childbirth. The unpleasant sensation appeared again in July, X year with no precipitating cause. The symptoms progressively worsened each day, eventually resulting in sleep disturbance. She was diagnosed as RLS in the department of neurology, but she did not want pharmacotherapy so she decided to start a treatment of acupuncture and moxibustion. She underwent the treatment once a week, with acupuncture in the triceps surae muscle of both lower legs, and an electronic moxibustion at acupoints BL57 and SP6 bilaterally. The International Restless Legs Syndrome Severity Rating Scale (IRLS) and the Numerical Rating Scale (NRS) were used for evaluation. [Result] The IRLS score gradually decreased from 26 to 2 by the 7th treatment. The NRS score also decreased from 8 to 0. The patient's chronic cold sensation also improved with reduction in RLS symptoms.[Discussion] Recently a dysfunction of the dorsoposterior hypothalamic dopaminergic A11 cell group has been implicated in the pathology of RLS. The dysfunction in this system induces an excessive sympathetic activity, which may cause microangiopathies resulting in the cold sensation. [Conclusion] RLS and cold sensation are shared pathologies relating to the dopaminergic and the autonomic nervous system, and our report suggests that acupuncture and moxibustion treatment may have acted upon these systems to improve symptoms.

Efecto de la Nicotina en un Modelo de Activación Dopaminérgica en Timing: Hacia un Modelo en Esquizofrenia / Nicotine Effect on a Model of Hyperactivation of the Dopaminergic System using a Temporal Bisection Task: Towards a Model in Schizophrenia

Resumen: La esquizofrenia es un trastorno que implica múltiples anomalías bioquímicas. Los pacientes con esquizofrenia tienen una prevalencia muy alta de tabaquismo, que se ha relacionado con el hecho de que la nicotina tiene importantes interacciones con la dopamina, siendo teóricamente capaz de reducir algunos de los síntomas positivos, negativos y cognitivos de la esquizofrenia. Sin embargo, existe controversia respecto al papel de la nicotina en la sintomatologia de los pacientes con esquizofrenia fumadores. El objetivo de la presente investigación fue evaluar el efecto de la administración de nicotina en un modelo de hiperactivación del sistema dopaminérgico, mediante una tarea de estimación temporal en animales del laboratorio. Los resultados sugieren una recuperación de las habilidades cognitivas, sin embargo el efecto procognitivo de la nicotina depende de una gran variedad de factores, incluyendo los sistemas neurales subyacentes a las tareas usadas y su interacción con otros fármacos y sistemas. Se propone que la evaluación del procesamiento de la información temporal puede servir como una herramienta en la comprensión y evaluación de los déficits cognitivos de la esquizofrenia.

Abstract: Schizophrenia is a disorder that involves multiple biochemical abnormalities. Patients with schizophrenia have a high prevalence of smoking, which has been linked with the fact that nicotine has significant interactions with dopamine, theoretically being able to reduce some of the positive, negative and cognitive symptoms of schizophrenia. However, there is controversy about the role of nicotine on symptoms of patients with schizophrenia who smoke. The objective of this research was to evaluate the effect of nicotine administration in a model of hyperactivation of the dopaminergic system using a temporal bisection task. The results suggest a recovery of cognitive skills, but the procognitive effect of nicotine depends on a variety of factors, including the underlying neural systems of the tasks and its interaction with other drugs and systems. It is proposed that the evaluation of the temporal processing of information could be a tool in the understanding and assessment of cognitive deficits of schizophrenia.

El sistema antioxidante del glutatión en la etiopatología de la disfunción nigro-estriatal / Glutathione antioxidant system in the etiopathology of nigrostriatal dysfunction

La enfermedad de Parkinson es una enfermedad neurodegenerativa crónica que afecta a las personas de la tercera edad. En una minoría de los casos la enfermedad es de origen genético pero en el resto, la causa es idiopática. En este sentido, la acumulación de los radicales libres y la pérdida de la homeostasis del glutatión se han señalado como posibles agentes causales. El presente texto se propuso revisar las evidencias experimentales que apoyan la participación de los radicales libres y la pérdida de la homeostasis del glutatión en el comienzo y la progresión de la degeneración de la substantianigrapars compacta. El estrés oxidativo en la enfermedad de Parkinson´s puede estar relacionado con las propiedades pro-oxidantes intrínsecas de la dopamina y elevadas concentraciones de hierro en la substantianigrapars compacta, que promueven la oxidación de la dopamina y la generación de especies reactivas del oxígeno. Cualquier evento que desencadene estos mecanismos, genera un daño celular. La disminución del glutatión es una de las alteraciones bioquímicas más tempranas, detectadas en asociación con la enfermedad de Parkinson y se ha relacionado con la inhibición del complejo I de la cadena de transporte mitocondrial, daño oxidativo, activación glial, entre otros que favorecen la neurodegeneración. Estas evidencias sugieren la necesidad de mantener la homeostasis del glutatión en el sistema dopaminérgico y su vínculo con la etiología de la degeneración nigro-estriatal, lo que tiene una potencial aplicación en la práctica clínica.

Parkinson's disease is a chronic neurodegenerative condition affecting elderly persons. In a minority of cases the disease has a genetic origin, but in most the cause is idiopathic. Accumulation of free radicals and loss of glutathione homeostasis have been pointed at as possible causal agents. The purpose of the study was to review experimental evidence supporting the involvement of free radicals and loss of glutathione homeostasis in the outset and progress of substantia nigra pars compacta degeneration. Oxidative stress in Parkinson's disease may be related to the intrinsic pro-oxidant properties of dopamine and high iron concentrations in the substantia nigra pars compacta, promoting dopamine oxidation and the generation of reactive oxygen species. Any event triggering these mechanisms will cause cell damage. Glutathione reduction is one of the earliest biochemical alterations detected in association with Parkinson's disease, and it has been related to the inhibition of complex I of the mitochondrial transport chain, oxidative damage and glial activation, among other factors leading to neurodegeneration. This evidence points to the need to maintain glutathione homeostasis in the dopaminergic system, as well as its relationship to the etiology of nigrostriatal degeneration, of potential application in clinical practice.

Is Antipsychotic Intake a Risk Factor for the Restless Legs Syndrome?

BACKGROUND: Restless-legs syndrome (RLS) is known to be caused by dopaminergic hypofunction in the brain. We investigated whether antipsychotics that act as antidopaminergics increase the risk of RLS. METHODS: We prospectively recruited 72 schizophrenic patients who had been medicated with antipsychotic drugs in a psychiatry clinic. We evaluated RLS diagnostic criteria and basic sleep habits using the Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index by face-to-face interviews using a structured questionnaire. We also applied the Unified Parkinson's Disease Rating Scale to evaluate extrapyramidal symptoms. RESULTS: Three of the 72 patients (4.2%) met RLS criteria, which is similar to the previously reported RLS incidence among the general population in Korea. CONCLUSIONS: There is no evidence that antipsychotics increase the risk of RLS. We believe that the mild antidopaminergic effect of antipsychotics does not overwhelm their prominent antipsychotic effect.

Imaging of Dopaminergic System in Movement Disorders / 핵의학분자영상

Parkinson's disease is a common neurodegenerative disorder that is mainly caused by dopaminergic neuron loss in the substantia nigra. Several radiopharmaceutics have been developed to evaluate the integrity of dopaminergic neuronal system. In vivo PET and SPECT imaging of presynaptic dopamine imaing are already applied to Parkinson's disease and other parkinsonism, and can demonstrate the dopaminergic dysfunction. This review summarized the use of the presynaptic dopaminergic imaging in PD as biomarkers in evaluation of disease progression as well as in diagnosis of PD.

Delusion and Hallucination in Parkinson's Disease: A Pilot Study of Clinical Features and Pathogenesis

BACKGROUND: Although the clinical and epidemiological characteristics of delusions and visual hallucinations in Parkinson's disease (PD) have been described, the underlying etiology and pathogenesis of those neuropsychiatric manifestations in PD remains a matter of debate. The purpose of this study was to investigate whether or not delusion is in the same spectrum of dopamine related neuropsychiatric manifestations as visual hallucination is in patients with PD. METHODS: We studied the clinical features of 13 PD patients with delusions and 32 with hallucinations. Patients with a history of psychotic symptoms before the onset of PD were excluded. RESULTS: Age at onset of PD was younger in patients with delusions (56.3+/-8.7 years) than in those with hallucinations (63.9+/-9.2 years) (p=0.019). The level of education was higher in patients with delusions than those with hallucinations (p=0.006). Daily levodopa equivalent dosages were higher in patients with delusions (982+/-653.7 mg/day) than those with hallucinations (559+/-311.2 mg/day) (p=0.002). Dopamine agonists were more frequently used in patients with delusions than in those with hallucinations (p=0.020). CONCLUSIONS: Compared with PD patients with hallucinations, those with delusions were associated with longer disease durations, higher levodopa-equivalent daily doses, and use of dopamine agonists. To evaluate the role of dopaminergic dysfunction for the development of delusions and hallucinations in PD patients, further well- designed prospective studies are needed.