Is restless legs syndrome in Parkinson disease patients associated with any specific factor? / A síndrome das pernas inquietas nos pacientes com doença de Parkinson está associada a algum fator específico?

ABSTRACT Background: Restless legs syndrome or Willis-Ekbom disease is a disorder characterized by unpleasant sensations associated with the need to mobilize the lower limbs. In Parkinson disease patients, restless legs syndrome is associated with worse quality of life and excessive sleepiness. Regarding other factors, results of different studies are controversial. Objective: To determine the factors associated with the restless legs syndrome presence in Parkinson disease patients. Methods: A cross-sectional study was conducted in 88 consecutive Parkinson disease patients from the outpatient clinic for 21 months. Participants underwent a clinical interview, assessment based on standardized scales (Epworth Sleepiness Scale, Parkinson Disease Questionnaire - 39, Pittsburgh Sleep Quality Index, International Restless Legs Syndrome Study Group rating scale), and video-polysomnography. Results: Out of the 88 participants, 25 had restless legs syndrome. In the multivariate analysis, restless legs syndrome in Parkinson disease has been associated with the symptom of smell loss and quality of sleep and life. In the univariate analysis, restless legs syndrome in Parkinson disease has occurred more frequently in women with higher frequency of insomnia, constipation, and anosmia than in the group without restless legs syndrome. Conclusion: Restless legs syndrome is a prevalent condition in patients with Parkinson disease and is associated with specific characteristics in this group of patients.

RESUMO Introdução: A síndrome das pernas inquietas, ou doença de Willis-Ekbom, é um transtorno caracterizado por sensações de desconforto associadas à necessidade de movimentar os membros inferiores. Nos pacientes com doença de Parkinson, a síndrome das pernas inquietas está associada a uma qualidade de vida inferior e sonolência excessiva. Em relação a outros fatores, resultados de diferentes estudos mostraram resultados controversos. Objetivo: Determinar os fatores associados à presença da síndrome das pernas inquietas nos pacientes com doença de Parkinson. Métodos: Um estudo transversal foi conduzido com 88 pacientes com doença de Parkinson, consecutivos, acompanhados em ambulatório especializado, durante 21 meses. Participantes passaram por uma entrevista clínica, avaliação por meio de escalas padronizadas (Escala de Sonolência de Epworth, Questionário de Qualidade de Vida da Doença de Parkinson, Índice de Qualidade de Sono de Pittsburgh, Escala de Gravidade Internacional da Síndrome das Pernas Inquietas) e videopolissonografia. Resultados: Do total de 88 participantes, 25 tinham síndrome das pernas inquietas. Na análise multivariada, a síndrome das pernas inquietas na doença de Parkinson esteve associada à perda de olfato, assim como à qualidade de vida e ao sono. Na análise univariada, a síndrome das pernas inquietas na doença de Parkinson ocorreu mais frequentemente em mulheres, com maior frequência de insônia, constipação e anosmia, do que no grupo sem síndrome das pernas inquietas. Conclusão: A síndrome das pernas inquietas é uma condição prevalente na doença de Parkinson e está associada a características específicas neste grupo de pacientes.

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.

Restless legs syndrome in end-stage renal disease patients undergoing hemodialysis / Síndrome de Piernas Inquietas en enfermedad renal crónica terminal en hemodiálisis

ABSTRACT Restless legs syndrome (RLS) is a frequent complication of hemodialysis that has been associated with poor quality of life and increased risk for complications. Nevertheless, few studies regarding this entity exist in resource-limited settings. Objectives: To determine the prevalence of RLS among Mexican patients on hemodialysis; and compare these patients with a control group of the same population. Methods: We recruited 105 hemodialysis patients. Restless legs syndrome was diagnosed according to the updated criteria set out by the International RLS Study Group. We selected patients who did not meet the criteria, as controls. Results: We found an RLS prevalence of 18%. The RLS patients had a significantly higher prevalence of iron deficiency anemia and uremic pruritus. None of the patients reported RLS symptoms prior to hemodialysis initiation. Conclusions: Restless legs syndrome is common among Mexican patients on hemodialysis. Larger studies are required to address the impact of RLS in hemodialysis patients.

RESUMEN El síndrome de piernas inquietas (SPI) es una complicación de la hemodiálisis que se ha asociado con menor calidad de vida y riesgo aumentado de complicaciones. Sin embargo, existen pocos estudios acerca de esta entidad en escenarios de recursos limitados. Objetivos: Determinar la prevalencia de SPI en pacientes mexicanos en hemodiálisis, y comparar las características con un grupo control de la misma población. Métodos: Reclutamos 105 pacientes en hemodiálisis. El SPI se diagnosticó de acuerdo con los criterios actualizados del grupo de estudio internacional del síndrome de piernas inquietas. Seleccionamos a los pacientes que no cumplieron dichos criterios como controles. Resultados: Encontramos una prevalencia de SPI del 18%. Los pacientes con SPI tenían una prevalencia más alta de anemia ferropénica, y prurito urémico. Ninguno de los pacientes reportó síntomas de SPI previo a iniciar la hemodiálisis. Conclusiones: El SPI es frecuente en pacientes mexicanos en hemodiálisis; se requieren estudios más grandes para evaluar el impacto del síndrome en ésta población.

Spinal cord injury as a trigger to develop periodic leg movements during sleep: an evolutionary perspective / Lesão medular como gatilho para desenvolver movimentos periódicos das pernas durante o sono: uma perspectiva evolutiva

The primary trigger to periodic limb movement (PLM) during sleep is still unknown. Its association with the restless legs syndrome (RLS) is established in humans and was reported in spinal cord injury (SCI) patients classified by the American Spinal Injury Association (ASIA) as A. Its pathogenesis has not been completely unraveled, though recent advances might enhance our knowledge about those malfunctions. PLM association with central pattern generator (CPG) is one of the possible pathologic mechanisms involved. This article reviewed the advances in PLM and RLS genetics, the evolution of CPG functioning, and the neurotransmitters involved in CPG, PLM and RLS. We have proposed that SCI might be a trigger to develop PLM.

O gatilho principal para o desenvolvimento de movimentos periódicos dos membros (MPM) durante o sono ainda é desconhecido. A associação entre o MPM e a síndrome das pernas inquietas (SPI) em seres humanos já foi previamente estabelecida e relatada em pacientes com lesão medular (LM), classificados pela American Spinal Injury Association (ASIA) como A. A patogênese do MPM não foi completamente desvendada, apesar de avanços recentes poderem ampliar o conhecimento sobre essas disfunções. Um dos possíveis mecanismos patológicos envolvidos é o gerador de padrão central (GPC). Este artigo revisou os avanços na genética do MPM e da SPI, a evolução do funcionamento do GPC e os neurotransmissores relacionados ao GPC, ao MPM e à SPI. Foi proposta a hipótese de que a LM poderia ser um gatilho para deflagrar os MPM.

Clinical correlates of the restless legs syndrome / Correlações clínicas da síndrome das pernas inquietas

OBJECTIVE: To determine the clinical correlates of the restless legs syndrome (RLS) in a Brazilian sleep disorders center. METHODS: We retrospectively studied 118 patients with RLS from January, 2004, to December, 2010. The analyzed variables were: age at disease onset, gender, race, years of school instruction, primary and secondary RLS, and treatment options. RESULTS: Among the studied patients, 83.9% were women with a female/male sex ratio of 5:1. Mean age of the patients at symptom onset ± standard deviation was 41.7±17.9 years-old. The primary RLS was found in 85% of patients. The other 15% remainders consisted of secondary forms, and they were associated with neuropathy, iron deficiency anemia, end-stage renal disease, or Parkinson's disease. Drug therapy for RLS was introduced in 67% of patients. CONCLUSIONS: Most patients presented primary RLS with an early disease onset. Further epidemiological studies are welcomed to provide better information on secondary RLS in Brazil.

OBJETIVO: Determinar as correlações clínicas da síndrome das pernas inquietas (SPI) em um centro brasileiro de distúrbios de sono. MÉTODOS: Foram estudados retrospectivamente 118 pacientes com SPI atendidos entre janeiro de 2004 e dezembro de 2010. As variáveis analisadas compreendiam: idade ao início da doença, sexo, raça, escolaridade, SPI primária e secundária e tratamento da SPI. RESULTADOS: Do total de pacientes estudados, 83,9% eram mulheres e a razão mulher∕homem foi de 5:1. A média de idade dos pacientes ± desvio padrão de quando iniciaram sintomas da SPI foi de 41,7±17,9 anos. Oitenta e cinco por cento dos pacientes apresentaram SPI primária. Os restantes 15% apresentaram a forma secundária, que estava associada à neuropatia periférica, anemia por deficiência de ferro, insuficiência renal crônica e doença de Parkinson. Foi introduzida medicação para SPI em 67% dos pacientes. CONCLUSÕES: A maioria dos pacientes apresentou SPI primária com início precoce da doença. Mais estudos epidemiológicos são necessários para prover informações sobre as causas secundárias de SPI no Brasil.

Restless legs syndrome and multiple sclerosis: a Brazilian multicenter study and meta-analysis of the literature / Síndrome das pernas inquietas e esclerose múltipla: um estudo brasileiro multicêntrico e metanálise da literatura

OBJECTIVE: The increased prevalence of restless legs syndrome (RLS) in multiple sclerosis (MS) has recently been the subject of a few papers. The present study investigated the prevalence of RLS symptoms in MS patients and in controls in four Brazilian cities. Additionally, a systematic review and meta-analysis of the literature was carried out on the subject of RLS-MS. METHOD: MS patients and controls were investigated regarding the presence of the four typical symptoms of RLS. A questionnaire assessing RLS severity was also used for patients and controls presenting the four RLS symptoms criteria. The systematic review and meta-analysis on the subject were carried out according to the strict international criteria. RESULTS: In the present report, the RLS-MS association was confirmed as being more than fortuitous in Brazilian MS patients, in a multicenter case-control study. MS patients also presented RLS symptoms of greater severity than did the control population. A systematic review and meta-analysis of the literature showed that MS patients had a fourfold higher chance of presenting RLS than did the controls. CONCLUSION: Although underlying mechanisms to explain the association RLS-MS are still a matter of discussion, there is a clear association of these two neurological conditions.

OBJETIVO: A maior prevalência de síndrome das pernas inquietas (SPI) em esclerose múltipla (EM) foi recentemente assunto de algumas publicações. O presente trabalho investigou a prevalência de sintomas de SPI em pacientes com EM e em controles em quatro cidades brasileiras. Além disto, uma revisão sistemática da literatura e metanálise dos dados foi feita considerando o tema SPI-EM. MÉTODO: Pacientes com EM e controles foram investigados com relação aos quarto sintomas típicos de SPI. Um questionário avaliando a intensidade da SPI também foi utilizado para pacientes e controles que apresentassem os quatro sintomas para critério diagnóstico de SPI. A revisão sistemática e meta-análise do tema foram realizadas de acordo com os rígidos critérios internacionais. RESULTADOS: No presente estudo, a associação de SPI-EM foi confirmada como sendo mais que coincidência nos pacientes brasileiros com EM, através do estudo caso-controle multicêntrico. Os pacientes com EM também apresentaram maior gravidade dos sintomas de SPI que os controles. A revisão sistemática e metanálise da literatura mostraram que os pacientes com EM tiveram quatro vezes mais chance de apresentar SPI do que controles. CONCLUSÃO: Embora os mecanismos envolvidos na associação SPI-EM ainda sejam motivo de discussão, existe uma clara associação entre estas duas condições neurológicas.

Restless legs syndrome in subjects with a knee prosthesis: evidence that symptoms are generated in the periphery

OBJECTIVE: There are no data adressing the prevalence of restless legs syndrome in subjects who have knee prosthesis. Therefore, we conducted a cross-sectional survey of subjects who underwent knee prosthesis surgery. METHOD: A total of 107 subjects (30 male, 77 female) were interviewed over the telephone regarding restless legs syndrome symptoms. If the patients exhibited symptoms of the syndrome, we conducted face-to-face interviews. Lastly, a therapeutic test with pramipexole was proposed for each subject. RESULTS: In our cohort, 7 males (23 percent) and 30 females (39 percent) had restless legs syndrome. Of these, 6 males and 23 females were submitted to face-to-face-interview. Of the males, 5 (83 percent) had restless legs after the knee surgeryexclusively in the operated leg- and reported no family restless legs history. One man had a prior case of bilateral restless legs syndrome, a positive family history and claimed exacerbation of symptoms in the operated leg. Among the females, 16 (69 percent) had restless legs prior to surgery. A total of 10 female patients reported bilateral symptoms, with fewer symptoms in the operated leg, while 6 displayed a worse outcome in the operated leg. The 7 females (31 percent) without restless legs prior to surgery and without a family history experienced symptoms only in the operated leg. All subjects responded favorably to the pramipexole therapeutic test. CONCLUSION: Our results suggest that secondary unilateral restless legs syndrome may ensue from knee prosthesis surgery and that the symptoms are generated in the peripheral nervous system.

Imbalance between thyroid hormones and the dopaminergic system might be central to the pathophysiology of restless legs syndrome: a hypothesis

Data collected from medical literature indicate that dopaminergic agonists alleviate Restless Legs Syndrome symptoms while dopaminergic agonists antagonists aggravate them. Dopaminergic agonists is a physiological regulator of thyroid-stimulating hormone. Dopaminergic agonists infusion diminishes the levels of thyroid hormones, which have the ability to provoke restlessness, hyperkinetic states, tremors, and insomnia. Conditions associated with higher levels of thyroid hormones, such as pregnancy or hyperthyroidism, have a higher prevalence of Restless Legs Syndrome symptoms. Low iron levels can cause secondary Restless Legs Syndrome or aggravate symptoms of primary disease as well as diminish enzymatic activities that are involved in dopaminergic agonists production and the degradation of thyroid hormones. Moreover, as a result of low iron levels, dopaminergic agonists diminishes and thyroid hormones increase. Iron therapy improves Restless Legs Syndrome symptoms in iron deprived patients. Medical hypothesis. To discuss the theory that thyroid hormones, when not counterbalanced by dopaminergic agonists, may precipitate the signs and symptoms underpinning Restless Legs Syndrome. The main cause of Restless Legs Syndrome might be an imbalance between the dopaminergic agonists system and thyroid hormones.

Síndrome de piernas inquietas en niños / Restless legs syndrome in children

En la última década se ha descrito el síndrome de piernas inquietas en pacientes pediátricos, diagnóstico importante de reconocer como causa de trastorno del sueño. Este artículo aporta antecedentes para que los pediatras puedan realizar diagnóstico y tratamiento oportunos.

Sleep disturbances in patients on maintenance hemodialysis: role of dialysis shift

OBJECTIVES: Subjective sleep complaints have been reported in up to 80 percent of patients with end stage renal disease (ESRD). In these patients, sleep disturbances manifesting as insomnia, sleep apnea syndrome, restless leg syndrome (RLS), periodic limb movement disorder and excessive daytime sleepiness (EDS) have been frequently reported. Moreover, studies about the role of dialysis shift on sleep abnormalities, morbidity and mortality are still scarce. The aim of this study was to investigate the influence of dialysis shift on the quality of sleep and sleep abnormalities in patients with ESRD. MÉTHODS: We studied one hundred consecutive patients from a dialysis center. Quality of sleep was assessed by the Pittsburgh Sleep Quality Index and subjective EDS by the Epworth Sleepiness Scale. Restless leg syndrome was diagnosed using the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Clinical and laboratory parameters were obtained by interview and chart review. Adequacy of dialysis was evaluated by the Kt/V index. RESULTS: Poor quality sleep (PSQI>6) was found in 75 percent of cases and was associated with RLS (p=0.004) and with snoring (p=0.016). EDS (ESS>10) was present in 28 percent of cases. Patients with EDS (1.33±0.29) had lower values of the Kt/v index (P=0.01) than those without EDS (1.52±0.32). RLS was present in 48 percent of cases. Irrespective of dialysis shift, poor quality sleep, EDS and RLS were not different among patients. CONCLUSION: Poor quality sleep, EDS and RLS were common and not related to dialysis shift.

OBJETIVOS: Alterações do sono têm sido relatadas em até 80 por cento dos pacientes com Insuficiência renal crônica dialítica (IRCD). Insônia, síndrome da apnéia do sono, síndrome das pernas inquietas (SPI), movimentos periódicos de extremidades e sonolência excessiva diurna (SED) têm sido descritos. A influência que o turno da diálise exerce sobre as alterações do sono e sobre a morbidade e mortalidade ainda é desconhecida. O objetivo deste estudo foi avaliar a influência do turno da diálise sobre as anormalidades do sono em pacientes com IRCD. MÉTODOS: Estudamos 100 pacientes consecutivos provenientes de um centro de diálise. A qualidade do sono foi avaliada através do Índice de Qualidade do Sono de Pittsburgh (IQSP) e a SED através da Escala de sonolência de Epworth (ESE). A SPI foi avaliada utilizando os quatro critérios mínimos definidos internacionalmente pela International Restless Legs Syndrome Study Group. Os parâmetros clínicos e laboratoriais foram obtidos através de entrevistas e revisão de prontuários. A qualidade da diálise foi avaliada pelo índice Kt/V. RESULTADOS: Má qualidade do sono (IQSP>6), encontrada em 75 por cento dos casos, associou-se à SPI (P= 0.004) e à presença de ronco (P= 0.016). Pacientes com SED (ESE>10) (1.33±0.29) apresentaram valores do índice Kt/v menores (P=0.01) do que aqueles sem SED (1.52±0.32). Observou-se a presença de SPI em 48 por cento dos pacientes. Má qualidade do sono, SED e SPI não diferiram entre os pacientes agrupados quanto ao turno de diálise. CONCLUSÃO: Má qualidade do sono, SED e SPI são freqüentes e não se relacionam com o turno da diálise.

Restless leg syndrome

Restless leg syndrome [RLS] is a very common medical condition that is under recognized and often misdiagnosed and maltreated in general practice in Pakistan. It is a very distressing condition for patients and often attributed to nutritional deficiencies or labeled as simple cramps. Its cure is rarely possible. In this article the authors intend to discuss the diagnosis and management of this condition

El impacto de tener las piernas inquietas: avances en el diagnóstico y tratamiento de una patología prevalente, pero subdiagnosticada / The impact to have the restless legs: advances in the diagnosis and treatment of a prevalent, but under-diagnosed pathology

El Síndrome de Piernas Inquietas (SPI) se caracteriza por una sensación desagradable en las piernas que lleva a la imperiosa necesidad de moverlas. Ocurre en reposo y es de preferencia nocturna. Su frecuencia varía entre 2-15 por ciento de la población general adulta y 20-30 por ciento en pacientes urémicos en diálisis. A nivel nacional se da una frecuencia estimativa de 13 por ciento en la población general adulta y 27 por ciento en los pacientes urémicos en diálisis.

Síndrome das pernas inquietas na gestação / Restless legs syndrome in pregnancy

O Objetivo do presente estudo é determinar freqüência e características da síndrome das pernas inquietas em grávidas, e detectar possíveis fatores associados à sua ocorrência. Desenvolvemos estudo observacional em gestantes consecutivamente internadas em trabalho de parto durante 60 dias em maternidade conveniada com o SUS. Foi realizada no puerpério imediato entrevista utilizando questionário padronizado para diagnóstico da síndrome, e coletadas informações quanto às características dos sistemas e quanto a história obstétrica e patológica. Os dados foram tabulados e analisados com a utilização do programa Epi-Info 6.04b. Realizadas 262 entrevistas, 9,5 porcento (n=25) das entrevistadas haviam apresentado a síndrome durante a gestação; destas, 60 porcento queixaram-se de insônia. A síndrome foi mais comum no terceiro trimestre, e não houve relação entre a sua presença e qualquer variável obstétrica ou demográfica. Trata-se de síndrome relativamente comum na gestação, que pode levar a insônia e conseqüente diminuição na qualidade de vida. Possivelmente fatores genéticos e outros ligados a alterações do organismo materno, como por exemplo altos níveis séricos de estrogênio, participam da sua gênese neste contexto

Restless legs syndrome in patients on chronic hemodialysis in a Brazilian city: frequency, biochemical findings and comorbidities

OBJECTIVE: To evaluate the frequency of restless legs syndrome (RLS) in patients with chronic renal failure (CRF) in Petrópolis, Brazil, and investigate associations between the syndrome and: demographic characteristics, biochemical variables and comorbidities. METHOD: A cross-sectional study in which we interviewed 176 patients on dialytic therapy based on criteria elaborated by the International Restless Legs Syndrome Study Group, and compared data of patients with and without RLS. RESULTS: The frequency was 14.8 percent. There were no significant differences between the two groups in demographic and biochemical variables investigated (iron, creatinine, intact parathyroid hormone, hemoglobin, calcium, phosphate). We found no association between RLS and the most common comorbidities, except for chronic glomerulonephritis (CGN) (OR = 3.84, p < 0.01). CONCLUSION: In the studied population RLS is a common disorder, and is not associated with the investigated biochemical abnormalities. A higher frequency of RLS in subjects with CGN is a finding that needs further investigation

Síndrome das pernas inquietas com herança autossômica dominante piorada pelo uso de mirtazapina: relato de caso / Worsening of autosomal dominant restless legs syndrome after use of mirtazapine: case report

Relatamos o caso de uma paciente de 78 anos, com diagnóstico estabelecido de síndrome das pernas inquietas (SPI), de etiologia primária com herança autossômica dominante. A paciente apresentava quadro depressivo associado. Enfatiza-se a piora do quadro clínico da SPI após o uso de anti-depressivo com ação inibidora seletiva da recaptação de serotonina (mirtazapina), com atenuação dos sintomas após a retirada da droga, e a excelente resposta terapêutica com o uso de agonista dopaminérgico (pramipexol) em baixa dose