Is restless legs syndrome an entirely neurological disorder?

Restless legs syndrome (RLS) has been thought to be a basically neurological disorder, often observed among patients with sleep disturbance. Although the disease identity was proposed more than half a century ago, the pathogenesis of RLS has not been elucidated, and high prevalence of the disease has been demonstrated in many reports. I hypothesize that the crucial event for the occurrence of unpleasant sensations in the legs at night should be the change of blood flow dynamics. Acceleration of blood flow in the legs when lying down should stimulate nerve fibres which are closely located to the blood vessels. This hypothesis can explain many aspects of RLS, including symptoms as well as epidemiological findings. Treatment utilizing vitamin E might be extremely easy, safe, and inexpensive compared with the dopaminergic agents or opioids usually recommended for treatment.

[Two cases of Hansen's disease].

We report two cases of Hansen's disease. Case 1 was 71-year old Japanese man who developed left ulnar nerve palsy since 7 years ago, multiple erythema on his body since 2-3 years ago, and erythematous nodules on his face since 3 months ago. He had no history of living outside Ibaraki prefecture. The clinical feature, the skin biopsy, laboratory data showed that he had borderline lepromatous leprosy. He was treated with multi-drug therapy which was effective and was stopped 3 years after the bacterial index showed negative. Ten months later, erythema on his body and face appeared and the therapy was restarted. Case 2 was 68-year old Japanese man who developed 5 cm of nummular erythema with slight numbness on his right forearm since 3 months ago. He had lived in Brazil since he was 24 to 64 years old. The skin biopsy showed epithelioid cell granuloma in the dermis involving vessels and nerves. Polymerase chain reaction test showed the M.leprae DNA, and he was diagnosed as indeterminate leprosy. He was treated with dapson and rifampicin and 2 months later, erythema and numbness disappeared.

[A case of multibacillary leprosy].

We report a 74-year-old Japanese man who occurred leprosy at the age of 68. He moved to Bolivia at the age of 33 as an immigrant. He complained erythematous plaques on his trunk and extremeties and dysuria. Skin biopsy specimen revealed granulomatous lesions and acid fast staining showed numerous number of positively stained bacilli. He was diagnosed as multibacillary leprosy and MDT containing DDS, RFP, and CLF was started. During the treatment, he developed borderline reaction twice presenting severe pain and marked swelling on his hand and foot. The reaction was successfully treated with daily dose of 50 mg prednisolone combined with anti-leprosy drugs. SPFX, MINO, and CAM were not able to be used due to the side effects. One year has been passed after the stop of treatment without relapse.

[Survey of newly diagnosed leprosy patients in Japan (1993-2000)].

We analyzed the medical and social problems of newly registered leprosy patients in the past 8 years from 1993 to 2000 in a low endemic country, Japan. There were 56 registered Japanese patients (males, 32; females, 24), and 76 registered foreign patients (males, 56; females, 20). The number of Japanese patients in each year was between 5 and 9, and 2/3 of them were from Okinawa Prefecture, located in subtropical zone. But the number of foreign patients in each year was between 5 and 18, and 2/5 of them were from Brazil. The number of foreign patients was greater than that of Japanese patients. Male/female ratio has decreased among the Japanese.

[Clinical cure of leprosy--a criteria in Japan(2002)].

In Japan, a cautious definition of clinical cure of leprosy has been used since 1988. This report presents a new definition of clinical cure for leprosy patients after multi-drug treatment is completed. When the patients complete the standard treatment published in 2000, they are defined as "clinically cured". The doctor in charge should inform the patient of the cure of the disease clearly. On the release from the treatment, it is important to explain necessary cares for protection against injuries and prevention from deformities. The patient should be careful about signs of relapse and reactions.