From owner-psycho-pharm@netcom.com Sun Sep 10 03:40:01 1995 [192.100.81.136]) id UAA22225; Sat, 9 Sep 1995 20:26:57 -0700 To: Psychopharmacology Forum cc: PBDunn@aol.com Results of MEDLINE Search on Treatment of Patients with Restless Legs Syndrome By, Ivan Goldberg, MD 1 UI - 95306509 AU - Staedt J AU - Stoppe G AU - Kogler A AU - Riemann H AU - Hajak G AU - Munz DL AU - Emrich D AU - Ruther E TI - Nocturnal myoclonus syndrome (periodic movements in sleep) related to central dopamine D2-receptor alteration. SO - European Archives of Psychiatry & Clinical Neuroscience 1995;245(1):8-10 AB - The nocturnal myoclonus syndrome (NMS) consists of stereotyped, repetitive jerks of the lower limbs that occur during sleep or wakefulness. NMS is often related with restless-legs syndrome (RLS) and can cause severe sleep disturbances and daytime sleepiness. The efficacy of dopamine agonists in the treatment points to a dopaminergic dysfunction in NMS. We investigated the central dopamine D2-receptor occupancy with [123I] labeled (S)-2-hydroxy-3-iodo-6-methoxy-([1-ethyl-2-pyrrolidinyl]methyl) benzamide (IBZM) (a highly selective CNS D2 dopamine receptor ligand) ([123I]IBZM) and single photon emission tomography (SPET) in 20 patients with NMS and in 10 healthy controls. In most of the patients with NMS there was a lower [123I]IBZM binding in the striatal structures compared to controls. The results indicate that NMS is related to a decrease of central D2-receptor occupancy. 2 UI - 95287679 AU - Diaz Guzman J AU - Lopez Valdes E AU - Benito J TI - [The treatment of the restless legs syndrome and periodic sleep movements (letter)]. [Spanish] OT - Tratamiento del sindrome de piernas inquietas y movimientos periodicos del sueno. SO - Medicina Clinica 1995 Apr 22;104(15):597 3 UI - 95092950 AU - Vahedi H AU - Kuchle M AU - Trenkwalder C AU - Krenz CJ TI - [Peridural morphine administration in restless legs status (published erratum appears in Anasthesiol Intensivmed Notfallmed Schmerzther 1994 Dec;29(8):521)]. [German] OT - Peridurale Morphiumanwendung bei Restless-Legs-Status. SO - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie 1994 Oct;29(6):368-70 AB - The restless-legs syndrome is known to occur in a familial form. The paraesthesias, which are hard to define, are sometimes compared to a painful sensation that can be alleviated only by movement. The pathomechanism of the syndrome and its aetiology are still unknown. A 67-year old patient was admitted as an emergency with most severe pain in her legs. In her family the syndrome occurred in an autosomal dominant form. A long-standing history of abuse of various analgesics was known. Initially the symptoms could not be influenced by any of the various drugs given; even epidural bupivacaine showed no effect. Dramatic relief, however, was obtained by epidural morphine. The maintenance therapy with oral morphine sulfate provided equally good results. 4 UI - 95245713 AU - Kanter AH TI - The effect of sclerotherapy on restless legs syndrome. SO - Dermatologic Surgery 1995 Apr;21(4):328-32 AB - BACKGROUND. Restless Legs syndrome (RLS) is a disorder of unknown etiology characterized by relentless leg discomfort when stationary, which compels voluntary leg movement to obtain temporary relief. We have received anecdotal reports of coincidental relief from symptoms of RLS in patients following sclerotherapy for varicose vein disease. OBJECTIVE. To prospectively evaluate the concomitant occurrence of RLS and varicose veins in a population seeking treatment for varicose veins, and to assess the therapeutic response of RLS to sclerotherapy. METHODS. One thousand three hundred and ninety-seven patients were screened for RLS symptoms by questionnaire and interview, and for saphenous vein disease by clinical examination, including continuous-wave Doppler. Sclerotherapy with sodium tetradecyl sulphate was performed on 113 RLS patients. RESULTS. RLS symptoms were present in 22% (312/1,397), with a Doppler-negative to Doppler-positive ratio of 3:2. One hundred and eleven of the 113 treated patients (98%) reported initial relief from RLS symptoms. Follow-up thus far shows a recurrence rate of 8% and 28% at 1 and 2 years, respectively. CONCLUSIONS. RLS is common in patients with both saphenous and nontruncal varicose vein disease, and can respond frequently and rapidly to sclerotherapy. This subpopulation of RLS sufferers should be considered for phlebological evaluation and possible treatment before being consigned to chronic drug therapy. 5 UI - 95191551 AU - Iannaccone S AU - Zucconi M AU - Marchettini P AU - Ferini-Strambi L AU - Nemni R AU - Quattrini A AU - Palazzi S AU - Lacerenza M AU - Formaglio F AU - Smirne S TI - Evidence of peripheral axonal neuropathy in primary restless legs syndrome. SO - Movement Disorders 1995 Jan;10(1):2-9 AB - Restless legs syndrome (RLS) is a well-defined clinical entity characterized by an unpleasant creeping sensation arising in the legs with an irresistible need to move them. The trouble is more pronounced when the affected people lie in a prolonged rest position and try to fall asleep. It is known that RLS may be consequent to systemic disorders and to diseases affecting the central or peripheral nervous system. The International Classification of Sleep Disorders states that peripheral neuropathy should be ruled out by medical history and clinical grounds before diagnosing primary RLS (pRLS). The present study extended peripheral nerve investigation in eight consecutive pRLS patients with normal neurological examination results and showed that all patients exhibited two or more electrical, psychophysiological, and/or morphological features of peripheral axonal neuropathy. Morphometric analysis of sural nerve showed a significant reduction in myelinated fiber density and g ratio (axon diameter/fiber diameter) in the pRLS group compared with eight control biopsy specimens. These results suggest that axonal neuropathy is often present in patients with RLS. A comprehensive peripheral nerve investigation should be considered in RLS patients. 6 UI - 95036781 AU - Zoe A AU - Wagner ML AU - Walters AS TI - High-dose clonidine in a case of restless legs syndrome. [Review] SO - Annals of Pharmacotherapy 1994 Jul-Aug;28(7-8):878-81 AB - OBJECTIVE: To describe a patient with idiopathic restless legs syndrome (RLS). CASE SUMMARY: A 37-year-old man developed severe symptoms of RLS. Treatment using combinations of levodopa, opioids, benzodiazepines, and baclofen provided only partial benefit or resulted in intolerable adverse effects. Higher dosages of clonidine than previously reported in the literature (0.9 mg/d in divided doses) were needed to completely relieve his RLS symptoms. The only prominent adverse effect was dry mouth. The RLS symptoms returned after subsequent reductions in the dosage. After the dosage of clonidine was again increased, complete relief of the symptoms was achieved again. After several months, clonidine was tapered to zero and the patient entered a period of spontaneous remission. When his symptoms returned four months after clonidine had been discontinued, clonidine therapy was restarted. DISCUSSION: Clonidine alleviated RLS symptoms in 30 of 41 patients reported in the literature, indicating that the adrenergic nervous system may play a role in RLS. CONCLUSIONS: High-dose clonidine appears to be useful in treating RLS when other therapies fail. However, well-controlled, polysomnographic studies are needed. [References: 26] 7 UI - 95003332 AU - Mullan E AU - Katona C AU - Bellew M TI - Patterns of sleep disorders and sedative hypnotic use in seniors. [Review] SO - Drugs & Aging 1994 Jul;5(1):49-58 AB - Adequate sleep is required for good physical and psychological health. Sleep disturbance is common and its prevalence increases with advancing age. Physiologically, sleep in elderly adults differs from that in younger adults, both in terms of quantity and quality. Sleep disturbance in old age may be associated with many physical and psychological conditions, and less commonly can occur as a primary disturbance. It must be distinguished from the understandable but unrealistic expectations of many elderly people that they will sleep for as long and as soundly as when they were younger. The evaluation of a patient with a sleep disorder requires full medical psychiatric and social histories, mental state and physical examinations and appropriate investigations. If present, an underlying condition should be treated. Management strategies for sleep disorders include attention to sleep hygiene, behavioural treatment and hypnotics. Ideally, a hypnotic should be prescribed for a limited period and then in the smallest effective dose. [References: 50] 8 UI - 94367757 AU - O'Keeffe ST AU - Gavin K AU - Lavan JN TI - Iron status and restless legs syndrome in the elderly. SO - Age & Ageing 1994 May;23(3):200-3 AB - The relationship between iron status and the restless legs syndrome (RLS) was examined in 18 elderly patients with RLS and in 18 matched control subjects. A rating scale with a maximum score of 10 was used to assess the severity of RLS symptoms. Serum ferritin levels were reduced in the RLS patients compared with control subjects (median 33 micrograms/l vs. 59 micrograms/l, p < 0.01, Wilcoxon signed rank test); serum iron, vitamin B12 and folate levels and haemoglobin levels did not differ between the two groups. Serum ferritin levels were inversely correlated with the severity of RLS symptoms (Spearman's rho -0.53, p < 0.05). Fifteen patients with RLS were treated with ferrous sulphate for 2 months. RLS severity score improved by a median value of 4 points in six patients with an initial ferritin < or = 18 micrograms/l, by 3 points in four patients with ferritin > 18 micrograms/l, < or = 45 micrograms/l and by 1 point in five patients with ferritin > 45 micrograms/l, < 100 micrograms/l. Iron deficiency, with or without anaemia, is an important contributor to the development of RLS in elderly patients, and iron supplements can produce a significant reduction in symptoms. 9 UI - 94261080 AU - Montplaisir J AU - Lapierre O AU - Lavigne G TI - [The restless leg syndrome: a condition associated with periodic or aperiodic slowing of the EEG]. [Review] [French] OT - Le syndrome d'impatiences musculaires: une maladie associee au ralentissement periodique ou aperiodique de l'EEG. SO - Neurophysiologie Clinique 1994 Apr;24(2):131-40 AB - There are several new developments with regard to semiology, diagnosis, physiopathology and the treatment of restless leg syndrome (RLS). We present here the hypothesis that motor manifestations of the RLS are synchronous to slowing of the cortical activity as measured by the spectral analysis of the EEG. When the subject is resting in bed with his leg outstretched, slowing of the EEG is observed, which could be periodic at the frequency of approximately 1 every 20 seconds or sustained. Leg movements can be periodic at the frequency of approximately 1 every 20 seconds or sustained. Leg movements can be periodic or aperiodic accordingly. On the contrary, periodic leg movements in sleep (PLMS) occur in close temporal relationship with periodic arousal. These results raised the hypothesis that leg movements (RLS and PLMS) may appear at a critical level of cortical activation. This level is reached during sleepiness in the awake subject or during periodic micro-arousal when the subject is asleep. Other results suggest that these periodic changes in the level of cortical activation may also modulate other abnormal motor behavior in sleep such as rhythmic masticatory muscles activity as seen in sleep bruxism. The same mechanism may also be involved in setting the duration of apneic episodes during slow-wave sleep. [References: 32] 10 UI - 94237522 AU - Staedt J AU - Stoppe G AU - Kogler A AU - Munz DL AU - Hajak G AU - Staedt U AU - Riemann H AU - Ruther E TI - [Nightly myoclonus syndrome (NMS) and restless legs syndrome (RLS)--review and case report]. [Review] [German] OT - Nachtliches Myoklonie-Syndrom (NMS) und Restless-Legs-Syndrom (RLS)--Ubersicht und Fallbeschreibung. SO - Fortschritte der Neurologie-Psychiatrie 1994 Mar;62(3):88-93 AB - The paper gives a brief review of the existing literature concerning the nocturnal myoclonus syndrome (NMS). The clinical symptomatology, criteria for differential diagnosis and the relation to the restless legs syndrome (RLS) are discussed. Recently we investigated central dopamine receptor density with 123I-labeled 3'-iodo-6-methoxybenzamide (IBZM) (a highly selective CNS D2 dopamine receptor ligand) and single photon emission tomography (SPECT) in patients with NMS and found a reduced density of dopamine D2-receptors in the striatal structures, indicating a dopaminergic dysfunction in NMS and RLS. We present a report concerning a 58- year old female with NMS-associated insomnia and present IBZM SPECTs and hypnograms before and after a 3-month treatment with L-dopa and discuss the results with regard to pathophysiological theories. [References: 37] 11 UI - 94218619 AU - Becker PM AU - Jamieson AO AU - Brown WD TI - Dopaminergic agents in restless legs syndrome and periodic limb movements of sleep: response and complications of extended treatment in 49 cases. SO - Sleep 1993 Dec;16(8):713-6 AB - Restless legs syndrome (RLS) is a common neurosensorimotor disorder that presents with paresthesias, sleep disturbances and, in most cases, periodic limb movements of sleep (PLMS). Although many treatments have been described, interest has recently been focused on dopaminergic mechanisms of etiology and treatment. The dopamine agonists L-dopa/carbidopa, bromocriptine mesylate or both were initiated in 49 patients with RLS/PLMS who sought consultation at a sleep disorders center. This retrospective study describes the symptoms, time course of response and complications in 36 men and 13 women with a mean age of 53.9 years. Only 47 of the patients were available for extended follow-up. The most common presenting complaints were the sensation of restless legs and sleep maintenance insomnia lasting over 20 years. In the extended follow-up group of 47, four failed to respond to L-dopa or bromocriptine, five discontinued treatment because of side effects and two reported loss of therapeutic effect within the first month. Between month one and six, only three additional subjects discontinued treatment. At a mean follow-up of 283 days (SD 316), 33 patients continued on L-dopa/carbidopa at a mean bedtime dose of 160 mg L-dopa (SD 300). Treatment-emergent morning leg restlessness developed in eight patients, seven of whom required daytime medication for relief. Other side effects, generally nausea, occurred in only eight of 43 patients. Psychiatric side effects of dyskinesia were not seen. The > 70% long-term response is comparable to other studies in the literature. 12 UI - 93391850 AU - Schenck CH AU - Hurwitz TD AU - O'Connor KA AU - Mahowald MW TI - Additional categories of sleep-related eating disorders and the current status of treatment. SO - Sleep 1993 Aug;16(5):457-66 AB - Sleep-related eating disorders distinct from daytime eating disorders have recently been shown to be associated with sleepwalking (SW), periodic limb movement (PLM) disorder and triazolam abuse in a series of 19 adults. We now report eight other primary or combined etiologies identified by clinical evaluations and polysomnographic monitoring of 19 additional adults (mean age 40 years; 58% female): i) obstructive sleep apnea (OSA), with eating during apnea-induced confusional arousals (n = 3); ii) OSA-PLM disorder (n = 1); iii) familial SW and sleep-related eating (n = 2); iv) SW-PLM disorder (n = 1); v) SW-irregular sleep/wake pattern disorder (n = 1); vi) familial restless legs syndrome and sleep-related eating (n = 2); vii) anorexia nervosa with nocturnal bulimia (n = 2) and viii) amitriptyline treatment of migraines (n = 1). In our cumulative series of 38 patients (excluding six with simple obesity from daytime overeating), 44% were overweight (i.e. > 20% excess weight) from sleep-related eating. Nightly sleep- related binge eating (without hunger or purging) had occurred in 84% of patients. Onset of sleep-related eating was also closely linked with i) acute stress involving reality-based concerns about the safety of family members or about relationship problems (n = 6), ii) abstinence from alcohol and opiate/cocaine abuse (n = 2) and iii) cessation of cigarette smoking (n = 2). Current treatment data indicate a primary role of dopaminergic agents (carbidopa/L-dopa; bromocriptine), often combined with codeine and clonazepam, in controlling most cases involving SW and/or PLM disorder. Fluoxetine was effective in two of three patients. Nasal continuous positive airway pressure therapy controlled sleep-related eating in two OSA patients. 13 UI - 93173330 AU - Guilleminault C AU - Cetel M AU - Philip P TI - Dopaminergic treatment of restless legs and rebound phenomenon. SO - Neurology 1993 Feb;43(2):445 14 UI - 94218620 AU - Kaplan PW AU - Allen RP AU - Buchholz DW AU - Walters JK TI - A double-blind, placebo-controlled study of the treatment of periodic limb movements in sleep using carbidopa/levodopa and propoxyphene. SO - Sleep 1993 Dec;16(8):717-23 AB - We studied the relative benefits of carbidopa/levodopa (25/100 mg and 50/200 mg) and propoxyphene (100 mg and 200 mg) in six subjects with periodic limb movements (PLM) using a randomized, double- blind, placebo-controlled, cross-over design with a 4-day placebo wash- out period between test medications. Each subject received, for successive 2-week periods, 4 days of placebo followed by 5 days of low-dose and then 5 days of high-dose medication. Outcome was úÿ measured with polysomnograms and sleep latency tests on the last night of the high dose, and leg activity was monitored for each night of the study. Carbidopa/levodopa normalized PLM and improved sleep, particularly in the first 3 hours in most subjects. Propoxyphene had marginal benefit and significantly decreased arousals and mildly decreased leg movements for leg activity monitoring, but not for PLM on the polysomnograms. Subjects reported better sleep and alertness on carbidopa/levodopa than on propoxyphene or placebo. Our results support the premise of a central dopaminergic abnormality in PLM. 15 UI - 94204957 AU - Bassetti C AU - Hess CW TI - [Parasomnias]. [German] OT - Parasomnien. SO - Therapeutische Umschau 1993 Oct;50(10):692-7 AB - Parasomnias are frequent. They usually represent either the exaggeration of a physiological phenomenon (e.g. sleep starts) or a non-disturbing, idiopathic and usually benign sleep disorder (e.g. sleep talking and bruxism), which need only counseling and improvement of sleep hygiene. However, occasionally parasomnias are of clinical relevance. They can cause insomnia or hypersomnia (e.g. 'myoclonus nocturnus'), psychosocial stress (e.g. sleep-related enuresis and sleep walking) and injuries to oneself and others (e.g. REM-parasomnia). Finally, they can be symptomatic of neurological and medical disorders (e.g. sleep paralysis and 'myoclonus nocturnus'). In these cases special investigations including video-polysomnography can establish a correct diagnosis and allow a specific treatment. 16 UI - 94167993 AU - Aver'ianov IuN AU - Zenkov LR AU - Golubev VL AU - Toropina GG TI - [The painful leg and moving toe syndrome]. [Review] [RUSSIAN] OT - Sindrom boleznennykh nog i dvizhushchikhsia pal'tsev stop. SO - Zhurnal Nevropatologii i Psikhiatrii Imeni S - S - Korsakova 1993;93(4):93-6 AB - The paper reports a case of painful-legs-and-moving-toes syndrome in a 75-year-old woman who developed it after a paralytic ischias attack at the age of 70. The syndrome was characterized by persistent pains in distal parts of the legs and feet and constant involuntary flexion-extension wave-like toe movements. SSEP studies revealed a defect of conduction in high-speed myelinated fibers of the lumbo-sacral radices of both sides. A cortical motor potential corresponding to the toe hyperkinetic movement was present. It the base of the hyperkinesis a reflectory mechanism may underlie initiated from radiculo-spinal nociceptive systems disinhibited in consequence of the deficiency of inhibitory control from high speed rear column afferents. Neurophysiological data suggest participation of cerebral mechanisms in realization of the hyperkinesis. [References: 14] 17 UI - 94082240 AU - Grandjean P TI - [Restless legs syndrome. Report of experience]. [German] OT - Restless-legs-Syndrom. Ein Erfahrungsbericht. SO - Schweizerische Rundschau fur Medizin Praxis 1993 Oct 26;82(43):1195-7 AB - Clinical presentation and therapy of the Restless-Leg-Syndrome are featured using the report of the author's own case. Although this is a harmless disease, it can considerably reduce the quality of life. The syndrome is not rare (1 to 5% of prevalence). Effective therapeutic means have only been known for a few years. In the presented report, an alternating therapy with L-Dopa and Codeine, given in a rhythm of 2 months, produced very good results. No addiction to the drugs, and in particular no need of a dosage increase was observed during the whole period of 18 months. 18 UI - 93342293 AU - Walters AS AU - Wagner ML AU - Hening WA AU - Grasing K AU - Mills R AU - Chokroverty S AU - Kavey N TI - Successful treatment of the idiopathic restless legs syndrome in a randomized double-blind trial of oxycodone versus placebo. SO - Sleep 1993 Jun;16(4):327-32 AB - In a double-blind randomized crossover trial, oxycodone or placebo was given in divided night-time doses to 11 patients with idiopathic restless legs syndrome (RLS) for 2 weeks prior to appropriate polysomnographic studies. Under double-blinded conditions, patients were asked to do daily ratings of their leg sensations, motor restlessness and daytime alertness on a 1-4 scale for the 2 weeks prior to the polysomnographic studies and for the nights of the polysomnographic studies as well. Leg sensations (p < 0.009), motor restlessness (p < 0.006) and daytime alertness (p < 0.03) were significantly improved on oxycodone as compared to baseline or placebo. Patients were studied polysomnographically under double-blinded conditions for 2 nights in each phase of the protocol. On an average dose of 15.9 mg oxycodone (equivalent to approximately three 5-mg tablets of commercial preparation), there was a statistically significant reduction in the number of periodic limb movements in sleep [(PLMS)/hour sleep (p < 0.004)] and in the number of arousals/hour sleep (p < 0.009) on drugs as compared to baseline or placebo. A statistically significant improvement was also noted in sleep efficiency (p < 0.006) and 10 of the 11 patients preferred oxycodone over placebo. We conclude that oxycodone is an effective treatment for RLS and PLMS. 19 UI - 93252028 AU - Trenkwalder C AU - Bucher SF AU - Oertel WH AU - Proeckl D AU - Plendl H AU - Paulus W TI - Bereitschaftspotential in idiopathic and symptomatic restless legs syndrome. SO - Electroencephalography & Clinical Neurophysiology 1993 Apr;89(2):95-103 AB - Patients with idiopathic and symptomatic restless legs syndrome (RLS) suffer from "dyskinesia while awake" or "daytime myoclonus" when at rest preceded by sensory symptoms. In order to characterise the RLS either as reflex movement or as voluntary movement we measured movement-related cortical potentials in 5 idiopathic and 8 uraemic RLS patients. Movements from both legs were polygraphically recorded concomitantly with cortical activity 2000 msec before to 500 msec after onset of EMG activity. These data were compared with a voluntary simulation of each patient's movement pattern and with 5 age-matched controls performing dorsiflexion of the right, left and both feet. Cortical activity preceding daytime myoclonus was absent in RLS patients whereas self-initiated leg movements in patients elicited onset times (1180-1380 msec) and amplitudes of Bereitschaftspotential (readiness potential) not significantly different from readiness potentials in control subjects (P > 0.05). Lack of movement-related potentials in myoclonus and/or dyskinesias during daytime in RLS patients is compatible with an involuntary mechanism of induction and points towards a subcortical or spinal origin of RLS. 20 UI - 93188791 AU - Guilleminault C AU - Stoohs R AU - Clerk A TI - Daytime somnolence: therapeutic approaches. [Review] SO - Neurophysiologie Clinique 1993 Jan;23(1):23-33 AB - Excessive daytime somnolence is a major neurological problem involving about 4% of the general population. Its treatment is based on accurate etiological dissection. Sleep-disordered breathing is a major cause of EDS. Stimulant medication is helpful in many other instances. [References: 37] 21 UI - 93087917 AU - Montplaisir J AU - Lapierre O AU - Warnes H AU - Pelletier G TI - The treatment of the restless leg syndrome with or without periodic leg movements in sleep. [Review] SO - Sleep 1992 Oct;15(5):391-5 AB - There are presently three main treatments for restless leg syndrome-periodic leg movements in sleep (RLS-PLMS). The benzodiazepines (especially clonazepam) are considered by most clinicians to be the treatment of choice in mild cases, especially in young subjects. In our experience, however, L-dopa and bromocriptine are more effective treatments, although no controlled studies have ever been conducted to compare their therapeutic benefits and the side effects of benzodiazepines and dopaminergic drugs. The use of opioids should be restricted to patients who have severe symptoms and who fail to respond to benzodiazepines or L-dopa. Propoxyphene was found less effective than L-dopa in decreasing PLMS, but some patients resistant to L-dopa may exhibit a masked therapeutic response to opioids. However, there is currently no method to predict the response to any treatment modality. [References: 70] 22 UI - 92380527 AU - Bachman DL TI - Sleep disorders with aging: evaluation and treatment. SO - Geriatrics 1992 Sep;47(9):53-6, 59-61 AB - Sleep disorders are especially common among elderly patients and may be the result of psychiatric illness, a medical problem, poor sleep habits, or a primary sleep disorder. Because a sleep complaint (especially insomnia) is only a symptom, the physician must undertake a careful evaluation in an attempt to identify a specific treatable cause. Although some patients may require referral to a psychiatrist or sleep disorders clinic, many patients may benefit from behavioral strategies, such as improved sleep hygiene. In general, hypnotics should be prescribed for only a limited period of time and should be combined with other therapeutic approaches in patients with chronic insomnia. 23 UI - 93140255 AU - Horiguchi J AU - Inami Y AU - Sasaki A AU - Nishimatsu O AU - Sukegawa T TI - Periodic leg movements in sleep with restless legs syndrome: effect of clonazepam treatment. SO - Japanese Journal of Psychiatry & Neurology 1992 Sep;46(3):727-32 AB - Fifteen patients with restless legs syndrome underwent whole-night polysomnographic recordings before and during clonazepam treatment. The treatment with 0.5 to 1.5 mg clonazepam improved subjective complaints of all the 15 patients. All the patients presented periodic leg movements on the polysomnograms before the treatment. The clonazepam treatment significantly decreased the total numbers of leg movements and the numbers of leg movements per hour without affecting the mean intermovement interval. 24 UI - 92320174 AU - Hertz G AU - Fast A AU - Feinsilver SH AU - Albertario CL AU - Schulman H AU - Fein AM TI - Sleep in normal late pregnancy. SO - Sleep 1992 Jun;15(3):246-51 AB - Twelve women in their third trimester of pregnancy and 10 age-matched nonpregnant controls underwent complete polysomnography for one night in the laboratory. Seven of the original women returned for a second study 3-5 months postpartum. During late pregnancy, women showed increased wake after sleep onset (WASO) and a lower sleep efficiency in comparison with the control group. The percentage of rapid eye movement (REM) sleep was significantly decreased and the percentage of stage 1 significantly increased compared to the nonpregnant group. At 3-5 months postpartum, a significant reduction in WASO and increased sleep efficiency were noted. However, only a slight increase was noted in REM sleep during the postpartum period compared to the prepartum period. The most frequent sleep complaints in the pregnant group were restless sleep, low back pain, leg cramps and frightening dreams. In summary, in accordance with their complaints, women in their third trimester demonstrated polysomnographic patterns of sleep maintenance insomnia. 25 UI - 92270180 AU - Milne IK TI - Akathisia associated with carbamazepine therapy [letter]. SO - New Zealand Medical Journal 1992 May 13;105(933):182 26 UI - 92053948 AU - Walters AS AU - Hening W AU - Rubinstein M AU - Chokroverty S TI - A clinical and polysomnographic comparison of neuroleptic-induced akathisia and the idiopathic restless legs syndrome. SO - Sleep 1991 Aug;14(4):339-45 AB - Neuroleptic-induced akathisia (NIA) is motor restlessness caused by dopamine receptor blocking antipsychotic agents. Nine patients with NIA and 11 patients with idiopathic restless legs syndrome (RLS) were studied polysomnographically. The sleep disturbances were milder in NIA than idiopathic RLS but increased numbers of awakenings and decreased sleep efficiencies were common to both groups. In addition, RLS patients demonstrated prolonged sleep latencies. Periodic movements in sleep (PMS) were present in only 5 of 9 patients with NIA but in all 11 patients with idiopathic RLS. In no NIA patient did we see the multiple, large amplitude, violent, resting myoclonic jerks of the legs that we saw during wakefulness in some of our more severe cases of idiopathic RLS. NIA patients tended to experience inner restlessness and idiopathic RLS patients tended to experience leg paresthesias as an antecedent to motor restlessness. Idiopathic RLS patients had symptoms that were worse at night and in repose far more frequently than patients with NIA. NIA and idiopathic RLS have similarities and differences. Because both NIA and idiopathic RLS are characterized by motor restlessness and sleep disturbances, the pharmacodynamics of antipsychotic medications may give clues as to both the cause and treatment of idiopathic RLS. 27 UI - 91278889 AU - Walters AS AU - Hening WA AU - Chokroverty S TI - Review and videotape recognition of idiopathic restless legs syndrome. [Review] SO - Movement Disorders 1991;6(2):105-10 AB - The motor phenomena associated with idiopathic restless legs syndrome (RLS) are infrequently seen in the physician's office because they are present only after prolonged sitting or lying and usually at night. These motor phenomena are captured on videotape in four unrelated patients with idiopathic RLS. The clinical features of idiopathic RLS are reviewed in detail, and therapeutic advances in its treatment are summarized. [References: 39] 28 UI - 92056717 AU - Oboler SK AU - Prochazka AV AU - Meyer TJ TI - Leg symptoms in outpatient veterans [see comments]. CM - Comment in: West J Med 1992 Feb;156(2):211 SO - Western Journal of Medicine 1991 Sep;155(3):256-9 AB - In a survey of outpatients at the Denver Veterans Affairs Medical Center for common leg symptoms--515 questionnaires returned in a 3-week period--56% reported nocturnal leg cramps, 29% reported the restless leg syndrome, and 49% reported symptoms of peripheral neuropathy. Only 33% of patients had no symptoms relating to their legs. Patients often did not report these symptoms to their physician but were more likely to do so if the symptoms were frequent. Conditions especially related to leg symptoms were hypertension, peripheral vascular disease, coronary artery disease, cerebrovascular disease, kidney disease, and hypokalemia. Most patients did not receive effective therapy for these symptoms. 29 UI - 93042050 AU - Bonnet MH AU - Arand DL TI - Chronic use of triazolam in patients with periodic leg movements, fragmented sleep and daytime sleepiness. SO - Aging 1991 Dec;3(4):313-24 AB - Many studies have shown a relationship between fragmented nocturnal sleep and daytime sleepiness. In the current study, 9 patients, aged 55-79, with fragmented nocturnal sleep secondary to periodic leg movements and objective daytime sleepiness, as verified by Multiple Sleep Latency Test (MSLT), had 12 weeks of treatment with 0.125 mg of triazolam following 2 screening nights and 2 placebo baseline nights; 2 final placebo nights were placed 5 nights following the last medication night. The medication increased total sleep time and sleep efficiency throughout the administration period, as compared to average placebo values; total leg movements were not changed. Generally, daytime performance, as measured by a vigilance task, and objective alertness, as measured by MSLT, were improved following the use of triazolam. No adverse reactions or significant side effects were noted. It was concluded that 0.125 mg triazolam, when used for up to 3 months, could improve sleep and daytime function in older patients with periodic leg movements, fragmented sleep, and daytime sleepiness. 30 UI - 92268306 AU - Okeson JP AU - Phillips BA AU - Berry DT AU - Cook YR AU - Cabelka JF TI - Nocturnal bruxing events in subjects with sleep-disordered breathing and control subjects. SO - Journal of Craniomandibular Disorders 1991 Fall;5(4):258-64 AB - Nocturnal bruxing events were recorded during a single night of sleep for 12 subjects with sleep-disordered breathing and 12 age- and sex-matched controls. The results suggest that bruxing events are very common in both groups and are closely associated with sleep arousals. There were few differences in the number, duration, or type of bruxing events between these two groups. Bruxing events were common during stage 1, stage 2, and REM sleep, while they rarely occurred during stage 3 and 4 sleep. The average duration of bruxing events ranged from 3.82 to 6.68 seconds. There was a trend toward more bruxing events occurring while sleeping on the back than on the side. 31 UI - 92113100 AU - Doghramji K AU - Browman CP AU - Gaddy JR AU - Walsh JK TI - Triazolam diminishes daytime sleepiness and sleep fragmentation in patients with periodic leg movements in sleep. SO - Journal of Clinical Psychopharmacology 1991 Oct;11(5):284-90 AB - Fifteen subjects (9 men and 6 women) exhibiting objective evidence of excessive daytime somnolence and periodic leg movements in sleep underwent 4-7 days of treatment with triazolam (0.25 or 0.50 mg) and placebo in a double-blind crossover design. One night of polysomnography followed by daytime multiple sleep latency testing were conducted on the first and last days of each treatment block. By the last day of treatment, the mean multiple sleep latency test score after triazolam (9.0 minutes) was significantly greater than that after placebo (5.7 minutes). Thus, triazolam treatment led to a decrease in daytime somnolence. Triazolam also improved sleep architecture and continuity; it increased total sleep time, decreased the number of awakenings and arousals, and decreased stage 1 and increased stage 2 percentages. Although the frequency of periodic electromyographic bursts remained unchanged, the frequency of associated arousals decreased after treatment. Short-term treatment with triazolam is thus effective in diminishing daytime sleepiness and in improving sleep architecture, continuity and duration in patients with periodic leg movements in sleep. These effects do not seem to be mediated through a decrease in periodic leg movement activity. 32 UI - 91375358 AU - Ambrogetti A AU - Olson LG AU - Saunders NA TI - Disorders of movement and behaviour during sleep. [Review] SO - Medical Journal of Australia 1991 Sep 2;155(5):336-40 AB - OBJECTIVE: To outline recently described movement disorders during sleep which are common and poorly recognised. DATA SOURCES: Computer-based literature search up to July 1990 (with the index úÿ terms sleep disorders, sleep myoclonus, nocturnal myoclonus, periodic movements in sleep, REM behaviour disorder and parasomnias) supplemented by a manual search through the references of papers obtained by computer search and a manual search through contents of the following journals: Sleep, Sleep Research, Neurology and Brain. DATA SYNTHESIS AND CONCLUSION: There is a group of common and poorly recognised movement disorders during sleep. The patient usually presents complaining of disturbed sleep, daytime somnolence and abnormal nocturnal behaviour. These conditions are susceptible to precise diagnosis and effective treatment. [References: 27] 33 UI - 91375350 AU - Johns MW TI - Polysomnography at a sleep disorders unit in Melbourne. SO - Medical Journal of Australia 1991 Sep 2;155(5):303-8 AB - OBJECTIVE: To outline the procedure of polysomnography as carried out in a sleep disorders unit in Melbourne and to describe the patients undergoing polysomnography in terms of their age and sex and the sleep disorder diagnosed. DESIGN: A retrospective survey of consecutive patients who required diagnostic polysomnography. SETTING: The Sleep Disorders Unit at Epworth Hospital, a large private hospital in Melbourne. PATIENTS: Two hundred consecutive patients who underwent polysomnography over a seven-month period. Their ages ranged from 19 to 77 years. INTERVENTIONS: All patients had diagnostic polysomnography for one night in the sleep laboratory. This involved 12 to 14 physiological variables being monitored continuously overnight by means of a new digital recording and sleep analysis system. MAIN OUTCOME MEASURES: Patients were categorised according to their main sleep disorder or primary diagnosis. Additional sleep disorders in some patients were categorised as secondary diagnoses. RESULTS: The commonest age group among both male and female patients was 40-49 years. Overall, men outnumbered women three to one. Almost two-thirds of all patients had as their primary diagnosis some degree of obstructive sleep apnoea syndrome or simple snoring. The next most common diagnosis was periodic limb movement disorder. The remaining diagnoses included a variety of sleep disorders, from narcolepsy to sleep terrors. CONCLUSIONS: Despite its complexity and time-consuming nature, polysomnography is an essential procedure for the diagnosis and treatment of a wide range of sleep disorders. More sleep laboratories and a greater emphasis on the multidisciplinary teaching of sleep disorders medicine will be required in Australia. 34 UI - 91332554 AU - Sachdev P AU - Longragan C TI - The present status of akathisia [see comments]. [Review] CM - Comment in: J Nerv Ment Dis 1992 Mar;180(3):208-10 SO - Journal of Nervous & Mental Disease 1991 Jul;179(7):381-91 AB - Akathisia is a common and distressing side effect of antipsychotic and some other psychotropic medications. This paper reviews the current state of knowledge of its clinical features, pathophysiology, and treatment. Restless legs syndrome and akathisia associated with Parkinson's disease are discussed in so far as they help understand drug-induced akathisia. The complexity of the disorder, and the difficulty in characterizing and quantifying it, may explain why researchers have relatively neglected akathisia for so long. The recent upsurge of research interest promises the hope of a better understanding of its pathophysiology so that effective therapy may result. [References: 132] 35 UI - 91292781 AU - Walton T AU - Kolb KW TI - Treatment of nocturnal leg cramps and restless leg syndrome. [Review] SO - Clinical Pharmacy 1991 Jun;10(6):427-8 36 UI - 91282611 AU - Kovacevic-Ristanovic R AU - Cartwright RD AU - Lloyd S TI - Nonpharmacologic treatment of periodic leg movements in sleep. SO - Archives of Physical Medicine & Rehabilitation 1991 May;72(6):385- 9 AB - The effects of a 30-minute stimulation of the dorsiflexors of the feet and toes before bedtime were investigated in eight patients with periodic leg movements in sleep (PLMS). None were taking medications at the time of the investigation. All subjects were treated with the EMS-250 Neuromuscular Stimulator, which has a maximum output per channel of 1.5mA and a frequency of 47Hz. Stimuli were delivered via a pulse train (on for 1.5sec and off for 1.8sec). A single all-night polysomnogram after this stimulation showed that all patients responded to stimulation, with reduction of leg movements from an average pretreatment PLMS index of 44.6 per hour to a posttreatment PLMS index of 14 per hour (p less than .01). Nocturnal leg movements were primarily reduced during the non-REM sleep. Multiple indices of sleep continuity did not change significantly, although there was a trend toward better sleep consolidation. 37 UI - 91273637 AU - Lavie P AU - Nahir M AU - Lorber M AU - Scharf Y TI - Nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis patients. Lack of association between clinical improvement and effects on sleep [see comments]. CM - Comment in: Arthritis Rheum 1992 Apr;35(4):487 SO - Arthritis & Rheumatism 1991 Jun;34(6):655-9 AB - Thirteen patients with rheumatoid arthritis (mean +/- SD age 55.8 +/- 10.5 years) received 20 mg of tenoxicam daily for 90 days following a 3-7 day "washout" period and 4 days of placebo treatment. Clinical evaluations were conducted at the end of the washout period and at monthly intervals thereafter. All-night polysomnography was performed in a sleep laboratory during the last 2 days of placebo treatment and on days 13, 14, 89, and 90 of tenoxicam treatment. Although there was improvement in the patients' clinical condition, there were no treatment-related changes in any of the sleep parameters. Eight of the 13 patients, however, were found to have primary sleep disorders. Four had periodic leg movements during sleep, 3 had sleep apneas, and 1 had a combination of both disorders. The implications of these findings in the treatment of sleep disorders in patients with rheumatoid arthritis are discussed. 38 UI - 91260904 AU - van Dijk JG AU - Bollen EL AU - Slootweg J AU - van der Meer CM AU - Durian FW AU - Zwinderman AH TI - [No difference in efficacy of hydroquinine and placebo in restless legs syndrome]. [Dutch] OT - Geen verschil in werkzaamheid tussen hydrokinine en placebo bij het 'restless legs'-syndroom. SO - Nederlands Tijdschrift voor Geneeskunde 1991 Apr 27;135(17):759-63 AB - OBJECTIVE. Determination of the efficacy of hydroquinine treatment of the restless legs syndrome. DESIGN. Double blind cross-over trial. SETTING. University Hospital Leiden. PATIENTS AND METHODS. Selection through an announcement in the press and followed by structured interview. Inclusion criteria according to the international classification of sleep disorders. Exclusion criteria defined by medication risks. Patients used either hydroquinine (200 mg in the evening and 200 mg before going to bed) or placebo in the second and fourth of four periods of two weeks duration. Severity of complaints was assessed using a daily questionnaire and a Suggested Immobilization Test (SIT) twice weekly, in which they noted the severity of complaints as experienced during a 15-minute period of immobilization. RESULTS. The study was completed by 59 out of 68 patients. Analysis of variance showed no significant differences between the two groups of patients (those starting with placebo and those starting with hydroquinine) for any of the questions of the daily questionnaire or of the SIT. McNemar's test showed no significant differences between the proportions of patients who wished to continue the use of either placebo or hydroquinine. CONCLUSION. This study showed no significant differences between the efficacy of placebo or hydroquinine in the restless legs syndrome. 39 UI - 91053825 AU - von Scheele C AU - Kempi V TI - Long-term effect of dopaminergic drugs in restless legs. A 2-year follow-up. SO - Archives of Neurology 1990 Nov;47(11):1223-4 AB - Thirty patients with restless legs syndrome, who initially had all responded well to treatment with levodopa and benserazide, were studied as to the long-term effect of the drugs (at least 2 years). During the 2-year period, two patients were switched from levodopa to bromocriptine. Two patients no longer needed levodopa; one of them had developed paraplegia and in the other the symptoms of restless legs syndrome had disappeared completely. The remaining 26 patients continued to use levodopa. Eight patients maintained the original dose, nine had to use an increased dose, and nine found a decreased dose to be sufficient. The only side effect was transient nausea reported by two of the 30 patients. The study showed that the relief of symptoms of restless legs syndrome by dopaminergic drugs does not wear off with the passage of time, that side effects are minimal even with long-term use, and that the dose needed to obtain relief may increase as well as decrease. 40 UI - 90331500 AU - Krueger BR TI - Restless legs syndrome and periodic movements of sleep. [Review] SO - Mayo Clinic Proceedings 1990 Jul;65(7):999-1006 AB - Two entities of special interest in sleep disorders medicine are restless legs syndrome and periodic movements of sleep. Most patients with restless legs syndrome have periodic movements of sleep, but most patients with the nocturnal disorder do not have restless legs when awake. In both conditions, the underlying cause is obscure, and the frequency of occurrence increases with advancing age. In most patients with restless legs syndrome, the results of complete blood cell counts and iron, ferritin, folate, and vitamin B12 levels are normal. No hematologic or chemical abnormalities have been reported in patients with periodic movements of sleep who do not also have restless legs syndrome. Various pharmacologic agents, including benzodiazepines, opiates, and levodopa, have been proposed for the treatment of both disorders. Although some patients respond to a single drug for long periods, in many patients tolerance develops and the efficacy diminishes. In such circumstances, a reasonable approach is to alternate chemically unrelated agents on a weekly or biweekly schedule. Transcutaneous electric nerve stimulation may be beneficial. [References: 81] 41 UI - 90305165 AU - McParland P AU - Pearce JM TI - Restless legs syndrome in pregnancy. Case reports. [Review] SO - Clinical & Experimental Obstetrics & Gynecology 1990;17(1):5-6 AB - Restless legs syndrome is a common complaint in pregnancy affecting up to one in every three women. The exact pathophysiology is poorly understood. The majority of patients respond to simple explanation and reassurance, however, a small proportion may suffer debilitating symptoms requiring drug therapy. We describe two such cases. [References: 11] 42 UI - 90185502 AU - von Albert HH TI - [Treatment of restless legs]. [German] OT - Die Behandlung von restless legs. SO - Fortschritte der Medizin 1990 Jan 20;108(2):40-4 43 UI - 90089791 AU - Newton JR AU - Shapiro C AU - Stewart A TI - Thirty years' war: a battle with insomnia. SO - British Journal of Psychiatry 1989 May;154:691-6 AB - A 72-year-old man with a 30-year complaint of intractable insomnia had a positive family history of depression. He first came to psychiatric attention in 1958, after attacking his wife. He was prescribed barbiturates, and later was given meprobamate and nitrazepam, but with no effect on his complaint. The patient tended to increase the dosage of any drug given, of his own accord. EEG sleep recording confirmed the diagnosis of nocturnal myoclonus. It was hoped that at the case conference further treatment stratagems would be suggested. 44 UI - 90006951 AU - Zucconi M AU - Coccagna G AU - Petronelli R AU - Gerardi R AU - Mondini S AU - Cirignotta F TI - Nocturnal myoclonus in restless legs syndrome effect of carbamazepine treatment. SO - Functional Neurology 1989 Jul-Sep;4(3):263-71 AB - We studied Restless Legs Syndrome (RLS) and nocturnal myoclonus (NM) in 9 patients before and after carbamazepine treatment, to verify the correlation between improvement of RLS and modification of NM pattern during sleep. Although CBZ proved effective in the treatment of RLS, it did not modify the pattern of nocturnal myoclonus and its relationship to arousal during sleep. The efficacy of CBZ on RLS may be due to other properties of the drug rather than to the effect on nocturnal sleep: reduction of sleep latency and wakefulness after sleep onset. 45 UI - 89289208 AU - Fry JM AU - DiPhillipo MA AU - Pressman MR TI - Periodic leg movements in sleep following treatment of obstructive sleep apnea with nasal continuous positive airway pressure. SO - Chest 1989 Jul;96(1):89-91 AB - Periodic leg movements in sleep are shown to be a common finding in patients with OSA and may become evident or increase in severity after treatment of the OSA with NCPAP. Periodic leg movements in sleep were measured during baseline polysomnography, a NCPAP treatment trial, and a repeat NCPAP recording in 33 patients treated with NCPAP for OSA. During baseline PSG, nine patients had five or more PLMS per hour of sleep (index), while 14 patients had a PLMSI of 5 or more during the NCPAP trial and the repeat NCPAP recording. Among those patients with a PLMSI of 5 or more during repeat NCPAP studies, the PLMSI showed a significant increase from baseline to initial NCPAP (16.9 +/- 25.3 vs 39.3 +/- 29.4; p less than 0.001) and from baseline to repeat NCPAP (16.9 +/- 25.3 vs 42.9 +/- 39.8; p less than 0.05). The number of PLMS associated with electroencephalographic arousal also increased significantly from baseline to initial NCPAP (4.3 +/- 7.4 vs 9.7 +/- 8.9; p less than 0.05) and from baseline to repeat NCPAP (4.3 +/- 7.4 vs 16.5 +/- 18.6; p less than 0.05). The 14 patients with a PLMSI of 5 or more on the repeat NCPAP had significantly more stage 1 sleep and less REM sleep than 19 patients with a PLMSI of less than 5. Bilateral anterior tibialis EMG must be measured during NCPAP recordings in order to recognize sleep disruption caused by PLMS. 46 UI - 90123678 AU - Paik IH AU - Lee C AU - Choi BM AU - Chae YL AU - Kim CE TI - Mianserin-induced restless legs syndrome [see comments]. CM - Comment in: Br J Psychiatry 1990 Feb;156:285 SO - British Journal of Psychiatry 1989 Sep;155:415-7 AB - Restless legs syndrome was observed in three patients receiving mianserin. The symptoms resolved when the treatment was discontinued or reduced. 47 UI - 89218660 AU - Missak SS TI - Understanding the pathogenesis of the restless legs syndrome at the level of the dopamine receptor. Are we about to identify the neurochemical deficiency causing schizophrenia?. SO - Medical Hypotheses 1989 Mar;28(3):177-9 AB - According to a recent hypothesis, the restless legs syndrome is thought to be due to a caffeine-like substance produced by the human body (1). Some researchers have reported a case of familial restless legs that had high concentration of free dopamine in the cerebrospinal fluid (2). Other researchers have noticed the beneficial effect of opioids in the treatment of the restless legs syndrome (3). In this article, I am compiling information reconciling the findings of those researchers with the hypothesis that proposes that the restless legs syndrome is due to a caffeine-like substance produced by the human body. Also, I am addressing the pathogenesis of the restless legs syndrome at the level of the dopamine receptors in the central nervous system. Understanding this pathogenesis probably will help in identifying the neurochemical deficiency causing schizophrenia. 48 UI - 89188081 AU - Jorgensen S AU - Ronborg S TI - [The restless leg syndrome]. [Danish] OT - Restless legs syndrom. SO - Ugeskrift for Laeger 1989 Mar 13;151(11):670-1 AB - The restless legs syndrome (RLS) is characterized by unusual sensations in the lower legs which are difficult to describe. These sensations are experienced in the muscles and bones. They always occur at rest, most frequently at night, and disappear normally on movement. The etiology and pathogenesis are still unknown. The incidence is stated to be 5%. RLS is the fourth most frequent cause of insomnia. Treatment has been empirical. In recent single controlled investigations clonazepam (Rivotril), carbamazepine (Tegretol) and levodopa plus benserazide (Madopar) have all proved to be superior to a placebo and these drugs are, therefore, recommended. Local treatment should, however, be tried initially in all patients. 49 UI - 89186755 AU - Ausserwinkler M AU - Schmidt P TI - [Successful clonidine treatment of restless leg syndrome in chronic kidney insufficiency]. [German] OT - Erfolgreiche Behandlung des "restless legs"-Syndroms bei chronischer Niereninsuffizienz mit Clonidin. SO - Schweizerische Medizinische Wochenschrift. Journal Suisse de Medecine 1989 Feb 11;119(6):184-6 AB - Restless legs syndrome is a common and sometimes incapacitating disorder in chronic uraemic patients. While therapeutic concepts have so far been disappointing, there have been recent reports on the favourable effect of clonidine in non-uraemic patients with symptoms of restless legs syndrome. Therefore, a double-blind study was conducted in 20 patients with chronic renal failure (11 conservatively treated, 9 on RDT) and symptoms of restless legs. 10 patients were treated with 0.075 mg clonidine twice daily and 10 received placebo. The patients were investigated 3 days after starting therapy. - In the clonidine-treated group complete relief of symptoms was noted in 8 out of 10 patients, a striking alleviation in one, while in one further patient the symptoms remained unchanged. In contrast, only one of 10 patients in the placebo group had a mild alleviation of symptoms. Blood pressure did not differ significantly in the two groups. The data show that low-dose clonidine administration is a very effective approach in the treatment of the restless legs syndrome in chronic uraemic patients. 50 UI - 89175502 AU - Mosko S AU - Zetin M AU - Glen S AU - Garber D AU - DeAntonio M AU - Sassin J AU - McAnich J AU - Warren S TI - Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients. SO - Journal of Clinical Psychology 1989 Jan;45(1):51-60 AB - Based on self-rating questionnaire evaluation of symptoms of major affective disorder, 67% of patients who presented to a major sleep disorders center reported an episode of depression within the úÿ previous 5 years, and 26% described themselves as depressed at presentation. Furthermore, patients with sleep apnea, narcolepsy, or sleep-related periodic leg movements all averaged high rates of self-reported depressive symptomatology, which suggests that sleep disorders should be considered in the differential diagnosis of affective disorders, and vice versa. Change scores on the Profile of Mood States were obtained for four subgroups of patients who were undergoing conventional treatment. Significant improvement in scores was observed in obstructive sleep apneics treated surgically and in patients with sleep-related periodic leg movements placed on clonazepam, but not in narcoleptics placed on a stimulant or in insomniacs with chronic use of sedative-hypnotic drugs who were withdrawn from sleep medications. Differential improvement in POMS scores after treatment for different sleep disorders could mean that the relationship to mood disturbance differs for different sleep disorders. 51 UI - 89090332 AU - Drake ME TI - Restless legs with antiepileptic drug therapy. SO - Clinical Neurology & Neurosurgery 1988;90(2):151-4 AB - The restless legs syndrome is generally benign but is occasionally associated with anemia, metabolic disorder, or polyneuropathy. Leg restlessness with disruptive nocturnal myoclonus has been described as a sleep disorder. We report two patients with complex partial and secondarily generalized seizures, who developed restless legs while taking methsuximide and phenytoin. They had no evidence of metabolic disturbance or neuromuscular disease, although one patient had fragmented sleep and disruptive myoclonus on polysomnography, and leg restlessness subsided with change of antiepileptic drugs. These symptoms could reflect transient alteration in peripheral nerve function not evident by examination or electrophysiologic studies, sleep disturbance by antiepileptic drugs or the effects of temporal lobe seizure foci on perception of the physiologic state of nerves and muscles. 52 UI - 89149022 AU - Walters AS AU - Hening WA AU - Kavey N AU - Chokroverty S AU - Gidro-Frank S TI - A double-blind randomized crossover trial of bromocriptine and placebo in restless legs syndrome. SO - Annals of Neurology 1988 Sep;24(3):455-8 AB - A double-blind randomized crossover study of 7.5 mg bromocriptine at bedtime versus placebo was conducted in 30-day phases (with a 2- week washout period between phases) in 6 patients with idiopathic restless legs syndrome. Five patients experienced partial subjective improvement in restlessness and paresthesias on bromocriptine as opposed to placebo and expressed a desire to continue on the medication. On bromocriptine, the patients showed polysomnographically a mean decrease of 43% from control and a mean decrease of 57% from placebo in the number of periodic movements of sleep per hour of sleep (p less than 0.025). Two of 3 patients with abnormally decreased total sleep time and sleep efficiency showed an improvement in these measures on therapy. The dopamine agonist bromocriptine may be a useful therapy in some patients with restless legs syndrome. 53 UI - 89057241 AU - Brodeur C AU - Montplaisir J AU - Godbout R AU - Marinier R TI - Treatment of restless legs syndrome and periodic movements during sleep with L-dopa: a double-blind, controlled study. SO - Neurology 1988 Dec;38(12):1845-8 AB - Six patients with restless legs syndrome (RLS) and periodic movements during sleep (PMS) received placebo or L-dopa in a double-blind study. We recorded patients for 36 consecutive hours in the sleep laboratory during a baseline investigation and at the end of each treatment period. Daily evening questionnaires and a suggested immobilization test (SIT) performed at bedtime on each recording night documented the effect of L-dopa in RLS. A nocturnal EMG recording of the anterior tibialis muscles revealed the effect of L-dopa on PMS. L-Dopa proved effective in treating both RLS and PMS. Although not present in every patient, leg movements recorded during the SIT exhibited a clear periodicity. These observations support the hypothesis that RLS and PMS are two manifestations of the same central sensorimotor disorder. 54 UI - 88176697 AU - Golden RN AU - James SP TI - Insomnia. Clinical assessment and management of the patient who can't sleep. SO - Postgraduate Medicine 1988 Mar;83(4):251-8 55 UI - 88145584 AU - Kuny S AU - Blattler W TI - [Psychological findings in alleged phlebologic disorders of the leg]. [German] OT - Psychische Befunde bei vermeintlich phlebologischen Beinbeschwerden. SO - Schweizerische Medizinische Wochenschrift. Journal Suisse de Medecine 1988 Jan 9;118(1):18-22 AB - Twenty-six female patients with restless legs underwent psychiatric investigation as part of a pilot study. Most exhibited a depressive-anxious-hypochondric syndrome. The development of physical symptoms in connection with psychic disturbances and the treatment of patients with restless legs are discussed. 56 UI - 87152994 AU - Pagel JF Jr TI - Diagnosis and treatment of insomnia. SO - American Family Physician 1987 Mar;35(3):191-7 AB - Insomnia is a disorder of initiation and maintenance of sleep that results in daytime somnolence. The differential diagnosis of the various forms of insomnia is based primarily on the history, including information from the sleeping partner. The possibility of underlying depression or sleep apnea must be given consideration in every patient with insomnia, because inappropriate therapy may be dangerous in these instances. In general, the benzodiazepines have supplanted the traditional hypnotics in the treatment of insomnia. 57 UI - 87130804 AU - Akpinar S TI - Restless legs syndrome treatment with dopaminergic drugs. SO - Clinical Neuropharmacology 1987;10(1):69-79 AB - Sixteen patients with symptoms of restless legs syndrome and resulting insomnia are included in this study. They were nine women and seven men with a mean age of 50.8 years and with a mean duration of symptoms of 6.3 years. The purpose of the study is to determine the drugs that are useful for the treatment of restless legs syndrome. In 13 patients L-Dopa plus benserazide, in two patients bromocriptine, and in the remaining one patient piribedil were used orally at night approximately 1 h before bedtime. Compared with placebo these dopaminergic drugs decreased the times of waking up and staying awake periods at a statistically significant level (p changed between 0.025 and 0.01, t test). In this susceptibility of CNS there is dysfunction of the dopamine system triggered by sleep, and resting and dopaminergic potentiation by drugs affect the symptoms. 58 UI - 88140812 AU - Peled R AU - Lavie P TI - Double-blind evaluation of clonazepam on periodic leg movements in sleep. SO - Journal of Neurology, Neurosurgery & Psychiatry 1987 Dec;50(12):1679-81 AB - Treatment with clonazepam was studied in a group of 20 patients suffering from periodic movements in sleep, in a double-blind parallel group design. Eleven complained of excessive daytime sleepiness, and nine complained of insomnia. Ten patients received clonazepam, and 10 received placebo, over a period of 1 month. Clonazepam (0.5-2 mg per night) proved to be an effective treatment of periodic movements in sleep. Polysomnographic recordings demonstrated a significant decrease in the number of leg movements and a significant improvement in sleep parameters in the clonazepam group as compared with placebo. Subjective responses to treatment corroborated the sleep laboratory findings. 59 UI - 88061290 AU - Askenasy JJ AU - Weitzman ED AU - Yahr MD TI - Are periodic movements in sleep a basal ganglia dysfunction?. SO - Journal of Neural Transmission 1987;70(3-4):337-47 AB - Muscle activity during sleep is a new area of interest in sleep research. No precise brain structures are known to be involved in sleep movement. The etiology of periodic movements during sleep is unknown. The present study was dedicated to evaluate involvement of basal ganglia in periodic movements of the legs during sleep (PMS) in Parkinson's diseased patients. Sleep was monitored in 3 patients suffering from Parkinson's disease and PMS (PMS/PD) and in 3 patients suffering from restless legs syndrome and PMS (PMS/non PD). Following treatment, the six patients were monitored again during sleep. It was found that only the PMS/PD group of patients had improved significantly with appropriate treatment. Improved motor function in PD patients is associated with decreased PMS, regardless of wether the patients are treated with dopaminergic or anticholinergic agents. This is consistent with our previous data. It may be suggested that the striopallidal system is involved in periodic sleep movements of Parkinson's diseased patients. 60 UI - 88006580 AU - Sandyk R AU - Bernick C AU - Lee SM AU - Stern LZ AU - Iacono RP AU - Bamford CR TI - L-dopa in uremic patients with the restless legs syndrome. SO - International Journal of Neuroscience 1987 Aug;35(3-4):233-5 AB - Restless legs syndrome (RLS) is a poorly understood, often distressing condition that is particularly prevalent among patients with chronic renal failure. A wide variety of medications have been used to treat RLS with variable results. In order to evaluate the efficacy of carbidopa/levodopa therapy, eight consecutive uremic patients with RLS on maintenance hemodialysis were treated with doses ranging from 25/100 to 25/250 twice daily. Six of eight patients obtained satisfactory relief which has continued for 3 months follow-up. Carbidopa-levodopa appears to be an effective opinion in management of RLS in patients with chronic rental failure. 61 UI - 87248890 AU - Delfino M AU - Muscettola G AU - Misasi D AU - Prisco A AU - Santoianni P TI - [Use of pimozide in the treatment of dermatoses of psychogenic origin]. [Italian] OT - L'uso di pimozide nel trattamento di dermatosi di origine psicogena. SO - Giornale Italiano di Dermatologia e Venereologia 1987 Mar;122(3):139-41 62 UI - 87018486 AU - Mitler MM AU - Browman CP AU - Menn SJ AU - Gujavarty K AU - Timms RM TI - Nocturnal myoclonus: treatment efficacy of clonazepam and temazepam. SO - Sleep 1986;9(3):385-92 AB - Clonazepam (1 mg h.s.) and temazepam (30 mg h.s.) were studied in 10 patients diagnosed as having insomnia with nocturnal myoclonus. Each subject underwent two nocturnal polysomnographic recordings while drug-free, two during treatment with clonazepam, and two during treatment with temazepam. Treatment sessions were 7 days long, and recordings were done on nights 6 and 7 of the treatment sessions. A 14-day washout period separated the treatment sessions. The order of drugs used in the first and second treatment sessions was randomized. Objective and subjective sleep laboratory data showed that both drugs improved the sleep of patients with insomnia in association with nocturnal myoclonus. Neither drug significantly reduced the number of nocturnal myoclonic events. Sleep changes were consistent with those produced by sedative benzodiazepines in general. Thus, the data support clinical reports that clonazepam, a benzodiazepine marketed for the indication of seizure, is useful in improving sleep disturbances associated with nocturnal myoclonus. Temazepam, a benzodiazepine marketed for the indication of insomnia, was found to be a suitable alternative to clonazepam in the treatment of insomnia associated with nocturnal myoclonus. The present data and other studies suggest the need for a model that explains why leg movements and sleep disturbances may wax and wane independently. 63 UI - 86283891 AU - von Scheele C TI - Levodopa in restless legs. SO - Lancet 1986 Aug 23;2(8504):426-7 AB - The effectiveness of levodopa in the treatment of restless legs was assessed in a double-blind trial. 20 patients were given levodopa and lactose on alternate days. Treatment was continued until patients stated a preference for one of the treatments or were unable to discriminate between the two. 17 patients preferred levodopa, none lactose, and 3 were unable to discriminate. The 17 patients who responded to levodopa reported complete relief. 64 UI - 86177079 AU - Jeste DV AU - Wisniewski AA AU - Wyatt RJ TI - Neuroleptic-associated tardive syndromes. [Review] SO - Psychiatric Clinics of North America 1986 Mar;9(1):183-92 AB - We have briefly reviewed the literature on late-onset akathisia, dystonia, and Tourette-like syndrome in patients on long-term neuroleptic treatment. To date, there is no satisfactory epidemiologic or other evidence directly implicating neuroleptics in the etiology of these so-called tardive syndromes. Similarities between these disorders and tardive dyskinesia, however, make them worthy of some consideration. [References: 34] 65 UI - 87028023 AU - Montplaisir J AU - Godbout R AU - Poirier G AU - Bedard MA TI - Restless legs syndrome and periodic movements in sleep: physiopathology and treatment with L-dopa. SO - Clinical Neuropharmacology 1986;9(5):456-63 AB - Seven patients suffering from restless legs syndrome (RLS) and periodic movements in sleep (PMS) were investigated before and after treatment with L-Dopa. The effect of treatment was evaluated by polysomnography, structured interviews, and daily questionnaires. Sleep organization and subjective complaints improved during treatment with 100 to 200 mg of L-Dopa. Polysomnographic recordings also revealed a significant decrease of periodic leg movements during the first third of the night and a rebound during the last third. These results and previous biochemical findings raise the hypothesis that RLS and PMS may both result from reduced dopaminergic activity in the CNS, perhaps resulting from decreased sensibility of postsynaptic receptors. 66 UI - 86297876 AU - Boghen D AU - Lamothe L AU - Elie R AU - Godbout R AU - Montplaisir J TI - The treatment of the restless legs syndrome with clonazepam: a prospective controlled study. SO - Canadian Journal of Neurological Sciences 1986 Aug;13(3):245-7 AB - The effect of clonazepam on the restless legs syndrome was studied in a group of 6 patients. Following a drug-free period, 3 patients received clonazepam for 4 weeks followed by placebo for 4 weeks thereafter and 3 patients received the same medication and for the same length of time but in reverse order. The effectiveness of the medication was evaluated by means of a self-rating system in which patients assigned a score daily to the degree of discomfort experienced in the previous 24 hours. Three patients improved on clonazepam but 2 of these also improved on placebo. Clonazepam was not shown to be significantly more effective than placebo in the treatment of RLS. 67 UI - 87016703 AU - Pearce JW AU - Akamine HS AU - Kapuniai LE AU - Crowell DH TI - Insomnia. Rational diagnosis and treatment. SO - Postgraduate Medicine 1986 Sep 15;80(4):151-6 68 UI - 87015275 AU - Hening WA AU - Walters A AU - Kavey N AU - Gidro-Frank S AU - Cote L AU - Fahn S TI - Dyskinesias while awake and periodic movements in sleep in restless legs syndrome: treatment with opioids. SO - Neurology 1986 Oct;36(10):1363-6 AB - In five unrelated patients with the restless legs syndrome, opioid drugs relieved restlessness, dysesthesias, dyskinesias while awake, periodic movements of sleep, and sleep disturbances. When naloxone was given parenterally to two treated patients, the signs and symptoms of the restless legs syndrome reappeared. Naloxone placebo had no effect. Opioid medications may offer a useful therapy for the restless legs syndrome. The endogenous opiate system may be involved in the pathogenesis of the syndrome. 69 UI - 86239801 AU - Ginsberg HN TI - Propranolol in the treatment of restless legs syndrome induced by imipramine withdrawal [letter]. SO - American Journal of Psychiatry 1986 Jul;143(7):938 70 UI - 86183575 AU - Walsh JK AU - Sugerman JL AU - Chambers GW TI - Evaluation of insomnia. SO - American Family Physician 1986 Apr;33(4):185-94 AB - The effective treatment of patients with a complaint of insomnia requires an appreciation of the range of etiologic factors underlying the symptom of insomnia, as well as sound clinical judgment and appropriate application of available therapeutics. Systematic inquiry regarding nocturnal and daytime aspects of a patient's life is helpful in narrowing the range of diagnostic possibilities. Specialized evaluation at a sleep disorders center may be useful in cases of chronic insomnia that remain refractory to initial interventions. 71 UI - 86156388 AU - Sandyk R TI - L-Tryptophan in the treatment of restless legs syndrome [letter]. SO - American Journal of Psychiatry 1986 Apr;143(4):554-5 72 UI - 86126425 AU - Walters A AU - Hening W AU - Cote L AU - Fahn S TI - Dominantly inherited restless legs with myoclonus and periodic movements of sleep: a syndrome related to the endogenous opiates?. SO - Advances in Neurology 1986;43:309-19 AB - The restless legs syndrome is a sensory and motor disorder of evening, repose, and sleep. The cardinal features include (a) restlessness, which is frequently associated with (b) dysesthesias, (c) myoclonic jerks and other dyskinesias while awake, (d) periodic movements of sleep, and (e) sleep disturbances. We have recently had the opportunity to study two patients severely affected by this syndrome whose family histories are consistent with dominant inheritance. Both patients serendipitously discovered that their symptoms responded uniquely well to opiate medication. Both patients were studied extensively with electrophysiological and videotape úÿ monitoring, and their movements were characterized. In both patients, all elements of the syndrome responded to opiates, with marked relief of symptoms and without any significant side effects. The specific opiate antagonist naloxone blocked the therapeutic benefit of the opiates. Our findings support the involvement of the endogenous opiate system in the pathogenesis of restless legs and related dyskinesias and suggest that opiate therapy may be a potentially valuable treatment for this sometimes disabling syndrome. 73 UI - 86039581 AU - Sandyk R TI - The endogenous opioid system in neurological disorders of the basal ganglia. [Review] SO - Life Sciences 1985 Nov 4;37(18):1655-63 AB - The endogenous opioid peptides have for some time been implicated in the regulation of motor behavior in animals. Recently, however, there is increased evidence to suggest a role for these peptides in the control of human motor functions as well as in the pathophysiology of abnormal movement disorders. Degeneration of opioid peptide-containing neurons in the basal ganglia has been demonstrated in Parkinson's disease and Huntington's chorea, but the clinical significance of these findings is largely unknown. On the other hand, there is evidence that excessive opioid activity may be important in the pathophysiology of some movement disorders such as tardive dyskinesia, progressive supra-nuclear palsy, and a subgroup of Tourette's patients. These findings indicate that diseases of the basal ganglia are possibly associated with alterations in opioid peptide activity, and that these alterations may be useful in designing experimental therapeutic strategies in these conditions. [References: 116] 74 UI - 86046269 AU - Auff E AU - Holzner F AU - Wessely P TI - [Further therapeutic possibilities with valproic acid (Convulex)]. [German] OT - Weitere Therapiemoglichkeiten mit Valproinsaure (Convulex). SO - Wiener Medizinische Wochenschrift 1985 Sep 15;135(17):421-3 AB - Valproic acid is used in first case as an antiepileptic; own clinical observance and references from the literature show other indication-fields outside of the group of cerebral fits; so Convulex was employed successfully also in the therapy of perioral dyskinesia of variable etiology and in the medical treatment of therapy-resistant pains within the bounds of Polyneuropathy-Polyneuritis Syndrome. Our own experience is presented by the description of the 10 case histories. 75 UI - 86047200 AU - Larsen S AU - Telstad W AU - Sorensen O AU - Thom E AU - Stensrud P AU - Nyberg-Hansen R TI - Carbamazepine therapy in restless legs. Discrimination between responders and non-responders. SO - Acta Medica Scandinavica 1985;218(2):223-7 AB - One hundred and seventy-four patients suffering from restless legs were included in a double-blind trial. Eighty-four patients were treated with carbamazepine (CBZ) and 90 with placebo. Discrimination analysis was carried out in order to characterize the patients who did not benefit from the treatment. Patients treated with CBZ were divided into responders and non-responders. A discriminant function classified 15 out of 19 actual non-responders as non-responders and 60 out of 65 actual responders as responders. By using the "leaving-one-out" technique, 14 of the non-responders and 57 of the responders were still correctly classified. The probability of erroneously classifying a patient increased from about 10 to 15% by this correction. The discriminant function classified approximately 80% of the patients in the placebo group as responders to CBZ. 76 UI - 86104825 AU - Cybulska E AU - Rucinski J TI - Restless legs syndrome. SO - British Journal of Hospital Medicine 1985 Dec;34(6):370-1 AB - Restless legs syndrome is a trivial complaint, but it may become a nightmare for some patients. Clinicians may either misdiagnose or dismiss it whilst proper scrutiny and treatment could be helpful. 77 UI - 86040225 AU - Handwerker JV Jr AU - Palmer RF TI - Clonidine in the treatment of "restless leg" syndrome [letter]. SO - New England Journal of Medicine 1985 Nov 7;313(19):1228-9 78 UI - 84278112 AU - Trzepacz PT AU - Violette EJ AU - Sateia MJ TI - Response to opioids in three patients with restless legs syndrome. SO - American Journal of Psychiatry 1984 Aug;141(8):993-5 AB - Three patients with restless legs syndrome, two of whom also had nocturnal myoclonus, responded well to treatment with low doses of opioids. The pathophysiology of the syndrome and the mechanism of opioids' therapeutic action are discussed. 79 UI - 84105674 AU - Telstad W AU - Sorensen O AU - Larsen S AU - Lillevold PE AU - Stensrud P AU - Nyberg-Hansen R TI - Treatment of the restless legs syndrome with carbamazepine: a double blind study. SO - British Medical Journal Clinical Research Ed. 1984 Feb 11;288(6415):444-6 AB - One hundred and seventy four patients suffering from the restless legs syndrome were examined in a double blind, between patient, placebo controlled study in general practice for five weeks to investigate the effects of carbamazepine and placebo on the syndrome. The syndrome was more common among middle aged women with relatively low systolic blood pressure. The median haemoglobin concentration was about average for the population, but the severity of the symptoms seemed to increase with decreasing concentrations of haemoglobin. Both placebo and carbamazepine showed a significant therapeutic effect (p less than 0.01). Carbamazepine was significantly more effective than placebo (p less than or equal to 0.03). The significant therapeutic effect of placebo in restless legs showed that only double blind controlled trials can confirm the efficacy of suggested treatments. 80 UI - 84286225 AU - Ungvari G AU - Vladar K TI - [Pimozide therapy in dermatozoon delusion]. [German] OT - Pimozid-Therapie des Dermatozoenwahns. SO - Dermatologische Monatsschrift 1984;170(7):443-7 81 UI - 84276799 AU - Montagna P AU - Sassoli de Bianchi L AU - Zucconi M AU - Cirignotta F AU - Lugaresi E TI - Clonazepam and vibration in restless legs syndrome. SO - Acta Neurologica Scandinavica 1984 Jun;69(6):428-30 AB - There have been no controlled therapeutic trials in Restless Legs Syndrome (RLS). In 6 patients with RLS, a randomized double-blind cross-over trial vs placebo showed a significant efficacy of clonazepam in improving subjective quality of sleep and leg dysaesthesia. Vibratory stimulation of the leg showed a less pronounced and non-significant effect. Clonazepam is a safe and effective drug for treatment of RLS; however its long-term efficacy needs confirmation. 82 UI - 85112913 AU - Byerley B AU - Gillin JC TI - Diagnosis and management of insomnia. SO - Psychiatric Clinics of North America 1984 Dec;7(4):773-89 AB - The symptom of insomnia concerns not only psychiatrists, but other physicians as well. Most cases of insomnia resolve with the passage of time or when the underlying medical or psychiatric condition is treated. For situational insomnias or psychophysiologic insomnias, consider nonpharmacologic interventions before prescribing a sedative-hypnotic. When a sedative-hypnotic is indicated, the BZs are the drugs of choice because of their better margin of safety and lower potential for abuse. In most cases, limit the use of a sedative-hypnotic to several days to a few weeks. 83 UI - 83296460 AU - Lipinski JF AU - Zubenko GS AU - Barreira P AU - Cohen BM TI - Propranolol in the treatment of neuroleptic-induced akathisia [letter]. SO - Lancet 1983 Sep 17;2(8351):685-6 84 UI - 84028841 AU - Lundvall O AU - Abom PE AU - Holm R TI - Carbamazepine in restless legs. A controlled pilot study. SO - European Journal of Clinical Pharmacology 1983;25(3):323-4 AB - Carbamazepine or placebo were given in random order, during two four-week periods, in a double-blind, cross-over trial in six patients presenting with symptoms of restless legs. On global evaluation after completing the trial three patients and the physician preferred to continue treatment with carbamazepine. In the remaining three cases both the physician and the patients preferred not to continue with either of the treatments. However, the patients who did not give any preference also had less pronounced symptoms during treatment with carbamazepine. No patient felt better during treatment with placebo as compared to carbamazepine. The results indicate that certain patients have fewer attacks of restless legs during treatment with carbamazepine. 85 UI - 83255933 AU - Menon MK AU - Kling AS TI - Treatment of restless leg syndrome [letter]. SO - Archives of Neurology 1983 Aug;40(8):526 86 UI - 83247721 AU - Boquet J AU - Guillerot E AU - Monnier JC TI - [Limping and muscle hypertonia concentrated in the calves. Relation to spasmophilia. Clinical and electromyographic study and treatment plan]. [French] OT - Boiterie et hypertonie musculaire focalisee aux mollets. Relation avec la spasmophilie. Etude clinique, electromyographique et schema therapeutique. SO - Phlebologie 1983 Apr-Jun;36(2):121-36 AB - The authors report several cases of patients who presented with pain in one or both calves and a limping gait. Clinical examination and the EMG confirmed that these disorders were of musculo-tendinous origin, maximal at the level of the gemellus tendon, frequently forming a tendinitis. The syndrome consists of a hypertonia of the calves which is maximal on waking and which improves on stretching the muscles. Most of the subjects examined suffered from a syndrome of restless legs and presented alterations of the autonomic nervous system and spasmophilia (simultaneous EMG recording of the left and right soleus muscles). Examination of the pathogenesis reveals the possibility of a phenomenon of tonic muscular training synchronous with variations in an elevated and unstable autonomic tone. The authors discuss a possible relationship with spasmophilia and algodystrophy. Finally, they propose a plan of treatment. 87 UI - 83233466 AU - Bernardi A AU - Dainese R AU - Brazzo F AU - Caniato G AU - Uliari U AU - De Stefani D AU - Poluzzi P AU - Bernardi G TI - [Gangliosides: a new prospective therapy of uremic neuropathy]. [Italian] OT - I gangliosidi: nuova prospettiva terapeutica della neuropatia uremica. SO - Clinica Terapeutica 1983 Feb 15;104(3):211-8 88 UI - 83197850 AU - Sandyk R TI - The restless legs syndrome (Ekbom's syndrome). SO - South African Medical Journal 1983 Apr 30;63(18):701-2 AB - The restless legs syndrome is a condition of unknown aetiology characterized by nocturnal paraesthesiae in the lower limbs, an irreversible tendency to move the limbs, pain in the distribution of the paraesthesiae, and psychiatric disturbances. The syndrome may occur at any age and in either sex and usually runs a course over many years with spontaneous improvements and exacerbations. An association with iron deficiency has been suggested but in most cases no apparent cause has been found, and treatment at present is symptomatic with analgesics and sedatives. The differential diagnosis includes phenothiazine-induced akathisia and meralgia paraesthetica. 89 UI - 82136143 AU - Braude W AU - Barnes T TI - Clonazepam: effective treatment for restless legs syndrome in uraemia [letter]. SO - British Medical Journal Clinical Research Ed. 1982 Feb 13;284(6314):510 90 UI - 82024788 AU - Read DJ AU - Feest TG AU - Nassim MA TI - Clonazepam: effective treatment for restless legs syndrome in uraemia. SO - British Medical Journal Clinical Research Ed. 1981 Oct 3;283(6296):885-6 91 UI - 85066410 AU - Hoffmann H TI - Use of Frenolon in the treatment of delusion of parasitosis "Ekbom's syndrome"). SO - Therapia Hungarica 1982;30(1):23-4 92 UI - 83021939 AU - Akpinar S TI - Treatment of restless legs syndrome with levodopa plus benserazide [letter]. SO - Archives of Neurology 1982 Nov;39(11):739 93 UI - 82155552 AU - Biland L AU - Blattler P AU - Scheibler P AU - Studer S AU - Widmer LK TI - [On the therapy of so-called leg pains. Controlled double-blind study of the therapeutic efficacy of Daflon]. [German] OT - Zur Therapie sogenannt venoser Beinbeschwerden. (Kontrollierte Doppelblind-Studie zur Untersuchung der therapeutischen Wirksamkeit von Daflon). SO - Vasa 1982;11(1):53-8 94 UI - 82152674 AU - Blattler W AU - Muhlemann M TI - [Restless legs and nocturnal leg spasms--forgotten facts in diagnosis--new facts for therapy]. [German] OT - Restless legs und nachtliche Beinkrampfe - Vergessenes zur Diagnose - Neues zur Therapie. SO - Schweizerische Medizinische Wochenschrift. Journal Suisse de Medecine 1982 Jan 23;112(4):115-7 AB - An angiologist's experience with the symptom of restless legs is reported. The condition was diagnosed in 103 patients presenting with pain in their legs occurring predominantly at rest and vanishing with walking. Organic lesions could not be identified (in 76%) or were not responsible for the discomfort (in 24%). A depressive state, most often masked, was recognized in 67%. In 42% anxiety was present alone, and in 49% frank depression was diagnosed. In 9% psychiatric treatment was mandatory. Patients with no depression were either not treated (33%) or were given type I-antiarrhythmic drugs (mostly disopyramide) with good results. These drugs were only transiently effective in depressed patients since anxiety was often intensified when the symptom of restless legs disappeared. Antidepressant agents, though ineffective when given alone, were most helpful when administered together with disopyramide. 95 UI - 81060936 AU - Boghen D TI - Successful treatment of restless legs with clonazepam [letter]. SO - Annals of Neurology 1980 Sep;8(3):341 96 UI - 80167214 AU - Pulvertaft TB TI - Paroven in the treatment of chronic venous insufficiency. SO - Practitioner 1979 Dec;223(1338):838-41 97 UI - 78097807 AU - Montplaisir J TI - [Insomnia and its treatment]. [Review] [French] OT - L'insomnie et son traitement. SO - Union Medicale du Canada 1977 Dec;106(12):1611-6 98 UI - 77188453 AU - Freeman JT TI - The restless legs of a Nantucket farmer. SO - Journal of the American Geriatrics Society 1977 Jun;25(6):?279-80 AB - Ekbom's syndrome of restless legs is common but not restricted primarily to the elderly. Records of familial occurrence and association with several pathologic disorders preclude exclusive age-association. Most cases of the syndrome in the general population are seen in persons of middle or old age. Lack of awareness of the frequency of the syndrome and lack of an adequate dependable form of treatment attest the need for additional study. Historical documentation is one way of alerting the profession to the nature, frequency and lineage of a clinical disorder that requires an accepted form of amelioration. Notes from the 1870-73 diary of a Nantucket farmer are presented. 99 UI - 79230280 AU - Botez MI AU - Peyronnard JM AU - Berube L AU - Labrecque R TI - Relapsing neuropathy, cerebral atrophy and folate deficiency. A close association. SO - Applied Neurophysiology 1979;42(3):171-83 AB - The case of a 48-year-old woman with a relapsing radial palsy which followed diarrheic episodes is reported. She had low folate concentrations in serum and cerebrospinal fluid, as well as low and borderline values of cerebrospinal fluid and erythrocyte folates. She had chronic gastrointestinal disease with edema of jejunal mucosa. The patient had some degree of cerebral atrophy. The effect of folate therapy on the neuropathy was spectacular. A beneficial effect of the therapy has been observed on both EEG tracings and neuropsychological performances after 6 months of treatment. 100 UI - 79167020 AU - Matthews WB TI - Treatment of the restless legs syndrome with clonazepam [letter]. úÿ SO - British Medical Journal 1979 Mar 17;1(6165):751 101 UI - 78238745 AU - Botez MI AU - Fontaine F AU - Botez T AU - Bachevalier J TI - Folate-responsive neurological and mental disorders: report of 16 cases. Neuropsychological correlates of computerized transaxial tomography and radionuclide cisternography in folic acid deficiencies. SO - European Neurology 1977;16(1-6):230-46 AB - Two groups of patients with folic acid responsive neurological and psychiatric disorders are reported. The first group (7 patients) had well-established acquired folate deficiency due either to defective absorption (4 cases with atrophy of jejunal mucosa) or to a deficient diet (3 cases). One patient had a subacute combined degeneration of the spinal cord while others were depressed and had weight loss, permanent muscular and intellectual fatigue, restless legs syndrome, depressed ankle jerks, diminution of the sense of vibration in the knees and a stocking-type tactile hypoesthesia. The second group (9 patients) comprised idiopathic cases of folic acid deficiency. Their main subjective complaints were chronic fatigability and familial restless legs syndrome. The neurological findings were similar to those of the patients with acquired disorders. Neuropsychological testing procedures revealed an abnormal intellectual functioning in all 16 patients. Abnormal patterns of radionuclide cisternograms and computerized transaxial tomography (CTT) were found in 11 patients. After 6-12 months of folic acid therapy a striking improvement regarding their intellectual functioning was noticed: the IQ, Kohs Block Design and Category tests were significantly improved. The correlation of neuropsychological findings with CTT and radionuclide cisternograms led to the conclusion that chronic folate deficiency could induce cerebral atrophy. 102 UI - 76255325 AU - Botez MI AU - Cadotte M AU - Beaulieu R AU - Pichette LP AU - Pison C TI - Neurologic disorders responsive to folic acid therapy. SO - Canadian Medical Association Journal 1976 Aug 7;115(3):217-23 AB - Six women aged 31 to 70 years had folate deficiency and neuropsychiatric disorders. The three with acquired folate deficiency were depressed and had permanent muscular and intellectual fatigue, mild symptoms of restless legs, depressed ankle jerks, diminution of vibration sensation in the legs, stocking-type hypoesthesia and long-lasting constipation; D-xylos absorption was abnormal. The bone marrow was megaloblastic in only one patient, and she and one other had atrophy of the jejunal mucosa. The third was a vegan. All three recovered after folic acid therapy. The other three were members of a family with the restless legs syndrome, fatigability and diffuse muscular pain. One also had subacute combined degeneration of the spinal cord and kidney disease but no megaloblastosis; she improved spectacularly after receiving large daily doses of folic acid. The other two also had minor neurologic signs, controlled with 5 to 10 mg of folic acid daily. Unrecognized and treatable folate deficiency (with low serum folic acid values but normal erythrocyte folate values) may be the basis of a well defined syndrome of neurologic, psychiatric and gastroenterologic disorders, and the restless legs syndrome may represent the main clinical expression of acquired and familial (or inborn) folate deficiency in adults. 103 UI - 76174738 AU - Snider SR AU - Fahn S AU - Isgreen WP AU - Cote LJ TI - Primary sensory symptoms in parkinsonism. SO - Neurology 1976 May;26(5):423-9 AB - Forty-three of 101 outpatients with parkinsonism reported that they regularly experienced primary sensory symptoms, i.e., spontaneous abnormal sensations not caused by somatic disease. This is in contrast to similar symptoms reported by only 8 percent of a control population. The most striking and severe symptom was burning of the trunk and proximal extremities, occurring in 11 patients. Twenty-nine patients reported spontaneous pain; a variety of other paresthesialike sensations, e.g., tingling, numbness, and formication, occurred in 32 patients. These subjective sensory phenomena were not associated with sensory loss or autonomic or motor signs. In 20 percent of affected individuals (9 percent of the total), sensory symptoms preceded the onset of the movement disorder, causing difficulty in diagnosis. It is concluded that at least some sensory symptoms originate within the nervous system as a manifestation of the disease process and are not secondary effects of the motor disorder. 104 UI - 75186116 AU - Procacci P AU - Zoppi M AU - Maresca M TI - [Guanethidine therapy of reflex sympathetic syndromes]. [Italian] OT - Terapia con guanetidina di sindromi simpatiche riflesse SO - Clinica Terapeutica 1975 Jun 30;73(6):572-80 105 UI - 73152233 AU - Roberts HJ TI - Spontaneous leg cramps and "restless legs" due to diabetogenic (functional) hyperinsulinism. A basis for rational therapy. SO - JFMA - Journal of the Florida Medical Association 1973 May;60(5):29-31