Re: Interesting Stuff!

[Guest guest]

Hi Gang,

The primary purpose of this group is to share helpful information we run

across and personal experiences with RLS/PLMD that might help others in our

group.

I have collected the below latest medical journal articles and wanted to pass

them on.

From some comments, maybe some online services carried Dr. Elaty's write-up on

RLS via attachment. Would you let me know directly if it did for you; not to

the group. If enough had it via attachment, I will repost it in two parts as

at least one posted to me individually indicating she got it by attachment and

was unable to open it.

Barbara

Magnesium therapy for periodic leg movements-related insomnia and

restless legs syndrome: an open pilot study

Author: Hornyak M; Voderholzer U; Hohagen F; Berger M; Riemann D

Address: Department of Psychiatry and Psychotherapy, Albert-Ludwigs-

University, Freiburg, Germany.

Source: Sleep, 1998 Aug 1, 21:5, 501-5

Abstract: Periodic limb movements during sleep (PLMS), with or without

symptoms of a restless legs syndrome (RLS), may cause sleep disturbances. The

pharmacologic treatments of choice are dopaminergic drugs. Their use, however,

may be limited due to tolerance development or rebound phenomena. Anecdotal

observations have shown that oral magnesium therapy may ameliorate symptoms in

patients with moderate RLS. We report on an open clinical and polysomnographic

study in 10 patients (mean age 57 +/- 9 years; 6 men, 4 women) suffering from

insomnia related to PLMS (n = 4) or mild-to-moderate RLS (n = 6).

Magnesium was administered orally at a dose of 12.4 mmol in the evening over

a period of 4-6 weeks. Following magnesium treatment, PLMS associated with

arousals (PLMS-A) decreased significantly (17 +/- 7 vs 7 +/- 7 events per hour

of total sleep time, p < 0.05). PLMS without arousal were also moderately

reduced (PLMS per hour of total sleep time 33 +/- 16 vs 21 +/- 23, p = 0.07).

Sleep efficiency improved from 75 +/- 12% to 85 +/- 8% (p < 0.01). In the

group of patients estimating their sleep and/or symptoms of RLS as improved

after therapy (n = 7), the effects of magnesium on PLMS and PLMS-A were even

more pronounced. Our study indicates that magnesium treatment may be a useful

alternative therapy in patients with mild or moderate RLS-or PLMS-related

insomnia. Further investigations regarding the role of magnesium in the

pathophysiology of RLS and placebo-controlled studies need to be performed.

Iron and the restless legs syndrome

Author: Sun ER; Chen CA; Ho G; Earley CJ; RP

Address: s Hopkins University Dept. of Psychology, Baltimore, MD, USA.

Source: Sleep, 1998 Jun 15, 21:4, 371-7

STUDY OBJECTIVES: Using blinded procedures, determine the relation between

serum ferritin levels and severity of subjective and objective symptoms of the

restless legs syndrome (RLS) for a representative patient sample covering the

entire adult age range.

DESIGN: All patient records from the past 4 years were retrospectively

reviewed to obtain data from all cases with RLS. All patients were included

who had ferritin levels obtained at about the same time as a polysomnogram

(PSG), met diagnostic criteria for RLS, and were not on iron or medications

that would reduce the RLS symptoms at the time of the PSG.

SETTING: Sleep Disorders Center.

PATIENTS: 27 (18 females, 9 males), aged 29-81 years.

INTERVENTIONS: None.

MEASUREMENTS AND RESULTS: Measurements included clinical ratings of RLS

severity and PSG measures of sleep efficiency and periodic limb movements

(PLMS) in sleep with and without arousal. Lower ferritin correlated

significantly to greater RLS severity and decreased sleep efficiency.

All but one patient with severe RLS had ferritin levels < or = 50 mcg/l.

Patients with lower ferritin (< or = 50 mcg/l) also showed significantly more

PLMS with arousal than did those with higher ferritin, but the PLMS/hour was

not significantly related to ferritin. This last finding may be due to

inclusion of two 'outliers' or because of severely disturbed sleep of the more

severe RLS patients.

CONCLUSIONS: These data are consistent with those from a prior unblinded study

and suggest that RLS patients will have fewer symptoms if they have ferritin

levels greater than 50 mcg/l.

Folates: supplemental forms and therapeutic applications

Author: GS

Address: gregnd@...

Source: Altern Med Rev, 1998 Jun, 3:3, 208-20

Abstract: Folates function as a single carbon donor in the synthesis of serine

from glycine, in the synthesis of nucleotides form purine precursors,

indirectly in the synthesis of transfer RNA, and as a methyl donor to create

methylcobalamin, which is used in the re-methylation of homocysteine to

methionine. Oral folates are generally available in two supplemental forms,

folic and folinic acid. Administration of folinic acid bypasses the

deconjugation and reduction steps required for folic acid.

Folinic acid also appears to be a more metabolically active form of folate,

capable of boosting levels of the coenzyme forms of the vitamin in

circumstances where folic acid has little to no effect. Therapeutically, folic

acid can reduce homocysteine levels and the occurrence of neural tube defects,

might play a role in preventing cervical dysplasia and protecting against

neoplasia in ulcerative colitis, appears to be a rational aspect of a

nutritional protocol to treat vitiligo, and can increase the resistance of the

gingiva to local irritants, leading to a reduction in inflammation.

Reports also indicate that neuropsychiatric diseases secondary to folate

deficiency might include dementia, schizophrenia-like syndromes, insomnia,

irritability, forgetfulness, endogenous depression, organic psychosis,

peripheral neuropathy, myelopathy, and restless legs syndrome.

Olfactory function in restless legs syndrome

Author: Adler CH; Gwinn KA; Newman S

Address: Parkinson's Disease and Movement Disorders Center, Department of

Neurology, Mayo Clinic sdale, Arizona 85259, USA.

Source: Mov Disord, 1998 May, 13:3, 563-5

Abstract: Restless leg syndrome (RLS) is usually idiopathic but may occur in

patients with Parkinson's disease (PD). Both respond to dopaminergic

medications. Whether these disorders share a common pathophysiology is

unclear. Because PD is associated with a loss of olfactory function, we

compared the olfactory function of patients with RLS with control and PD

patients.

Using the University of Pennsylvania Smell Identification Test (UPSIT),

olfactory function was found to be normal in patients with idiopathic RLS and

significantly reduced in patients with PD. This suggests that the

pathophysiology of RLS differs from PD, and that RLS likely is not a " forme

fruste " or a preclinical sign of PD.

Periodic limb movement disorder

Author: Nozawa T

Address: Department of Neurology, Showa University School of Medicine.

Source: Nippon Rinsho, 1998 Feb, 56:2, 389-95

Abstract: The periodic limb movements (PLM) are defined as stereotyped,

periodic movements of the legs and/or upper limbs during sleep. The patient

exhibits dorsifilexion of the ankle and extension of the big toe with

occasional flexion of the knee and hip. PLM originally was described as

" nocturnal myoclonus " by Symonds in 1953.

Recently, the term " nocturnal myoclonus " has been replaced with PLM, because

the movements are slower than true myoclonic movement. The appearance of PLM

was reported in sleep apnea syndrome, delayed sleep phase syndrome,

narcolepsy, spinal cord tumor, diabetes mellitus and uremia. The prevalence of

PLM statistically increase with age. Patients with PLM show excessive daytime

sleepiness or insomnia. Several reports show the difficulty recognizing

periodic limb movement disorder (PLMD) without polysomnography (PSG). The

diagnosis of PLMD is established only by PSG.

Is excessive daytime sleepiness with periodic leg movements during sleep a

specific diagnostic category?

Author: Nicolas A; Lespérance P; Montplaisir J

Address: Centre d'étude du sommeil, Hôpital du Sacré-Coeur de Montréal,

Université de Montréal, Québec, Canada.

Source: Eur Neurol, 1998 Jul, 40:1, 22-6

Abstract: Thirty-four patients who presented with excessive daytime sleepiness

(EDS) and who showed an elevated number of periodic leg movements during sleep

(PLMS) were studied. None of these patients reported other symptoms or

presented sleep laboratory manifestations of narcolepsy or of breathing

disorders during sleep.

A diagnosis of restless leg syndrome, head trauma or a past history of

psychopathology or infectious diseases known to cause EDS were also ruled out.

In addition, none of the patients reported a history of drug or alcohol abuse,

chronic sleep deprivation or irregular sleep-wake schedule and none were

taking medications known to influence sleep at the time of the study.

Results of the present study showed no correlation between PLMS index and

poor sleep efficiency or daytime sleepiness as measured by the multiple sleep

latency test (MSLT). However, a significant negative correlation was found

between sleep efficiency at night and the mean sleep latency on the MSLT.

These results suggest not only that PLMS and nocturnal sleep disruption are

not the primary cause of EDS, but that these sleepy patients have a high

propensity to sleep both at night and during the daytime. Therefore, the

presence of PLMS during nocturnal sleep recording should not preclude the

diagnosis of idiopathic hypersomnia.

Gabapentin (Neurotin) for treatment of pain and tremor: a large case series

Author: Merren MD

Address: Neurology Clinic of San , TX 78229, USA.

Source: South Med J, 1998 Aug, 91:8, 739-44

BACKGROUND: Several anticonvulsant agents, including carbamazepine, phenytoin,

and valproate, are effective in some patients for the treatment of pain and

tremor. This study reports on a trial of the newly introduced anticonvulsant,

gabapentin, for pain and tremor control.

METHODS: A large case series of patients with centrally mediated pain,

peripherally mediated pain, migraine, and tremor were treated in an open-label

study with gabapentin (maximum of 2,700 mg/day).

RESULTS: Thirty-nine patients (65%) had moderate-to-excellent improvement in

symptoms, with the best responses occurring in patients with peripherally

mediated neuropathic pain. The other conditions treated that showed some

improvement were benign essential/familial tremor, restless legs syndrome,

centrally mediated pain, and periodic nighttime leg movements.

CONCLUSIONS: Gabapentin offers an effective, safe alternative therapy or co-

therapy for the listed painful conditions and tremor; it does not affect the

metabolism of other medications and is well tolerated.

Sleep disorders

Author: Thobaben M

Address: Department of Nursing, Humboldt State University, Arcata, CA 95521,

USA.

Source: Home Care Provid, 1998 Feb, 3:1, 14-6

Abstract: Many clients have trouble battling afternoon fatigue, falling

asleep, staying asleep, or having a restful night's sleep. Approximately 33%

of the adult U.S. population--about 65 million people--suffer from sleep

disorders. One of two people have experienced insomnia. At least 10 million

people have sleep apnea, hundreds of thousands have experienced narcolepsy,

and approximately 12 million suffer from restless legs syndrome or periodic

limb movements during sleep. However, most people with sleep disorders remain

undiagnosed and untreated.

ABNORMAL MOVEMENTS IN SLEEP AS A POST-POLIO SEQUELAE

Author: Bruno RL

Address: The Post-Polio Institute at Englewood Hospital and Medical Center,

New Jersey 07631, USA.

Source: Am J Phys Med Rehabil, 1998 Jul-Aug, 77:4, 339-43

Abstract: Nearly two-thirds of polio survivors report abnormal movements in

sleep, with 52% reporting that their sleep is disturbed by these movements.

Sleep studies were performed in seven polio survivors to document objectively

abnormal movements in sleep.

Two patients demonstrated generalized random myoclonus, with brief

contractions and even ballistic movements of the arms and legs, slow repeated

grasping movements of the hands, slow flexion of the arms, and contraction of

the shoulder and pectoral muscles. Two other patients demonstrated periodic

movements in sleep with muscle contractions and ballistic movements of the

legs, two had periodic movements in sleep plus restless legs syndrome, and one

had sleep starts involving only contraction of the arm muscles.

Abnormal movements in sleep occurred in Stage II sleep in all patients, in

Stage I in some patients, and could significantly disturb sleep architecture

even though patients were totally unaware of muscle contractions. Poliovirus-

induced damage to the spinal cord and brain is presented as a possible cause

of abnormal movements in sleep. The diagnosis of post-polio fatigue,

evaluation of abnormal movements in sleep, and management of abnormal

movements in sleep using benzodiazepines or dopamimetic agents are described.