The objective of this study is to emphasize the importance of the clinical suspicion of Restless Legs Syndrome (RLS) among patients with chronic insomnia.
We conducted a retrospective study referring ...to the period 2009–2018. All patients presenting with the complaint of insomnia and fulfilling the criteria of Chronic Insomnia (C.I.) were enrolled. In this group we estimated how many patients finally had the diagnosis of RLS. Demographic and clinical characteristics (sleep related problems, fatigue, daytime sleepiness and psychological profile) were recorded and analyzed between C.I. and RLS patients using logistic regression models.
A total of 532 patients presented with C.I. Among them 83 proved to have RLS. No differences in frequencies or odds were observed concerning the type of insomnia, daily fatigue, daytime sleepiness and depression. RLS is more frequent in women (p = 0.01) and in older patients (p = 0.05) who present with the picture of C.I. Anxiety levels are higher in the RLS group (p = 0.004).
RLS and C.I. patients demonstrate a very similar profile which complicates the differential diagnosis. Physicians and especially psychiatrists who deal with insomnia must have increased clinical suspicion for RLS as RLS and insomnia have a totally different therapeutic approach.
•Patients with insomnia may neglect the urge to move their limbs that accompanies RLS.•Anxiety levels are really increased in patients with insomnia due to RLS compared to those with pure Chronic Insomnia.•Anxiety and depression frequently comorbid with RLS.•Elderly women presenting with chronic insomnia should be screened for RLS.
Abstract
Study Objectives
Τo assess whether REM Sleep Behavior Disorder (RBD) and other sleep abnormalities occur in carriers of the p.A53T alpha-synuclein gene (SNCA) mutation, using both subjective ...and objective measures.
Methods
We have assessed 15 p.A53T carriers (10 manifesting Parkinson’s Disease PD-A53T and 5 asymptomatic carriers) with simultaneous Video-PSG (polysomnography) recording, the Epworth Sleepiness Scale (ESS) for daytime sleepiness, the Athens Insomnia Scale (AIS), the RBD Screening Questionnaire (RBDSQ) for clinical features of RBD, the Montreal Cognitive Assessment (MOCA) for cognition and the University of Pennsylvania Smell Identification Test (UPSIT) for olfaction.
Results
In our cohort, 90% of PD carriers had at least one sleep disorder and 40% had two: 4 RBD, 1 Periodic Limb Movements (PLM), 1 RBD plus PLM, 2 RBD plus moderate Obstructive Sleep Apnea (OSA), and 1 moderate OSA plus Restless Leg Syndrome. No asymptomatic carrier manifested a confirmed sleep disorder. 6/7 PD carriers with RBD had abnormal olfactory testing and 4/7 MOCA below cut off. There was a correlation of both impaired olfaction and cognition with RBD.
Conclusions
RBD occurs in the majority of PD-A53T, in contrast to most other genetic forms of PD, in which RBD is uncommon. The paucity of a sleep disorder in the asymptomatic carriers suggests that such carriers have not yet reached the prodromal phase when such sleep disorders manifest. Hyposmia in almost all subjects with RBD and cognitive decline in most of them are indicative of the general pattern of disease progression, which however is not uniform.
BACKGROUND AND PURPOSE—Even though current guidelines suggest that noninvasive ventilatory correction (NIVC) could be considered for acute ischemic stroke patients with obstructive sleep apnea, ...available evidence is conflicting, with no adequately powered randomized clinical trial being available to date.
METHODS—We conducted a systematic review and meta-analysis of all available literature data evaluating the effect of NIVC on neurological improvement (based on decrease in National Institutes of Health Stroke Scale score), vascular events (recurrent stroke, transient ischemic attack, myocardial infarction and unstable angina), and mortality during the follow-up period.
RESULTS—We identified 4 randomized clinical trials and 1 prospectively matched observational cohort, comprising a total of 389 patients (59.8% males, mean age64.4 years). The risk of both performance and detection bias was considered high in most of the included randomized clinical trials because of the lack of blinding in participants, personnel and/or outcome assessors. The mean decrease in National Institutes of Health Stroke Scale scores during the first (≤30) days of acute ischemic stroke was found to be greater in NIVC-treated patients in comparison to controls (standardized mean difference, 0.38; 95% confidence interval, 0.11–0.66; P=0.007). However, no significant differences were detected between NIVC-treated acute ischemic stroke patients and controls on both the risk of vascular events (risk ratio, 0.53; 95% confidence interval, 0.25–1.14; P=0.11) and mortality (risk ratio, 0.71; 95% confidence interval, 0.37–1.36; P=0.30). No evidence of heterogeneity (I=0%; P for Cochran Q>0.50) or publication bias were detected in all analyses.
CONCLUSIONS—NIVC seems to be associated with greater short-term neurological improvement in acute ischemic stroke patients with obstructive sleep apnea. This finding deserves further investigation within the settings of an adequately powered, sham-control, randomized clinical trial.
Background
Small vessel disease (SVD), and most specifically hereditary forms like CADASIL and cerebral amyloid angiopathy (hCAA), are conditions of increasing clinical importance. We report a rare ...case of hCAA in a Greek family that presented with a CADASIL clinical and neuroimaging phenotype.
Methods
A 65‐year‐old man was admitted with recurrent transient episodes of right leg numbness. The patient's medical history started at the age of 50 years with depression and behavioral disorders. His family history was positive for stroke (father), dementia (father and brother), migraine (daughter) and depression (father and daughter).
Results
Neurological examination disclosed anomic aphasia with severely impaired cognitive status, and brisk reflexes. Brain computed tomography and magnetic resonance imaging showed CADASIL‐like leukoencephalopathy (hyperintense lesions in bilateral temporopolar area, external capsule, thalami, centrum semiovale and superior frontal regions) with occipital calcifications and cerebral microbleeds. Screen for variants in NOTCH3 gene was negative. Exome sequencing revealed a novel pathogenic mutation for hCAA.
Conclusions
We report a novel amyloid precursor protein mutation which results in a CADASIL‐like clinical phenotype (progressive cognitive and motor decline, stroke, migraine and behavioral disorders) and CADASIL‐leukoencephalopathy coupled with occipital calcifications. Earlier recognition and swift hCAA diagnosis may prompt rational preventive and potential disease‐modifying interventions.
We report a rare case of hereditary cerebral amyloid angiopathy (hCAA) associated with a novel mutation of the amyloid precursor protein in a Greek family that presented with a CADASIL clinical and neuroimaging phenotype. hCAA may mimic CADASIL clinical and typical neuroimaging findings, while occipital calcifications may serve as an essential neuroimaging marker for the differential diagnosis of these two conditions.
Exit, pursued by a bear Proukakis, Christos, MRCP; Bonakis, Anastasios, MD; Salman, Ali M, MD ...
The Lancet (British edition),
07/2008, Letnik:
372, Številka:
9634
Journal Article
Recenzirano
On detailed questioning, the patient reported erectile dysfunction, urinary urgency, and a recurring nightmare of being chased by a bear, during which he had hit his wife. Multiple system atrophy is ...a term used to describe syndromes formerly known as Shy-Drager syndrome, striatonigral degeneration, and olivopontocerebellar atrophy.2 It is a neurodegenerative disease-which, like Parkinson's disease and Lewy-body dementia, is characterised histopathologically by cytoplasmic accumulation of a-synuclein.2 Patients with multiple system atrophy have motor and autonomie dysfunction.2 In 80% of patients, motor features are mainly parkinsonian; other patients have cerebellar dysfunction.2 Electromyography of the anal sphincter often gives abnormal results, but is not required for diagnosis.2 Manifestations of autonomie dysfunction include postural hypotension, urinary urgency, and erectile dysfunction.2 REM sleep behaviour disorder has been found in over half of patients with multiple system atrophy.3 Vocal-fold motion impairment develops in around 30% of patients;2 it was thought to be caused by impaired abduction of the vocal cords, attributable to degeneration of the nucleus ambiguus and recurrent laryngeal nerve.2 However, such a mechanism is difficult to reconcile with the spontaneous improvement in our patient's stridor, and with the worsening of symptoms at night.
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