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MOVEMENT DISORDERS 2012年第6期27卷 743-749页

作者： De Cock, Valerie Cochen Bayard, Sophie Yu, Huan Grini, Magda Carlander, Bertrand Postuma, Ron Charif, Mahmoud Dauvilliers, Yves Hop Gui de Chauliac Unite Troubles Sommeil Serv Neurol F-34235 Montpellier France INSERM U1061 Montpellier France Shangai Fudan Univ Shanghai Huashan Hosp Dept Neurol Shanghai Peoples R China McGill Univ Montreal Gen Hosp Dept Neurol Montreal ON Canada

Diagnosis of restless leg syndrome (RLS) in Parkinson's disease (PD) is difficult because of clinical confounds. The suggested immobilization test (SIT) is validated for diagnosis of primary RLS. This study evaluated the usefulness of the SIT for diagnosis of RLS in PD. We compared SIT scores, as well as polysomnography measures in 50 patients with PD (25 with RLS, 25 without), 25 patients with primary RLS, and 25 age/sex matched controls. Mean leg discomfort score was increased in patients with PD and RLS compared to PD without RLS, and also in patients with primary RLS compared to controls. Leg discomfort was significantly higher at the end of the test in patients with RLS compared to patients without RLS. Intensity of leg discomfort was similar between patients with RLS, with or without PD. Using a mean leg discomfort cutoff of 11, we showed sensitivity of 91% and specificity of 72% for RLS diagnosis in PD during symptomatic time intervals. Periodic leg movements index during the SIT did not differ between groups. Periodic leg movements index during sleep and wakefulness was increased in patients with primary RLS compared to controls, but did not differ between patients with PD, with and without RLS. The sensory SIT is a simple test that may help diagnose RLS in patients with PD. (C) 2012 Movement Disorder Society

关键词： suggested immobilization test Parkinson's disease restless legs syndrome periodic limb movements

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Restless legs syndrome in the dominant Parkinson's side related to subthalamic deep-brain stimulation

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SLEEP MEDICINE 2024年 115卷 174-176页

作者： Tordjman, Lionel Lagha-Boukbiza, Ouhaid Anheim, Mathieu Tranchant, Christine Bourgin, Patrice Ruppert, Elisabeth Univ Hosp Strasbourg CIRCSom Int Res Ctr ChronoSomnol 1 Pl Hop F-67000 Strasbourg France Univ Hosp Strasbourg Sleep Disorders Ctr 1 Pl Hop F-67000 Strasbourg France Univ Hosp Strasbourg Dept Neurol Movement Disorders Clin 1 Pl Hop F-67000 Strasbourg France CNRS Inst Cellular & Integrat Neurosci UPR 3212 8 Allee Gen Rouvillois F-67000 Strasbourg France Strasbourg Univ 8 Allee Gen Rouvillois F-67000 Strasbourg France

Background: Restless legs syndrome (RLS) has an increased estimated prevalence in patients with Parkinson's disease (PS). RLS frequently mimics symptoms intrinsic to PD, such as motor restlessness, contributing to making its diagnosis challenging in this population. We report the case of a patient with new-onset RLS following subthalamic deep-brain stimulation (DBS-STN). We assessed symptoms using suggested immobilization test (SIT) with both DBS-STN activated and switched off. Case description: A 59-year-old man with idiopathic PD developed disabling RLS following DBS-STN at age 58, with PD onset at 50 manifesting as left arm tremor. Despite improved motor symptoms during the month following surgery, the patient experienced left leg discomfort at rest, transiently alleviated by movements due to an irrepressible urge to move, and worsened at night. Symptoms had no temporal relationship with oral dopatherapy and disappeared when DBS-STN was deactivated. A 1 h SIT assessed motor behavior with irrepressible urge to move, as well as sensory symptoms by visual analog scale. After 30 m DBS-STN was switched off followed by the appearance of tremor in the left arm while both motor and sensory symptoms of RLS disappeared in the left leg. Discussion: The mechanisms of DBS-STN's impact on RLS remain controversial. We hypothesize the DBS-STN to induce in our patient a hyperdopaminergic tone. DBS-induced and DBS-ameliorated RLS represent interesting conditions to further understand the pathophysiology of RLS. Moreover, the present observation suggests that SIT can be a valuable tool to assess RLS in PD patients before and after DBS-STN in future prospective studies.

关键词： Restless legs syndrome Willis-Ekbom disease Parkinson disease Hyperdopaminergism suggested immobilization test Deep brain stimulation

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Clinical characteristics of Restless legs syndrome in patients with Parkinson's disease

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JOURNAL OF THE NEUROLOGICAL SCIENCES 2006年第1-2期250卷 39-44页

作者： Nomura, Takashi Inoue, Yuichi Nakashima, Kenji Yonago Med Ctr Dept Neurol Yonago Tottori 6838518 Japan Tottori Univ Fac Med Dept Neurol Inst Neurol Sci Tottori 680 Japan

To assess the characteristics, clinical significance and pathology of Restless legs syndrome (RLS) in patients with Parkinson's disease (PD), we studied clinical backgrounds, RLS symptoms, polysomnographic (PSG) variables and therapeutic outcomes in 13 PD patients with RLS (pRLS), and compared them with those of 22 idiopathic RLS patients (iRLS). In all but one pRLS patient, RLS symptoms arose within 5 years of PD onset. pRLS patients had a lower prevalence of family history of RLS, and the age at onset was higher than in iRLS subjects. Scores for the severity scale established by the International Restless Legs Syndrome Study Group (IRLS), the Pittsburgh Sleep Quality Index, and the suggested immobilization test did not differ between groups. However, the periodic limb movements index measured by polysomnogram was smaller in pRLS subjects. After RLS treatment, symptoms improved significantly in both groups;however, pRLS subjects showed higher IRLS scores despite receiving similar doses of RLS medications. The severity of RLS before treatment was quite similar between the two groups, but the response to treatment could be poorer in pRLS than in iRLS. Thus, degeneration of the diencephalospinal dopaminergic pathway due to PD itself and physiological aging could overlap in the pathology of pRLS. (c) 2006 Elsevier B.V. All rights reserved.

关键词： Restless legs syndrome Parkinson's disease International Restless Legs Syndrome Study Group severity scale of RLS Pittsburgh Sleep Quality Index suggested immobilization test dopamine agonist periodic limb movements during sleep

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Which Factors in Spinocerebellar Ataxia Type 3 Patients Are Associated with Restless Legs Syndrome/Willis-Ekbom Disease?

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CEREBELLUM 2021年第1期20卷 21-30页

作者： Gitai, Livia Leite Goes eckeli, Alan Luiz Sobreira-Neto, Manoel Alves Diniz, Paula Rejane Beserra Santos, Antonio Carlos Junior, Wilson Marques Fernandes, Regina Maria Franca Univ Fed Alagoas Fac Med Campus UnivAve Lourival Melo Mota S-N BR-57072900 Maceio Alagoas Brazil Univ Sao Paulo Fac Med Ribeirao Preto Dept Neurosci Campus UnivRua Bernardino Campos1000 Ctr BR-65470000 Ribeirao Preto SP Brazil Univ Fed Ceara Fac Med Dept Clin Med Rua Prof Costa Mendes 14084 Andar BR-60430140 Fortaleza Ceara Brazil Univ Sao Paulo Fac Med Ribeirao Preto Dept Radiol Campus UnivRua Bernardino Campos1000 Ctr BR-65470000 Ribeirao Preto SP Brazil

There is evidence of a higher prevalence of restless legs syndrome/Willis-Ekbom disease (RLS/WED) in individuals with spinocerebellar ataxia type 3 (SCA3), although the factors underlying this association remain unknown. The present study aimed to determine the prevalence of RLS/WED in SCA3 patients and to investigate which factors of SCA3 patients are associated with presence of RLS/WED. From February to August of 2006, we carried out clinical interviews in 40 controls and 40 SCA3 patients, diagnosed and followed up at Faculty of Medicine of Ribeirao Preto, University of Sao Paulo. Twenty-seven SCA3 patients were submitted to a detailed clinical protocol, electroneuromyography, blood work up, polysomnography (PSG), suggested immobilization test (SIT), and magnetic resonance image (MRI). RLS/WED was found in 27.5% of SCA3 patients and 2.5% of normal controls (p = 0.003). The factors related to RLS/WED in SCA3 patients were female gender, age at start of the symptoms of ataxia after 30 years, presence of peripheral neuropathy, and documented iron deficiency. Among SCA3 patients, those with RLS showed higher values of maximal discomfort level and discomfort level sum compared to non-RLS individuals on SIT. There is a relation between RLS/WED and SCA3, which seems to be resultant of different factors whose identification could improve the quality of assistance to those patients as well as to promote a better comprehension of the pathophysiology of both RLS/WED and SCA3.

关键词： Restless legs syndrome Willis-Ekbom disease Spinocerebellar ataxias Machado-Joseph disease Magnetic resonance imaging suggested immobilization test

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test-to-test variability in motor activity during the suggested immobilization test in restless legs patients

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SLEEP MEDICINE 2006年第7期7卷 561-566页

作者： Haba-Rubio, Jose Sforza, Emilia Univ Hosp Geneva Dept Psychiat Sleep Lab Geneva Switzerland

Background and purpose: To evaluate the test-to-test variability of the suggested immobilization test (SIT) in patients with restless legs syndrome (RLS). Patients and methods: Twenty patients with primary RLS (12 men and eight women;age: 53.3 +/- 11.3 years) were selected for the study. We compared the results of two SITS performed on two consecutive evenings prior to polysomnographic recordings. Results: Overall, the periodic leg movement index during the SIT (SIT PLM) and the SIT PLM index associated with sensory manifestations (SIT PLM+) were not significantly different between tests. The number of PLM sequences per SIT, the mean PLM duration and the PLM interval did not significantly change between the two consecutive tests. The pattern of temporal evolution of motor activity across the SIT was very reproducible, SIT PLM showing a clear tendency to a progressive increase across the test, with the SIT PLM+ index decreasing in the second half of the test. Despite good reproducibility, there were marked intra-individual differences. Considering the proposed cut-off value of 12 for the SIT PLM index to confirm RLS, 11 patients were positive at the first test and four additional patients became positive at the second test. SIT PLM index changes did not correlate with age, severity of disease and polysomnographic measures. Conclusions: Quantitative analysis of motor activity during two consecutive SITS in RLS patients showed a significant inter-test intraindividual variability unrelated to demographic, clinical or polysomnographic parameters. SIT PLM index variability suggests that a single test would not be sensitive enough for diagnostic purposes in unclear cases and that new criteria need to be applied to increase its specificity and sensitivity. (C) 2006 Elsevier B.V. All rights reserved.

关键词： restless legs syndrome suggested immobilization test periodic leg movements motor activity

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Subjective and objective criteria in the diagnosis of the restless legs syndrome

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SLEEP MEDICINE 2004年第3期5卷 285-292页

作者： Hening, WA UMDNJ RW Johnson Med Sch Dept Neurol New Brunswick NJ USA

The diagnosis of RLS has been undergoing a gradual evolution, but remains anchored in a 'gold standard' of an expert clinical interview. The most recent standards emphasize the presence of one main symptom - The urge to move - and three key modulators: rest, activity, and time of day. Beyond establishing these key features, the major diagnostic challenge is to eliminate mimics. Objective test scan be helpful in doubtful cases, but have not become accepted as diagnostic criteria. Improving technology may make them more useful in the future. Meanwhile, the diagnosis of RLS outside of the expert clinical interview and as applied to diverse populations is less clearly understood. Some studies suggest that those affected with RLS in the community may differ at least in severity from those who have become patients. The non-patient individual with RLS may present significant and greater diagnostic challenges than patients. Work remains to be done to further validate useful epidemiological and screening instruments for this population. Ongoing discoveries in the pathophysiology and genetics of RLS may contribute to greater diagnostic accuracy, additional diagnostic instruments, and new assessment measures in the future. © 2004 Published by Elsevier B.V.

关键词： restless legs diagnosis periodic limb movements suggested immobilization test actigraphy diary epidemiology

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Correlation between rating scales and sleep laboratory measurements in restless legs syndrome

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SLEEP MEDICINE 2004年第6期5卷 561-565页

作者： Garcia-Borreguero, D Larrosa, O de la Llave, Y Granizo, JJ Allen, R Univ Autonoma Madrid Fdn Jimenez Diaz Dept Neurol Sleep Disorders Unit Madrid 28040 Spain Fdn Jimenez Diaz Dept Epidemiol & Biometr E-28040 Madrid Spain Johns Hopkins Univ Baltimore MD USA

Objectives: The aim of this study was to test the external validity of the International Restless Legs Scale (IRLS) by assessment of the correlation between IRLS scores and objective measures of severity such as polysomnography (PSG) and suggested immobilization test. (SIT). Designs: Correlation analysis between rating scales for RLS (IRLS and Johns Hopkins RLS Scale -JHRLSS-) and sleep laboratory measurements in untreated RLS patients. Methods: The study included 30 untreated patients diagnosed with RLS according to the criteria of the International RLS Study Group. Diagnostic procedures included physical exam, laboratory analysis, PSG and a nocturnal SIT. Statistical analysis was performed by means of Spearman's correlations and Kruskal-Wallis test. Results: IRLS correlated significantly with Periodic Leg Movement of Sleep-index (PLMS), and PLMS-arousal index during PSG as well as with Periodic Leg Movement of Wakefulness (PLMW) during SIT (SIT-PLMW) (all r = 0.4;p < 0.01). There was no correlation between IRLS and the number of PLMW in PSG (PSG-PLMW) or any other sleep variable during PSG. Nor was any correlation found between IRLS scores and ferritin, age, duration of illness or any other clinical variables. Conclusions: This study represents the first demonstration of a correlation between IRLS and objective parameters of motor dysfunction such as PLMS-index or SIT. This finding is particularly relevant for the design of future clinical trials. Furthermore, the association between PLMS and SIT-PLMW supports the view that both PLMS and PLMW might share a common mechanism. (C) 2004 Elsevier B.V. All rights reserved.

关键词： restless legs syndrome rating scales periodic leg movements suggested immobilization test polysomnography

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Correlation between putative indicators of primary restless legs syndrome severity

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SLEEP MEDICINE 2007年第1期8卷 84-89页

作者： Aksu, Murat Demirci, Sevda Bara-Jimenez, William Erciyes Univ Fac Med Dept Neurol TR-38039 Kayseri Turkey NINDS Expt Therapeut Branch Bethesda MD 20892 USA

Background and purpose: Several methods of assessing disease severity in restless legs syndrome (RLS) have been suggested. The purpose of this study was to examine the relationship between the suggested immobilization test (SIT), the International RLS Study Group rating scale (IRLS), sleep efficiency, and periodic leg movements of sleep index (PLMI). Patients and methods: Forty primary RLS patients with periodic leg movements of sleep were included in this prospective study. Study procedures were all performed during the same night, beginning with IRLS administration and following with SIT and polysomnography (PSG) evaluations, in that order. SIT was composed of two parameters: SIT mean discomfort score (SIT-MDS) and SIT periodic leg movements of wakefulness index (SIT-PLMW). PSG target measures were PLMI and sleep efficiency. Pearson's correlation was used for analysis at a P < 0.01 significance level. Results: PSG-PLMI correlated with IRLS (r = 0.462;P = 0.003) and with SIT-PLMW (r = 0.681;P = 0.0004). A correlation was also found between IRLS and SIT-MDS (r = 0.447;P = 0.004), even though SIT-PLMW and IRLS did not correlate with each other (P = 0.286). A negative correlation was found between PSG-PLMI and sleep efficiency (r = -0.435;P = 0.005). Neither SIT nor IRLS correlated with sleep efficiency. Only SIT discomfort scores from the second half of SIT correlated with SIT-PLMW (r = 0.457, P = 0.004), and they had a stronger correlation with IRLS (P = 0.003). Conclusions: This study attempted a much needed comprehensive evaluation of the relationship between various RLS severity indicators. Our findings support a strong role of motor dysfunction on sleep quality in RLS, as well as the potential use of SIT-PLMW as a sensitive indicator of RLS severity. (c) 2005 Elsevier B.V. All rights reserved.

关键词： restless legs syndrome periodic limb movement disorder periodic movement disorder sleep suggested immobilization test

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Effects of acupuncture on sensory symptoms and motor signs in patients with restless legs syndrome: A crossover randomized controlled trial

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MEDICINE 2022年第51期101卷 e32317-e32317页

作者： Fukutome, Takero Murashima, Koji Fukuoka Sleep Clin Fukuoka Japan JCHO Kyushu Hosp Dept Anesthesia Kitakyushu Japan Fukuoka Sleep Clin Chambord B1301Chuo Ku 2-10-2 Fukuoka 8100041 Japan

Background:Rapid effects of acupoint injection (acuinjection) at 4 acupoints (4P) (ST36, GB41, SP6, and BL60) on legs presenting sensory symptoms and motor signs in restless legs syndrome (RLS) were first described in a case report. This study aimed to confirm the beneficial effects of acuinjection. Methods:A randomized, controlled, single-blinded, prospective crossover study was conducted during 2018 to 2021. Adult volunteers (age >= 20 years) with RLS symptoms for > 2 weeks were included. Eight adults were enrolled and randomized to receive acuinjection (Verum group) or sham injection (Sham group). The effects of acuinjection on discomfort and periodic leg movement (PLM) were evaluated using the suggested immobilization test in a crossover design. The acupoint used was 4P, and normal saline solution (0.1-0.25 mL) was injected in both groups. Leg discomfort was measured using the visual analog scale (VAS), and PLM was measured using an electromyogram. To compare the VAS scores between the groups, repeated measures analysis of variance was used, and the Student t test was used to assess the mean discomfort score (MLDS: average of the 6 VAS scores) and PLM index (PLMI) (defined as the degree of PLM/hour). Results:A significant difference in the VAS score was observed;however, no significant difference was noted in the PLMI between the groups. The MLDS was significantly lower in the Verum group than in the Sham group. Conclusion:Acuinjection at 4P remarkably inhibited leg discomfort in patients with RLS. Despite the drastic PLM suppression in 1 patient by acuinjection, a statistically significant inhibition of PLM was not confirmed. The results of our study can be applied easily and safely in clinical situations where it is necessary to temporarily reduce or eliminate RLS symptoms.

关键词： acupoint injection acupuncture periodic leg movement restless legs syndrome suggested immobilization test

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Investigation into the correlation between sensation and leg movement in restless legs syndrome

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MOVEMENT DISORDERS 2005年第9期20卷 1097-1103页

作者： Birinyi, PV Allen, RP Lesage, S Dean, T Earley, CJ Johns Hopkins Univ Bayview Med Ctr Ctr Restless Legs Syndrome Sch MedDept Neurol Baltimore MD 21224 USA Johns Hopkins Sch Arts & Sci Dept Neurosci Baltimore MD USA

We evaluated rest effects on restless legs syndrome (RLS) sensory and motor symptoms. During two 60-minute suggested immobilization tests (SIT) subject's signals of RLS lea sensations and periodic leg movements while awake (PLMW) were recorded. Sensations, PLMW, sensations preceding or after PLMW. sensations occurring without following PLMW. and PLMW occurring without preceding sensation were determined. The RLS patients were divided into equal-sized high and low PLMW groups for further analysis. Data from 46 subjects (28 RLS and 18 controls) revealed sensations increased linearly with rest in RLS patients and controls. Movement rate increased linearly with rest for controls but increased rapidly for the first 45 minutes for all RLS patients. PLMW/ hour increased with further rest for low but not high PLMW patients. Sensations followed by PLMW and PLMW without preceding sensations followed similar patterns. Sensations without subsequent PLMW increased dramatically in the last 15 minutes of the SITs. Whereas both sensory and motor signs of RLS increase with rest, there is minimal increase for controls. Patients with higher but not lower PLMW rates reached a ceiling for PLMW after 35 to 40 minutes. The temporal dissociation between sensory and motor events supports viewing these motor and sensory events as separate but loosely linked manifestations of RLS. (C) 2005 Movement Disorder Society.

关键词： restless legs syndrome suggested immobilization test periodic leg movements rest-induced sensations leg sensations restless legs syndrome diagnosis

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