Clinical Neuroscience

[Pathophysiology of restless leg syndrome and periodic leg movement disorder in view of the latest research findings]

KÖVES Péter1, SZAKÁCS ZOLTÁN1

MAY 10, 2005

Clinical Neuroscience - 2005;58(05-06)

[Both restless leg syndrome and periodic leg movement disorder have been classified as primary sleep disorders by the International Classification of Sleep Disorders. Considering the characteristic clinical symptoms, it is supposed that their pathomechanism involves the peripheral and central stimulusprocessing mechanisms of the nervous system as well as several elements of the motor system. During the last couple of years many new elements of the pathomechanism have been discovered, in particular the dysfunction of the postsynaptic dopamin receptors related to the iron metabolism of the central nervous system, the role of opiate receptors, and the involvement of subclinical small fiber neuropathy. Many of these findings have been incorporated into the diagnostic and treatment protocols used in the management of patients with restless leg syndrome or periodic leg movement disorder. Considering the rapidly increasing number of publications on their pathomechanism and the various fields it involves, the authors found it necessary to evaluate these data and to interpret their relationships within the frame of sleep-wake regulation.]

AFFILIATIONS

  1. Magyar Honvédség Központi Honvédkórház, NeurológiaI Osztály, Alvásdiagnosztikai és Terápiás Központ, Budapest

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[The authors report a comprehensive publication consisting of three parts going into the details of history, prevalence, clinical forms, differential diagnosis, genetics, molecular pathomechanism, pathology, clinical diagnosis and treatment of frontotemporal dementia (FTD). The first part of the present review deals with history, prevalence and clinical forms of FTD. The prototypical FTD with circumscribed atrophy was first described by Arnold Pick; Alois Alzheimer found the intraneural inclusions in the patients’ brain. Later it was recognised that many patients had neither the atrophy nor the cellular changes, but genetic mutations have been identified. Frontotemporal dementia is a degenerative condition with unknown etiology in the frontal and anterior temporal lobes of the brain. It is a progressive neurobehavioral syndrome characterized by early decline in social interpersonal conduct, early impairment in the regulation of personal conduct, early emotional blunting, and early loss of insight. There are no reliable epidemiological studies on the prevalence of FTD, but it is well-accepted that FTD is a common cause for dementia before the age of 65 (it constitues approximately five percent of all irreversible dementias). The nomenclature of the FTD has been confusing and continues to be. Three major clinical syndromes can be identified: 1 frontal variant FTD (dementia of frontal type) in which changes in social behavior and personality predominate, 2. in semantic dementia (progressive fluent aphasia) there is a breakdown in the conceptual database which underlies language production and comprehension, 3. in progressive nonfluent aphasia the phonologic and syntactic components of language are affected. The authors report two cases, which can point to clinical symptoms and forms, and mention the problems of the differential diagnosis and therapy.]

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SOMHEGYI Annamária, TÓTH János, MAKSZIN Imre, GARDI Zsuzsa, FESZTHAMMER Artúrné, DARABOSNÉ Tim Irma, TÓTHNÉ Steinhausz Viktória, TÓTHNÉ Szabó Klára, VARGA Péter Pál

[Introduction - The primary prevention program of the Hungarian Spine Society is set around 12 test exercises that assess performance of postural muscles and then develops their strength and flexibility. By this the scheme aims to make the biomechanically correct use of the spinal column spontaneous. Subjects and methos - The application of the scheme in the frame of physical education in a primary school was investigated in a prospective controlled study in the school-year of 2001/2002. Participating children were aged 6 to 14. The intervention group (n=200) regularly did the posture correction exercises with their teacher's direction in physical education classes, while the control group (n=213) did not. The 12 test exercises of the posture correction scheme of the Hungarian Spine Society were tested by an independent physiotherapist at the beginning and at the end of the school-year in both groups. Results were analyzed by paired and unpaired t-tests and by a chi-square test. Results - At the end of the school-year the strength and flexibility of the postural muscles of the intervention group improved significantly compared both to their own performance (p<0.01) at the beginning of the school-year and to the control group. Test results of the control group were significantly (p<0.05) worse at the end of the school-year than their own results at beginning of the school-year, and were more significantly (p<0.01) worse than the test results of intervention group. Conclusion - The results of the controlled study confirm that regular use of the preventive exercises in physical education improves the strength and flexibility of postural muscles. In order to analyze the results concerning specific muscle groups or age groups a detailed study with age- and gender-matched controls will be necessary.]

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Introduction - Restless Leg Syndrome (RLS) is a disease, primarily composed of sensational symptoms, caused by the urge to move lower extremities especially at night, and characterized by undesired feelings of the legs. Decreasing of the dopaminergic effect at night is thought to be responsible from these symptoms. RLS patients suffer from low quality of sleep affecting their daily life activities even causing socio-economic loss. Although RLS is a common and treatable disease, it can not be diagnosed easily due to the variability of symptoms. Aim - The purpose of this study is to determine the frequency of RLS among health workers and to define the disease causing factors. Method - A questionnaire was applied to 174 randomly selected health workers at Baskent University Medical Faculty (KA17/285). The demographic information, history of illnesses or usage of drugs, socioeconomic status, working hours and daytime sleepiness were questioned. Included in the questionnaire were diagnostic criteria for RLS, frequency assessment scale, and survey of sleep quality. We used “the diagnostic criteria of international RLS working group” for the diagnosis, and “Pittsburgh sleep quality index survey” to determine the quality of sleep. Reliability and validity studies were performed on both tests. Results - A significant relationship between socio-economic status and RLS was found (p<0.05) as an increase of RLS frequency in parallel with decreased socio-economic status. RLS was found to be common among health workers. We suggest that health workers should be checked regularly, and they should be informed about the disease in order to raise an awareness and hence increase their quality of life.

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