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5 results

  • Clinical management of restless legs syndrome in end-stage renal disease patients

  • Zeyad T. Sahli, Jae Jo, Shaker A. Mousa, Frank I. Tarazi
  • Journal:
    CNS Spectrums / Volume 22 / Issue 1 / February 2017
    Published online by Cambridge University Press:
    05 October 2016, pp. 14-21

  • Restless legs syndrome (RLS) is a common neurological movement disorder, characterized by restless and unpleasant sensations in the deep inside of legs. The symptoms of RLS are less noticeable during daytime, but more prevalent at night. Therefore, the disorder can induce low quality of life, insomnia, and impairment of daytime activity. RLS in end-stage renal disease (ESRD) patients is especially problematic due to premature discontinuation of dialysis and increased mortality. The prevalence of RLS among dialysis patients is much higher compared to the prevalence of the same disorder in patients with normal renal functions. Even though there are recommended treatment guidelines for the general population established by Medical Advisory Board of the RLS foundation, which include the use of dopamine agonists, levodopa, gabapentin, benzodiazepines, and opioids, limited information is available on the effects of these therapies in ESRD patients. Since the existing clinical data were extrapolated from small sample sizes in short-term clinical trials, further clinical studies are still needed to better assess the efficacy, safety, and tolerability of these medications in patients with ESRD.

  • Chapter 31 - Brain tumors, infections, and other CNS causes of sleepiness

  • from Section 3 - Medical, Psychiatric and Neurological Causes Of Sleepiness
  • Edited by Michael J. Thorpy, Michel Billiard
  • Book:
    Sleepiness
    Published online:
    04 February 2011
    Print publication:
    27 January 2011, pp 351-363

  • Summary

    Restless legs syndrome and periodic limb movement disorder are common neurological entities that may be associated with insomnia and excessive daytime sleepiness. This chapter reviews the clinical features, natural history, laboratory investigations, genetics, pathology, and management of primary restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Large epidemiological surveys have shown that self-reported symptoms of RLS were correlated with sleepiness. Electrodiagnostic testing with nerve conduction studies and electromyography are useful to detect subtle peripheral neuropathies. Several factors suggest that impaired dopaminergic function and iron homeostasis underlie the pathophysiology of RLS. One study demonstrated that dopaminergic treatment of RLS patients improved both RLS severity and sleepiness as measured by multiple sleep latency test (MSLT) score. Considerable research has been directed towards elucidating the basic mechanisms and optimizing the management of RLS and PLMD.

  • 30 - Sleep medication and traffic safety in the elderly

  • from Part 3 - Sleepdisorders in the elderly
  • Edited by S. R. Pandi-Perumal, Jaime M. Monti, Universidad de la República, Uruguay, Andrew A. Monjan, National Institute on Aging, Bethesda, Maryland
  • Book:
    Principles and Practice of Geriatric Sleep Medicine
    Published online:
    04 August 2010
    Print publication:
    26 November 2009, pp 319-324

  • Summary

    This chapter reviews the nocturnal sleep disorders associated with Parkinson's disease (PD). The most common sleep disorders in PD include insomnia, REM sleep behavior disorder (RBD), sleep apnea, restless legs syndrome (RLS), and periodic limb movement disorder (PLMD). The diagnosis of RLS in PD patients may be confounded by akathisia and nocturnal motor symptoms. The presence of diurnal variations of symptoms in RLS, and the feeling of inner restlessness without a sensory component in akathisia, may help to differentiate akathisia from RLS. The primary neurodegenerative process of PD, complex medication regimens, age-related changes in the sleep architecture, and co-existent sleep disturbances play an important role in the development of excessive daytime somnolence (EDS). Several objective and subjective diagnostic tools have been used for the diagnosis of EDS in PD patients. Deep brain stimulation (DBS) has become an important treatment option for PD patients with disabling motor complications and dyskinesias.

  • 13 - Sleep and geriatrics

  • from SECTION 3 - SLEEP IN SPECIALTY AREAS
    • By Marcel Hungs, Sleep Disorders Centre, University of California Irvine Department of Neurology, USA
  • Edited by Harold R. Smith, University of California, Irvine, Cynthia L. Comella, Birgit Högl
  • Book:
    Sleep Medicine
    Published online:
    08 August 2009
    Print publication:
    10 April 2008, pp 224-239

  • Summary

    The analysis of age-related changes in sleep requires the accumulation of data on a healthy population over 65 years of age. However, increased age raises the risk of cardiovascular, metabolic, cognitive, psychiatric, musculoskeletal, renal, hepatic, and hematological conditions. Structural decline in the elderly, including reduced brain mass and numbers of neurons, might lead to functional brain loss. Certain primary sleep disorders affecting sleep in the elderly includes insomnia, sleep-disordered breathing (SDB), periodic limb movement disorder and restless legs syndrome, circadian rhythm sleep disorders, and sleep in dementia. This chapter provides the clinical presentation, diagnosis and treatment for each disorder. As sleep and its restorative function become more widely recognized for their impact on both medical conditions and quality of life in the elderly, the healthcare community has ever-increasing responsibility for translating the growing knowledge of sleep medicine into clinical practice in geriatric medicine.

  • 27 - Sleep Disorders

  • from SECTION III - SPECIFIC NEUROLOGICAL CONDITIONS
    • By A. Sinan Baran, Department of Psychiatry University of Mississippi Jackson, Mississippi
  • Edited by Sid M. Shah, Michigan State University, Kevin M. Kelly, Drexel University, Philadelphia
  • Book:
    Principles and Practice of Emergency Neurology
    Published online:
    06 August 2009
    Print publication:
    18 February 2003, pp 273-278

  • Summary

    The sleep disorders that predispose to trauma are: disorders associated with excessive daytime sleepiness, obstructive sleep apnea, upper airway resistance syndrome, periodic limb movement disorder, narcolepsy, cataplexy, sleep paralysis and hypnagogic hallucinations. The disorders associated with behaviors while asleep (parasomnias) are: sleep terrors and sleepwalking and REM sleep behavior disorder. Injury can result from behaviors that occur during sleep. The patient's ability to recall the episode depends partly on the type of the parasomnia (occurrence during non-REM versus REM sleep). The other sleep disorders are recurrent hypersomnia and insomnia. Insomnia can result from multiple causes including psychiatric or general medical disorders, medication effects, substance abuse, and other sleep disorders. Restless legs syndrome (RLS) is another important cause of insomnia. RLS is thought to be related to periodic limb movement disorder and is characterized by lower extremity dysesthesias that occur at rest.