Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome

Montplaisir, Jacques; Boucher, Sylvie; Nicolas, Alain; Lespérance, Paul; Gosselin, Anik; Rompré, Pierre; Lavigne, Gilles

doi:10.1002/mds.870130220

Cited by 210 publications

(110 citation statements)

References 16 publications

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“…One-hour Suggested Immobilization Tests (SIT) were performed and scored using the published criteria [14]. The PSG and SIT tests included bilateral surface electrode measurements of the anterior tibialis EMG.…”

Section: Questionnaires and Proceduresmentioning

confidence: 99%

A randomized, double-blind, placebo-controlled trial of intravenous iron sucrose in restless legs syndrome

et al. 2009

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Objective: The aim of this study was to ascertain whether high-dose intravenous (IV) iron sucrose could improve symptoms and change brain iron concentrations in idiopathic RLS. Methods:The study was a randomized, parallel-group double-blind study of 1000 mg iron sucrose given IV versus placebo. Primary measures of the clinical status were global rating scale (GRS) and periodic leg movements of sleep (PLMS). Primary measures of brain iron status were CSF ferritin and MRI-determined iron in the substantia nigra.Results: At the time of the interim analysis there were 7 placebo and 11 iron-treated subjects. At 2-weeks post-treatment, iron treatment resulted in a small but significant increase in CSF ferritin and decrease in RLS severity (GRS) but did not change PLMS or MRI iron index. None of the secondary outcomes changed with treatment. There was no single case of clear treatment benefit in any of the patients. This interim analysis revealed an effect size that was too small to allow for adequate power to find significant differences with the planed 36-subject enrollment for either the primary objective outcome of PLMS or any of the secondary outcomes. The study was stopped at this planned breakpoint given the lack of both adequate power and any indication for clinically significant benefit.Conclusions: High-dose IV iron failed to demonstrate the robust changes reported in three prior open-label studies. Differences in iron formulation, dosing regiment, and peripheral iron status may explain some of the discrepancies between this and previous IV iron treatment studies.

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Section: Questionnaires and Proceduresmentioning

confidence: 99%

A randomized, double-blind, placebo-controlled trial of intravenous iron sucrose in restless legs syndrome

et al. 2009

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“…With this test we can see that PLMW are significantly more frequent in patients with RLS than in patients with PLMD connected to other causes. The test may represent a diagnostic aid and provide an objective measure to therapeutic control 35 .…”

Section: Other Methods Of Assessmentmentioning

confidence: 99%

Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome

Fröhlich

Éckeli

Bacelar³

et al. 2015

Arq. Neuro-Psiquiatr.

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“…The patients are asked to stay still in a semi-sitting position for 60 min. 13 Every 5 min during the test, subjects are asked to report the subjective level of leg discomfort on a scale from 0 (no discomfort) to 10 (maximal discomfort). The momentary values of skin temperature were recorded with the same interval.…”

Section: Methodsmentioning

confidence: 99%

Pramipexole Alters Thermoregulation in Restless Legs Syndrome

Salminen

Rimpilä

Polo

2014

Journal of Clinical Sleep Medicine

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Study Objectives: Previous studies have associated restless legs syndrome (RLS) with peripheral hypoxia and impaired thermoregulation in the lower extremities. We performed longterm monitoring of skin temperatures in order to investigate whether these fi ndings could be explained by reduced blood fl ow to the peripheral tissues. Methods: 96-hour continuous measurements of skin temperature were performed both in the distal and proximal parts of the body of 15 patients with RLS and 14 healthy controls. During the recording, the patients participated in suggested immobilization tests both with and without pramipexole medication. Results: We found no baseline differences in distal or proximal skin temperature between patients and controls in daytime or during immobilization. However, pramipexole signifi cantly increased distal skin temperature in the patient group during immobilization (31.1°C vs. 32.9°C, p < 0.05). Daytime temperatures were not affected by therapy or disease status. Conclusions:The data suggest that patients with RLS and healthy controls have similar blood fl ow to the peripheral skin tissue. Pramipexole, however, alters thermoregulation and the previous studies might have been biased by medication. Dopaminergic medication is a major confounding factor when assessing peripheral phenomena in RLS and should be controlled for in the future studies. S C I E N T I F I C I N V E S T I G A T I O N SR estless legs syndrome (RLS), recently known as Willis-Ekbom disease, is associated with discomfort precipitated by immobility in the evening hours.1 Traditionally, RLS is believed to be of central origin, but recently RLS has also been associated with several fi ndings suggesting peripheral abnormalities. Most importantly, a recent study suggested the appearance of peripheral hypoxia during immobilization in patients with RLS.2 In addition, the skeletal muscles of the legs of RLS patients have been shown to have higher capillary tortuosity 3 and up-regulated vascular endothelial growth factor (VEGF).4 These fi ndings imply that these patients suffer from peripheral hypoxia. The hypoxia could result from insuffi cient blood fl ow to the legs either during daytime or only during immobility. To assess this hypothesis, continuous blood fl ow measures are warranted in RLS patients.Continuous measurement of skin blood fl ow may be achieved by measuring changes in skin temperature. Skin temperatures are commonly measured both distally and proximally, and a distal-to-proximal gradient (DPG) is calculated to assess the blood fl ow to the distal parts of the body.5 Distal skin temperature rises at sleep onset while the DPG of skin temperature shifts closer to zero, coinciding with the increase in melatonin secretion. 6 These data show that DPG is a selective tool for continuously assessing the thermoregulatory blood fl ow.Body temperature could be an important factor in RLS. Thermal hypoesthesia, on the other hand, is associated with secondary but not idiopathic RLS.9 Recently, it was demonstrated that RLS could be as...

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Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome

Cited by 210 publications

References 16 publications

A randomized, double-blind, placebo-controlled trial of intravenous iron sucrose in restless legs syndrome

A randomized, double-blind, placebo-controlled trial of intravenous iron sucrose in restless legs syndrome

Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome

Pramipexole Alters Thermoregulation in Restless Legs Syndrome

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