Multicenter Case-Control Study on Restless Legs Syndrome in Multiple Sclerosis: the REMS Study

Manconi, Mauro; Ferini‐Strambi, Luigi; Filippi, Massimo; Bonanni, Enrica; Iudice, Alfonso; Murri, Luigi; Gigli, Gian Luigi; Fratticci, Lara; Merlino, Giovanni; Terzano, Giovanni; Granella, Franco; Parrino, Liborio; Silvestri, Rosalia; Aricò, Irene; Dattola, Vincenzo; Russo, Giovanna; Luongo, Carmela; Cicolin, Alessandro; Tribolo, Antonella; Cavalla, Paola; Savarese, Mariantonietta; Trojano, Maria; Ottaviano, S; Cirignotta, Fabio; Simioni, Valentina; Salvi, Fabrizio; Mondino, Fiorella; Perla, Franco; Chinaglia, G.; Zuliani, Cristina; Cesnik, Carlos E. S.; Granieri, Enrico; Placidi, Fabio; Palmieri, Maria Giuseppina; Manni, Raffaele; Terzaghi, Michele; Bergamaschi, Roberto; Rocchi, Raffaele; Ulivelli, Monica; Bartalini, Sabina; Ferri, Raffaele; Fermo, Salvatore Lo; Ubiali, E; Viscardi, Massimo; Rottoli, Mariarosa; Nobili, Lino; Protti, Alessandra; Ferrillo, Franco; Allena, Marta; Mancardi, Gianluigi; Guarnieri, Biancamaria; Londrillo, Francesco

doi:10.5665/sleep/31.7.944

Cited by 169 publications

(63 citation statements)

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“…This finding did not meet statistical significance likely because of the relative rarity (n=6) of self-reported sleep-disordered breathing symptoms in this population. Restless legs symptoms (n=18) were common in this population, as has been reported for other groups of subjects with MS. [10][11][12] It is difficult to determine whether the lack of difference in reaction times between the subjects with restless leg symptoms and the other MS subjects was related to the subjective reporting of symptoms or to a true sparing of psychomotor vigilance. It would be worthwhile to explore psychomotor vigilance in MS subjects for whom sleep disturbances were objectively quantified with polysomnography.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for this propensity may be related to lesion location, HLA-type, or other immunological mechanisms. 12,21,28 Sleep-disordered breathing tended to be associated with increased fatigue and poor alertness as it would in the general population. This finding did not meet statistical significance likely because of the relative rarity (n=6) of self-reported sleep-disordered breathing symptoms in this population.…”

Section: Discussionmentioning

confidence: 99%

“…2 It is known that some sleep disorders, in particular restless legs syndrome, are more prevalent in the MS population. [10][11][12][13] A pilot study involving polysomnography of 12 MS patients suggested differences in sleep quality in patients with MS compared to controls, and a trend for increased sleepiness as measured objectively with the multiple sleep latency test. 14 Several small studies have found that treatment with modafinil, a wake-promoting agent, improved symptoms of MS fatigue, although in a larger randomized controlled trial there was no difference.…”

Section: Original Articlementioning

confidence: 99%

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Multiple Sclerosis Fatigue is Associated with Reduced Psychomotor Vigilance

Rotstein

O’Connor²,

Lee³

et al. 2012

Can. J. Neurol. Sci.

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Fatigue is a common and disabling symptom in those who suffer from multiple sclerosis (MS). Studies indicate that more than 75% of MS patients suffer from fatigue. 1-3 Two-thirds of MS patients rank fatigue as one of their three most debilitating symptoms. 1 Multiple sclerosis fatigue is particularly aggravated by heat and can significantly impair physical activity. 1 It is one of the main causes of work absenteeism in individuals with MS. 4 Yet fatigue is a lay term that remains subjectively defined and assessment of fatigue is therefore dependent on self-report. Perhaps as a result, the physiologic substrates of MS fatigue are not well-described. The subjective experience of fatigue is multifactorial and has been correlated with factors such as disability, depression, and pain. [5][6][7] Interestingly, no clear association has been established between MS fatigue and demographic factors, such as age and gender; lesion burden; or the clinical form of MS. 1,[7][8][9] ABSTRACT: Background: Fatigue is common and disabling in multiple sclerosis, yet its physiologic substrates remain poorly defined. The aim of this study was to determine the relationship between fatigue and an objective measure of alertness in MS patients. Methods: This study enrolled 49 consecutive MS clinic patients at two academic hospitals in Toronto. Alertness was assessed with the psychomotor vigilance test (PVT), a ten-minute reaction-time test that measures attention and is sensitive to sleep loss. Patients with visual impairment or arm weakness were excluded. Validated tools were used to assess fatigue, disability, mood, and pain. Results: The average age was 43; 65% were women. Median EDSS was 2.0 (range 0-7.5). Fifty-five percent reported a high impact of fatigue on their lives. Psychomotor vigilance test performance was worse than in an age-and sex-matched population, with a mean reaction time of 315 msecs and 3.98 lapses >500 msec (p<0.001). In a multiple regression analysis, fatigue was the most significantly correlated factor with mean PVT reaction time (p<0.05), and disability was also significantly correlated (p<0.01). Mood and pain did not correlate with the PVT. Eighteen (37%) reported often experiencing restlessness in their legs at night. Conclusion: Subjective fatigue and disability were associated with poor performance on alertness testing in MS patients. This research highlights a potential role for psychomotor vigilance testing in providing a standardized assessment tool for an important aspect of MS-related fatigue.RÉSUMÉ: La fatigue dans la sclérose en plaques est associée à une diminution de la vigilance psychomotrice. Contexte : La fatigue est un symptôme fréquent et invalidant chez les patients atteints de la sclérose en plaques (SP) et sa cause physiologique demeure mal définie. Le but de cette étude était de déterminer la relation entre la fatigue et une mesure objective de vigilance chez des patients atteints de la SP. Méthode : Nous avons inclus 49 patients consécutifs de cliniques de SP situées dans deux hôpitaux ac...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

See 1 more Smart Citation

Multiple Sclerosis Fatigue is Associated with Reduced Psychomotor Vigilance

Rotstein

O’Connor²,

Lee³

et al. 2012

Can. J. Neurol. Sci.

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“…RLS symptoms appear usually after the onset of MS (18)(19)(20)23,26,27). There is no relationship between MS subtypes and the presence of RLS (18,20,(22)(23)(24)(25)31).…”

mentioning

confidence: 95%

“…There is no relationship between MS subtypes and the presence of RLS (18,20,(22)(23)(24)(25)31). There are only three studies that investigated the relationship between functional system involvement and the presence of RLS in MS patients (19,23,25). Two of them showed that there was a significant relationship between some functional system involvement and RLS (19,25).…”

mentioning

confidence: 99%

Restless legs syndrome in multiple sclerosis

Sorgun¹,

Aksun²,

Atalay³

et al. 2015

Turk J Med Sci

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IntroductionRestless legs syndrome (RLS) is a sleep disorder characterized by an urge to move the legs associated with uncomfortable paresthesias. Usually, the symptoms manifest in the evening or at night, when the patients take rest, and are relieved by walking or moving the legs (1). Diagnosis of RLS needs to involve the following clinical features: (a) uncomfortable and unpleasant sensations in the legs, (b) worsening of the symptoms during rest, (c) relief of the symptoms by movement, (d) exacerbation of the sensitive disturbance in the evening or at night (1). The majority of RLS cases are commonly classified as idiopathic and include sporadic and inherited forms. Secondary form of RLS has been associated with iron deficiency, renal failure, pregnancy, antidopaminergic therapy, rheumatoid arthritis, or several neurological disorders, including peripheral neuropathy, spinocerebellar ataxia, essential tremor, Parkinson disease, and myelopathies (2-4). The etiopathogenesis of RLS is unknown, yet there is increasing evidence of dopaminergic neurotransmission dysfunction (5-9).RLS prevalence has been reported to be 1.2%-15% and 12.12%-65.1% in the general population and in MS patients, respectively (10-30). RLS symptoms appear usually after the onset of 23,26,27). There is no relationship between MS subtypes and the presence of RLS (18,20,[22][23][24][25]31). There are only three studies that investigated the relationship between functional system involvement and the presence of RLS in MS patients (19,23,25). Two of them showed that there was a significant relationship between some functional system involvement and RLS (19,25). In contrast, Deriu et al. did not find any relationship between the presence of RLS and functional system involvement (23). Some studies suggested that the expanded disability status scale (EDSS) was not related to RLS in MS patients (22,23). However, other studies showed that EDSS score was higher in MS patients with RLS than in those without RLS (18)(19)(20)30).Lesion localization in brain MRI did not show any relationship with the presence of RLS in MS patients in most studies (18)(19)(20)22,23). There is only one study showing that MS patients with RLS (MS/RLS+) and patients without RLS (MS/RLS-) had similar cervical cord lesion load, but with less fractional anisotropy in cervical and brain MRI in the latter.Background/aim: There have been conflicting results in the literature regarding the relationship between functional system involvement, the expanded disability status scale (EDSS), and the presence of restless legs syndrome (RLS) in patients with multiple sclerosis (MS).Materials and methods: Ninety-one patients with MS and 40 patients in a control group (headache, essential tremor, and benign positional paroxysmal vertigo) were studied. The patients underwent a complete neurological examination and Kurtzke functional system scores were calculated. In order to assess the temporal relation between the onset of RLS and MS, a semistructured interview guided by a questionnaire about R...

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