Update of the pathophysiology of the Restless-Legs-Syndrome

Paulus, Walter; Dowling, Pascal; Rijsman, Roselyne M.; Stiasny‐Kolster, Karin; Trenkwalder, Claudia

doi:10.1002/mds.21824

Cited by 51 publications

(33 citation statements)

References 80 publications

(176 reference statements)

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“…However, we hypothesized that increased spinal cord excitability (9), particularly in the supraspinal regions of the lumbosacral segments (L4-S1) (4), and altered dopaminergic systems in the brain and spinal cord play a role in the generation of abnormal sensations in the lower abdomen and perineum that are relieved with urination (10). Afferent fibers from the bladder enter the sacral cord via the pelvic nerves and terminate in segments L4-S2, and these fibers relay essential information and sensations for urinary control.…”

Section: Discussionmentioning

confidence: 99%

Restless Bladder in an Elderly Woman: An Unusual Feature or a Variant of Restless Legs Syndrome?

et al. 2016

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We herein report an elderly patient with a history of restless legs syndrome (RLS) who developed unpleasant sensations in the lower abdomen and perineum. The patient's symptoms occurred during the evening and at rest and forced the patient to void, resulting in some symptom relief. Urological examinations and spinal magnetic resonance imaging findings were unremarkable. The adjunctive use of rotigotine resolved her symptoms. The symptoms were considered to be restless bladder . Further studies are required to elucidate whether restless bladder is an identical condition to the clinical entities of other RLS variants or whether it represents an unusual feature of RLS.

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Section: Discussionmentioning

confidence: 99%

Restless Bladder in an Elderly Woman: An Unusual Feature or a Variant of Restless Legs Syndrome?

et al. 2016

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“…Similar to RLS [88], several features of SRED suggest an underlying dopamine dysfunction. First, dopamine mediates impulsive behaviors, such as motor restlessness, smoking, and binge eating [88,89].…”

Section: The Relationship Between Sred and Rlsmentioning

confidence: 99%

“…First, dopamine mediates impulsive behaviors, such as motor restlessness, smoking, and binge eating [88,89]. Second, a PSG study of 35 SRED patients demonstrated that 77% had PSG confirmation of wakeful RLS and periodic limb movement during sleep [4].…”

Section: The Relationship Between Sred and Rlsmentioning

confidence: 99%

Parasomnias: An Updated Review

2012

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Parasomnias are abnormal behaviors emanating from or associated with sleep. Sleepwalking and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, or promote sleep inertia lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after an arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications; in particular, the widely prescribed benzodiazepine receptor agonists. Recently, compelling evidence suggests that nocturnal eating may in some cases be a nonmotor manifestation of Restless Legs Syndrome (RLS). rapid eye movement (REM) Sleep Behavior Disorder (RBD) is characterized by a loss of REM paralysis leading to potentially injurious dream enactment. The loss of atonia in RBD often predates the development of Parkinson's disease and other disorders of synuclein pathology. Parasomnia behaviors are related to an activation (in NREM parasomnias) or a disinhibition (in RBD) of central pattern generators (CPGs). Initial management should focus on decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders. Clonazepam and melatonin appear to be effective therapies in RBD, whereas paroxetine has been reported effective in some cases of sleep terrors. At this point, pharmacotherapy for other parasomnias is less certain, and further investigations are necessary.Keywords Parasomnia . Sleepwalking . Sleep terrors . REM sleep behavior disorder . Restless legs syndrome Classification of ParasomniasParasomnias are typically classified by the sleep state from which they arise: non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM) (see Table 1 NREM parasomnias include: confusional arousals, sleepwalking disorder, and sleep terrors. These behaviors arise when the cortex incompletely arouses from deep NREM sleep, often due to comorbid conditions that provoke repeated arousal or promote sleep inertia. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking and related disorders [3].Sleep-related eating disorder (SRED) is currently classified in the International Classification of Sleep Disorders, 2nd edition (ICSD-2) under "Other Parasomnia" [1]. However the vast majority of SRED cases emanate from NREM [4], and the complex amnestic behaviors with ambulation are striking similar to sleepwalking [5]. Furthermore, both SRED and sleepwalking are frequently triggered by sedating agents in the setting of underlying motor restlessness [6]. Thus, considering these similarities, SRED will be reviewed immediately after NREM parasomnias.REM sleep behavior disorder is the most clinically relevant REM parasomnia. The loss of atoni...

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“…As the symptoms of RLS respond dramatically to drugs increasing CNS dopamine (levodopa) and dopamine agonists, dopamine system dysfunction or decreased CNS dopamine at nighttime has been implicated in its pathophysiology [2,3]. Therefore, drugs that block dopamine receptors should cause or aggravate symptoms of RLS.…”

Section: Introductionmentioning

confidence: 99%