Published Research - General Sleep and RLS (WED)

For everything and anything else not covered in the other WED/RLS sections.
cornelia

Re: Published Research - General Sleep and RLS

Postby cornelia » Mon Feb 11, 2013 1:47 pm

Just read the dr Walters paper: very interitesting! He ends it by saying that new treatments are going to come. Not a spectacular sentence, but nevertheless I got a moment of hope for the future when I read it.

I always thought that varisose veins have nothing to do with RLS. In dr B's book it is on the list of RLS mimics. Still, after having read dr Walter's remarks on this subject I wonder if treatment will help some patients with venous problems.

Corrie

Chipmunk
Moderator
Posts: 655
Joined: Thu Mar 03, 2011 10:44 pm
Location: Madison, WI

Re: Published Research - General Sleep and RLS

Postby Chipmunk » Mon Feb 11, 2013 2:51 pm

badnights wrote:
clonazepam did the opposite, reducing
non-rapid eye movement sleep EEG instability without effects on PLMS.
[/b]

This was definitely my experience on clonazepam. I slept awfully. Thank goodness for my Zeo, which provided confirmation that I wasn't getting REM sleep, or I would probably have been on it longer. My psych felt that my tiredness during the day was due to the clonazepam carrying over. :roll: I was like, uh, no, I'm tired because I'm still not sleeping!!
Tracy

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the WED/RLS Foundation, and are not medical advice.

ViewsAskew
Moderator
Posts: 15795
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Mon Feb 11, 2013 6:41 pm

cornelia wrote:Just read the dr Walters paper: very interitesting! He ends it by saying that new treatments are going to come. Not a spectacular sentence, but nevertheless I got a moment of hope for the future when I read it.

I always thought that varisose veins have nothing to do with RLS. In dr B's book it is on the list of RLS mimics. Still, after having read dr Walter's remarks on this subject I wonder if treatment will help some patients with venous problems.

Corrie


I definitely see reports from Vein clinics that some people's symptoms are dramatically reduced when they have sclero-whatever-it-is. I think this might just be another form - won't help us all, but will help a certain population.

It's nice to feel hopeful about this, isn't it?
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
Moderator
Posts: 15795
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Mon Feb 11, 2013 6:42 pm

Chipmunk wrote:
badnights wrote:
clonazepam did the opposite, reducing
non-rapid eye movement sleep EEG instability without effects on PLMS.
[/b]

This was definitely my experience on clonazepam. I slept awfully. Thank goodness for my Zeo, which provided confirmation that I wasn't getting REM sleep, or I would probably have been on it longer. My psych felt that my tiredness during the day was due to the clonazepam carrying over. :roll: I was like, uh, no, I'm tired because I'm still not sleeping!!


This part of the study needs to be provided to every doctor immediately!!!!!
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
Moderator
Posts: 5325
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Re: Published Research - General Sleep and RLS

Postby badnights » Thu Feb 21, 2013 8:04 am

fyi I have snail-mailed Dr. Walters asking if he has a more-recent summary of recent research. It's a long shot, but maybe he has something already done up that he can fire back to us.
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

badnights
Moderator
Posts: 5325
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Re: Published Research - General Sleep and RLS

Postby badnights » Tue Apr 02, 2013 11:35 pm

Reply from Dr Walters was somewhat unsatifying, perhaps missed the point of my question. He is on sabbatical in Germany and has returned for a couple of weeks only. I asked if he might have a summary of ongoing research that was more up-to-date than the 2008 presentation. He replied,
"
Non-traditional expermental treatments for which there is the best evidence in RLS are (1) compression devices for the legs (2) light therapy and (3) recently there was a preliminary study showing some evidence of nitroglycerin for RLS. Nitroglycerin is normally taken for heart disease but seems to help RLS. (4) In addition if you get a Lactulose Breath test and find out that you have increased bacterial overgrowth in your gastrointestianl tract, antibiotics such as rifaximin may help the RLS.
"
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

badnights
Moderator
Posts: 5325
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Re: Published Research - General Sleep and RLS

Postby badnights » Tue Apr 02, 2013 11:36 pm

The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia.
Richard P Allen; Sarah Auerbach; Huzefa Bahrain; Michael Auerbach; Christopher J Earley
Am. J. Hematol. 88, 261 (2013)
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
Restless Legs Syndrome (RLS) a common, under-recognized disorder disrupts sleep and diminishes quality of life. Despite a clear relation between low peripheral iron and increased prevalence and severity of RLS, the prevalence and clinical significance of RLS in iron-deficient anemic (IDA) populations is unknown. In this study all new patients referred for anemia to a community-based hematology practice over a 1-year period (March 2011-2012) were included if they had IDA and no RLS treatment. Patients completed a validated questionnaire identifying RLS, blood tests, and a sleep-vitality questionnaire (SVQ). Patients with RLS were compared to patients with no RLS for differences on SVQ, blood tests, baseline characteristics, and sleep quality. Three hundred forty-three patients were evaluated and 251 (89.2% female, average age of 45.6 years) included in the study. The prevalence of clinically significant RLS (RLS sufferers) was 23.9%, nine times higher than the general population. IDA-RLS sufferers reported poorer quality of sleep, decreased sleep time, increased tiredness, and decreased energy during the day compared to patients with IDA without RLS. Blood tests did not relate to RLS diagnosis but RLS was less likely for African-American than Caucasian patients. Clinically significant RLS occurs commonly with IDA producing much greater disruption of sleep and shorter sleep times than does IDA alone. This indicates the need for identification of RLS with IDA and consideration of appropriate therapeutic interventions for this sizeable subgroup: either aggressive iron treatment to reduce the RLS symptoms or medications for RLS or both.
Am. J. Hematol. 88:261-264, 2013. © 2013 Wiley Periodicals, Inc.
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

ViewsAskew
Moderator
Posts: 15795
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: Published Research - General Sleep and RLS

Postby ViewsAskew » Tue Apr 02, 2013 11:55 pm

Wow, so out of 251 people with iron-deficient anemia, 23.9 percent of them had clinically significant WED. That is HUGE!
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

badnights
Moderator
Posts: 5325
Joined: Tue Mar 10, 2009 4:20 pm
Location: Northwest Territories, Canada

Re: Published Research - General Sleep and RLS

Postby badnights » Wed Apr 03, 2013 12:19 am

Totally expected, though. Kind of scary that no one bothered to do such a study before now.
Beth - Wishing you a restful sleep tonight
Click for info on WED/RLS AUGMENTATION & IRON
I am a volunteer moderator. My posts are not medical advice. My posts do not reflect RLS Foundation opinion.

ViewsAskew
Moderator
Posts: 15795
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: Published Research - General Sleep and WED (RLS)

Postby ViewsAskew » Wed Apr 03, 2013 4:22 am

Yes - to be expected. And, hopefully, the kind of study that gets more attention paid to WED.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
Moderator
Posts: 15795
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Subsets of WED

Postby ViewsAskew » Sat Apr 06, 2013 11:53 pm

Sounds like they are now hypothesizing different subsets of WED!

http://www.ncbi.nlm.nih.gov/pubmed/23440307

Movements Mimicking Myoclonus Associated with Spinal Cord Pathology: Is this a "Pure Motor Restless Legs Syndrome".
Ondo WG.
Source

University of Texas Health Science Center at Houston, Houston, TX 77025, United States of America.
Abstract
BACKGROUND:

The neuroanatomic substrate of restless legs syndrome (RLS) is poorly understood, and the diagnosis is clinically made based upon subjective sensory symptoms, although a motor component is usually present.
CASE REPORT:

We report two cases of elderly patients with spinal pathology who were referred by neurologists for myoclonus. Both had semi-rhythmic leg movements that partially improved while standing, but denied any urge to move. These movements improved dramatically with pramipexole, a dopamine agonist used for RLS.
DISCUSSION:

We propose that this "myoclonus" is actually the isolated stereotypic motor component of RLS.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
Moderator
Posts: 15795
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Depression and WED

Postby ViewsAskew » Sat Apr 06, 2013 11:57 pm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3574459/

Which comes first, depression or WED? In this study, people with depression had WED 31% of the time - but there was no correlation as to which came first.

Below is only the discussion portion - it's a long article:

This study found that RLS was frequent in the persons suffering from depressive illness compared to the general population. Earlier studies have found that depression is more prevalent in subjects with RLS.[10,11] Earlier studies addressing the prevalence of RLS in community sample suggested prevalence rates between 0.9% to 8.3% in Asian community and 17.7% in American community.[4,10,12] Only one study has examined the frequency of RLS in depressed subjects and reported prevalence of 27%.[5] We have found nearly similar prevalence in this study.

RLS has female predisposition in earlier studies.[10,11] However, we did not find any difference between genders. Perhaps, sample selection might have played a role. Earlier studies have included RLS sufferers and then looked for depression while we did the opposite. Other epidemiological studies cannot be compared with this study as this study was clinic based.

Whether RLS leads to depression or depression leads to or aggravates RLS symptoms is a debatable issue. Previous studies suggested that psychiatric morbidity is frequent in subjects with RLS.[4,10,13,14] However, contradictory data are also available, at least in subjects with mild RLS.[15] Our study suggest that onset of RLS symptoms was unrelated to onset of depressive symptoms. A large, prospective study addressing this issue is warranted to reach to any conclusion. Present evidence indicates that RLS may either precede or follow depression.[16]

RLS patients often suffer from chronic insomnia and its clinical presentation frequently masquerades or induce depression.[3,10,17] thereby favoring the notion that RLS precedes depression. Hornyak et al.[17] suggested that severity of RLS correlated with severity of insomnia but not with depression score. In addition, RLS subjects score high on only those items of depression rating scale which are consequent to insomnia[17] corroborating lower HAM-D scores in the present study. Thus the present literature is inconclusive regarding the role of insomnia in the development of depression in RLS patients! Our results did not find any difference in the prevalence of insomnia (primary and combined) in either of the groups suggesting that insomnia may be an independent factor which does not affect RLS.

A number of factors during depressive illness may increase the likelihood of development of RLS. It is known that RLS symptoms are often aggravated during periods of stress and with the antidepressant therapy.[3,18] Mirtazepine has been found to induce RLS more frequently compared to other antidepressants including SSRI.[18,19] In the present study, most of the patients had longstanding illness spanning upto 10 years and were taking antidepressants off and on. Since, RLS was never screened they were not able to recall its relationship with antidepressant therapy. This could be a confounding factor in present study. Our data suggest that depression may not predispose a person to RLS as total duration of depressive illness, duration of present episode, “number of depressive episodes” and family history of psychiatric illness were not different between two groups.

Pathophysiologically dopamine is implicated both in depression and RLS.[16] Benes et al.[2] concluded that dopaminergic treatment of RLS improved the depressive symptoms and antidepressants should be advised when resolution of RLS does not improve the depressive symptoms. This must also be kept in mind that dopaminergic agonists possess an antidepressant property.[20] It may be a simplistic view as treatment of RLS actually improves sleep quality and abolishes insufficient sleep syndrome. The latter can masquerade depression, hence, we need more data to assess these issues.

This study has some methodological limitations. Firstly, the sample size is small owing to robust exclusion criteria and hence, results are difficult to be generalized. Secondly, the data were retrospective and recall bias cannot be excluded in this group. Thirdly, a number of subjects were taking antidepressants at the time of presentation which could have aggravated RLS. Fourthly, owing to cross-sectional design we could not evaluate the effect of treatment of RLS on depressive symptoms or vice versa.

Nonetheless, this study is still important as it throws light on the possible comorbidity in depressive illness that can reduce the chances of remission of depression or precipitate future episodes. Large-sample prospective studies in future are required to reach to a conclusion on this issue.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
Moderator
Posts: 15795
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: Published Research - Buchfuhrer's 2012 paper

Postby ViewsAskew » Sat Apr 20, 2013 7:30 am

Beth posted this elsewhere; I thought it would be good here, too.
Beth notes: it has been moved, not copied, so this is the only place it is.

This paper by Dr Mark Buchfuhrer is (as of Feb 2013) the most up-to-date summary of RLS/WED treatment I know of. Most importantly, it is a published reference in a medical journal, and thererfore carries a lot more weight with your doctor than "I saw it on the internet".

Among other things, he states unequivocally that opioids are recommended to treat worsened symptoms during withdrawal from DAs after augmentation, and that opioids are appropriate treatment for daily refractory severe RLS/WED; and he makes the first mention in print that dopamine agonists might not be the best "first-line drugs of choice" for RLS/WED treatment because of the large percentage of patients who suffer augmentation from them.

The full paper in many ways replaces the excellent but somewhat-aged brochure by the RLSF/WEDF called RLS Medical Bulletin: A Publication for Healthcare Providers (2011), but it is copyrighted by its publisher, so I cannot give you a copy of it. This is the citation:
Buchfuhrer, M.J., 2012 Oct. Strategies for the Treatment of Restless Legs Syndrome. Neurotherapeutics 9(4):776-90. doi: 10.1007/s13311-012-0139-4.

I have reproduced the abstract, but if your doctor is new to RLS/WED treatment, she should get the full version and use it as her bible until something better comes along:

Abstract
Restless legs syndrome (RLS) is a common neurological disorder of unknown etiology that is managed by therapy directed at relieving its symptoms. Treatment of patients with milder symptoms that occur intermittently may be treated with nonpharmacological therapy but when not successful, drug therapy should be chosen based on the timing of the symptoms and the needs of the patient. Patients with moderate to severe RLS typically require daily medication to control their symptoms. Although the dopamine agonists, ropinirole and pramipexole have been the drugs of choice for patients with moderate to severe RLS, drug emergent problems like augmentation may limit their use for long term therapy. Keeping the dopamine agonist dose as low as possible, using longer acting dopamine agonists such as the rotigotine patch and maintaining a high serum ferritin level may help prevent the development of augmentation. The α2δ anticonvulsants may now also be considered as drugs of choice for moderate to severe RLS patients. Opioids should be considered for RLS patients, especially for those who have failed other therapies since they are very effective for severe cases. When monitored appropriately, they can be very safe and durable for long term therapy. They should also be strongly considered for treating patients with augmentation as they are very effective for relieving the worsening symptoms that occur when decreasing or eliminating dopamine agonists.

Download the abstract and first page here.
Buchfuhrer 2012 page 1.pdf
(46.42 KiB) Downloaded 140 times

Check the post of Mar 10, 2009 10:20 am on this thread as well: viewtopic.php?f=2&t=8329&p=66815
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Polar Bear
Moderator
Posts: 7631
Joined: Tue Dec 26, 2006 4:34 pm
Location: N. Ireland

Re: Published Research - General Sleep and WED (RLS)

Postby Polar Bear » Sat Apr 20, 2013 4:06 pm

Ann, when I click on this link it states that the attachment does not exist any more.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

ViewsAskew
Moderator
Posts: 15795
Joined: Thu Oct 28, 2004 6:37 am
Location: Los Angeles

Re: Published Research - General Sleep and WED (RLS)

Postby ViewsAskew » Sun Apr 21, 2013 9:47 am

I fixed it. I moved some things around yesterday and broke the link. It is a great article and it's too bad it's we can only see the abstract. I do have a copy of it; so does Beth. We can't post it, but we could potentially share it with someone who promised not to share it with anyone else.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.


Return to “General Topics: RLS/WED”

Who is online

Users browsing this forum: No registered users and 1 guest