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Haghshenas M, Veisani Y, Sahebi A. Restless legs syndrome variants: A systematic review. Heliyon 2024; 10:e28896. [PMID: 38596027 PMCID: PMC11002663 DOI: 10.1016/j.heliyon.2024.e28896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Restless Legs Syndrome (RLS) is a clinical syndrome that may manifest itself in non-leg parts of the body as well, called RLS variant, which is considered a distinct entity by some researchers. In this systematic review, we tried to evaluate various clinical features and effective treatments of RLS variants and compare them with that of typical RLS. Methods This study was conducted following the PRISMA guideline. The primary search was performed in the data resources of Medline (PubMed), Web of Science, and Scopus, as well as the Google Scholar search engine. The required data were extracted from the studies. Results In this review, 1565 studies were initially identified and finally 39 studies were selected. The most common RLS variants were observed to involve hands, head, abdomen, and genitalia. These patients mostly complained of sleep disturbance and feelings of itching, tingling and twitching. Supportive diagnostic criteria of RLS including familial history of RLS, periodic limb movements during sleep (PLMS) and response to treatment with dopaminergic agents were assessed. Conclusion It seems that patients with RLS variant can undergo the same diagnostic and therapeutic work-up as patients with conventional RLS. It is suggested that these two disorders fall into the same syndromic spectrum.
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Affiliation(s)
- Mandana Haghshenas
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Yousef Veisani
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Sahebi
- Non-Communicable Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
- Department of Medical Emergencies and Health in Disasters and Emergencies, Ilam University of Medical Sciences, Ilam, Iran
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Khan M. Restless Legs Syndrome and Other Common Sleep-Related Movement Disorders. Continuum (Minneap Minn) 2023; 29:1130-1148. [PMID: 37590826 DOI: 10.1212/con.0000000000001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article reviews common sleep-related movement disorders, including their clinical description, epidemiology, pathophysiology (if known), and evaluation and management strategies. This article will provide the reader with a good foundation for approaching concerns that are suggestive of sleep-related movement disorders to properly evaluate and manage these conditions. LATEST DEVELOPMENTS α2δ Ligands, such as gabapentin enacarbil, can be used for the initial treatment of restless legs syndrome (RLS) or in those who cannot tolerate, or have developed augmentation to, dopamine agonists. Another option is the rotigotine patch, which has a 24-hour treatment window and may be beneficial for those who have developed augmentation with short-acting dopamine agonists. IV iron can improve RLS symptoms even in those whose serum ferritin level is between 75 ng/mL and 100 ng/mL. At serum ferritin levels greater than 75 ng/mL, oral iron will likely have minimal absorption or little effect on the improvement of RLS. Research has found an association between RLS and cardiovascular disease, particularly in people who have periodic limb movements of sleep. ESSENTIAL POINTS RLS is the most common sleep-related movement disorder. Its pathophysiology is likely a combination of central iron deficiency, dopamine overproduction, and possibly cortical excitation. Treatment includes oral or IV iron. Dopaminergic medications can be very effective but often lead to augmentation, which limits their long-term use. Other sleep-related movement disorders to be aware of are sleep-related rhythmic movement disorder, nocturnal muscle cramps, sleep-related propriospinal myoclonus, sleep bruxism, and benign myoclonus of infancy.
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Wang XX, Zhu XY, Wang Z, Dong JW, Ondo WG, Wu YC. Restless abdomen: a spectrum or a phenotype variant of restless legs syndrome? BMC Neurol 2020; 20:298. [PMID: 32787789 PMCID: PMC7425072 DOI: 10.1186/s12883-020-01875-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background With the growing awareness of restless legs syndrome (RLS), sensory disorders similar to RLS but initially confined to the arms, abdomen, and perineum have been reported. One of them is restless abdomen, which refers to a restless sensation in abdomen. Our study is designed to evaluate the clinical phenotype of restless abdomen and investigate its relationship with RLS. Methods We enrolled 10 patients with restless abdomen according to RLS diagnostic criteria, excluding the requiring of leg involvement. Laboratory examinations were performed to exclude mimics and notable comorbidities. Results All 10 patients had RLS like symptoms in the abdomen and otherwise satisfied all other RLS diagnostic criteria, and responded to dopaminergic therapy. Conclusions Neurologists and gastroenterologists should be aware that RLS-related restlessness can occur in extra-leg anatomy in the absence of episodes of worsening or augmentation of restlessness.
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Affiliation(s)
- Xi-Xi Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, P.R. China.,Shanghai General Hospital of Nanjing Medical University, Nanjing, 210029, P.R. China
| | - Xiao-Ying Zhu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, P.R. China
| | - Zan Wang
- Department of Neurology, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021, P.R. China
| | - Jian-Wei Dong
- Department of Neurology, Changchun Central Hospital, Changchun, P.R. China
| | - William G Ondo
- Department of Neurology, Methodist Hospital, Weill Cornell Medical School, Houston, TX, USA
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, P.R. China.
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Laganière C, Pennestri MH, Rassu AL, Barateau L, Chenini S, Evangelista E, Dauvilliers Y, Lopez R. Disturbed nighttime sleep in children and adults with rhythmic movement disorder. Sleep 2020; 43:5847766. [DOI: 10.1093/sleep/zsaa105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/04/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study Objectives
Rhythmic movements (RMs) during sleep are frequent and often considered as benign in children. Disabling forms are diagnosed as RM disorder and may persist in adulthood. Whether RMs severely impact sleep architecture in patients with RM disorder remain unclear. We performed a case–control study to characterize the clinical and polysomnographic patterns of children and adults with a diagnosis of RM disorder in comparison to controls, and to assess the associations between the RMs and the sleep architecture.
Methods
All consecutive patients (n = 50; 27 children, 35 males) with RM disorder from a single sleep clinic (from 2006 to 2019) underwent a comprehensive clinical evaluation and a polysomnographic recording in comparison to 75 controls (42 children and 53 males).
Results
About 82% of children and adult patients had a complaint of disturbed nighttime sleep. Comorbid neurodevelopmental, affective or sleep disorders were found in 92% of patients. While RM sequences defined by video polysomnographic criteria were observed in 82% of patients (in wakefulness and in all sleep stages), no similar sequences were observed in controls. Patients had altered sleep continuity, with low sleep efficiency, increased wake time after sleep onset, and frequent periodic leg movements and apnea events. The severity of RMs was associated with disrupted nighttime sleep, even after controlling for comorbid motor and respiratory events.
Conclusions
RM disorder is a rare, highly comorbid and disabling condition both in children and adults with frequent disturbed nighttime sleep that may contribute to the burden of the disease.
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Affiliation(s)
- Christine Laganière
- Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Hôpital en Santé Mentale Rivière-des-Prairies, CIUSSS-du-Nord-de-l’île-de-Montréal, Montréal, QC, Canada
| | - Marie-Hélène Pennestri
- Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada
- Hôpital en Santé Mentale Rivière-des-Prairies, CIUSSS-du-Nord-de-l’île-de-Montréal, Montréal, QC, Canada
| | - Anna Laura Rassu
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Lucie Barateau
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
| | - Sofiène Chenini
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Elisa Evangelista
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
| | - Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
| | - Régis Lopez
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
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Turrini A, Raggi A, Calandra-Buonaura G, Martinelli P, Ferri R, Provini F. Not only limbs in atypical restless legs syndrome. Sleep Med Rev 2017; 38:50-55. [PMID: 28559087 DOI: 10.1016/j.smrv.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 03/23/2017] [Indexed: 11/19/2022]
Abstract
Restless legs syndrome (RLS) typically affects the limbs, but the involvement of other body parts has also been reported. In this essay, we critically review all literature reports of atypical RLS cases with unusual localizations. Applying the updated diagnostic criteria of the International restless legs syndrome study group (IRLSSG), which also consider symptoms localized outside of the lower limbs, a few of these atypical cases reported in the previous literature resulted in a definitive diagnosis of RLS. We also discuss the relationship between RLS and burning mouth syndrome (BMS) or restless genital syndrome (RGS). We conclude clinical sleep specialists should be aware of unusual RLS localizations because they respond to the usual treatment for RLS. All the IRLSSG diagnostic criteria should be applied in every suspected case, in order to establish a correct diagnosis of this disabling but treatable condition.
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Affiliation(s)
- Alessandra Turrini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Hospital, Forlì, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna, Italy
| | - Paolo Martinelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology, I.C., Oasi Institute (IRCCS), Troina, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna, Italy.
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Yeh P, Ondo WG, Picchietti DL, Poceta JS, Allen RP, Davies CR, Wang L, Shi Y, Bagai K, Walters AS. Depth and Distribution of Symptoms in Restless Legs Syndrome/ Willis-Ekbom Disease. J Clin Sleep Med 2016; 12:1669-1680. [PMID: 27655450 DOI: 10.5664/jcsm.6356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 08/17/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine the depth and distribution of sensory discomfort in idiopathic restless legs syndrome/Willis-Ekbom disease (RLS) and RLS concurrent with other leg conditions, specifically peripheral neuropathy, sciatica, leg cramps, and arthritis. METHODS RLS subjects (n = 122) were divided into 71 idiopathic RLS and 51 RLS-C, or Comorbid, groups. All subjects were examined by an RLS expert, answered standardized RLS questionnaires, and received a body diagram to draw the location and depth of their symptoms. RESULTS Age was 63.04 ± 12.84 years, with 77 females and 45 males. All patients had lower limb involvement and 43/122 (35.25%) also had upper limb involvement. Of the 122 subjects, 42.62% felt that the RLS discomfort was only deep, 9.84% felt that the discomfort was only superficial, and 47.54% felt both superficial and deep discomfort. There were no defining characteristics in depth or distribution of RLS sensations that differentiated those patients with idiopathic RLS from those patients with RLS associated with other comorbid leg conditions. The sensation of arthritis was felt almost exclusively in the joints and not in the four quadrants of the leg, whereas the exact opposite was true of RLS sensations. CONCLUSIONS Depth and distribution cannot be used as a discriminative mechanism to separate out idiopathic RLS from RLS comorbid with other leg conditions. Although seen in clinical practice, the total absence of patients with non-painful RLS only in the joints in the current study attests to the rarity of this presentation and raises the possibility of misdiagnosis under these circumstances. We recommend that such patients not be admitted to genetic or epidemiological studies.
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Affiliation(s)
- Paul Yeh
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, TX
| | - William G Ondo
- Department of Neurology, Methodist Neurological Institute, Houston, TX
| | - Daniel L Picchietti
- Carle Neuroscience Institute, University of Illinois College of Medicine at Urbana-Champaign, Urbana, IL
| | | | - Richard P Allen
- RLS Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charles R Davies
- Carle Neuroscience Institute, University of Illinois College of Medicine at Urbana-Champaign, Urbana, IL
| | - Lily Wang
- Department of Biostatistics, Vanderbilt School of Medicine, Nashville, TN
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt School of Medicine, Nashville, TN
| | - Kanika Bagai
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Arthur S Walters
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
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Koo YS, Lee GT, Lee SY, Cho YW, Jung KY. Topography of sensory symptoms in patients with drug-naïve restless legs syndrome. Sleep Med 2013; 14:1369-74. [DOI: 10.1016/j.sleep.2013.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 11/28/2022]
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Abstract
Several movement disorders may occur during nocturnal rest disrupting sleep. A part of these complaints is characterized by relatively simple, non-purposeful and usually stereotyped movements. The last version of the International Classification of Sleep Disorders includes these clinical conditions (i.e. restless legs syndrome, periodic limb movement disorder, sleep-related leg cramps, sleep-related bruxism and sleep-related rhythmic movement disorder) under the category entitled sleep-related movement disorders. Moreover, apparently physiological movements (e.g. alternating leg muscle activation and excessive hypnic fragmentary myoclonus) can show a high frequency and severity impairing sleep quality. Clinical and, in specific cases, neurophysiological assessments are required to detect the presence of nocturnal movement complaints. Patients reporting poor sleep due to these abnormal movements should undergo non-pharmacological or pharmacological treatments.
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9
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Vetrugno R, Montagna P. Sleep-to-wake transition movement disorders. Sleep Med 2011; 12 Suppl 2:S11-6. [DOI: 10.1016/j.sleep.2011.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/12/2011] [Accepted: 10/12/2011] [Indexed: 11/16/2022]
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10
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Sexual intercourse and masturbation: potential relief factors for restless legs syndrome? Sleep Med 2011; 12:422. [PMID: 21377419 DOI: 10.1016/j.sleep.2011.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 01/18/2011] [Indexed: 11/23/2022]
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12
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Tassinari C, Cantalupo G, Högl B, Cortelli P, Tassi L, Francione S, Nobili L, Meletti S, Rubboli G, Gardella E. Neuroethological approach to frontolimbic epileptic seizures and parasomnias: The same central pattern generators for the same behaviours. Rev Neurol (Paris) 2009; 165:762-8. [DOI: 10.1016/j.neurol.2009.08.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Merlino G, Serafini A, Dolso P, Canesin R, Valente M, Gigli GL. Association of body rolling, leg rolling, and rhythmic feet movements in a young adult: A video-polysomnographic study performed before and after one night of clonazepam. Mov Disord 2008; 23:602-7. [PMID: 18175344 DOI: 10.1002/mds.21902] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report clinical and polysomnographic data of a young adult affected by several forms of rhythmic movement disorder (RMD), present in the same night, including a new kind of it, known as rhythmic feet movements. The patient was monitored by means of three consecutive video-polysomnographic recordings, the first two performed to confirm the presence of the sleep disorder and the last one to observe the acute effectiveness of clonazepam on rhythmic movements. We discuss the characteristics of the RMD and the response to the first administration of pharmacological treatment, observed in our patient.
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Affiliation(s)
- Giovanni Merlino
- Sleep Disorder Center, Neurology and Clinical Neurophysiology, Santa Maria della Misericordia University Hospital, Udine, Italy
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Akcali A, Ferini-Strambi L, Kaynak H, Karadeniz D, Akcali C. Genital restlessness (vulvodynia) events accompanying restless legs syndrome. Sleep Med 2008; 10:395-6. [PMID: 18583186 DOI: 10.1016/j.sleep.2008.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 03/17/2008] [Accepted: 03/21/2008] [Indexed: 10/21/2022]
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Schenck CH, Arnulf I, Mahowald MW. Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep 2007; 30:683-702. [PMID: 17580590 PMCID: PMC1978350 DOI: 10.1093/sleep/30.6.683] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To formulate the first classification of sleep related disorders and abnormal sexual behaviors and experiences. DESIGN A computerized literature search was conducted, and other sources, such as textbooks, were searched. RESULTS Many categories of sleep related disorders were represented in the classification: parasomnias (confusional arousals/sleepwalking, with or without obstructive sleep apnea; REM sleep behavior disorder); sleep related seizures; Kleine-Levin syndrome (KLS); severe chronic insomnia; restless legs syndrome; narcolepsy; sleep exacerbation of persistent sexual arousal syndrome; sleep related painful erections; sleep related dissociative disorders; nocturnal psychotic disorders; miscellaneous states. Kleine-Levin syndrome (78 cases) and parasomnias (31 cases) were most frequently reported. Parasomnias and sleep related seizures had overlapping and divergent clinical features. Thirty-one cases of parasomnias (25 males; mean age, 32 years) and 7 cases of sleep related seizures (4 males; mean age, 38 years) were identified. A full range of sleep related sexual behaviors with self and/or bed partners or others were reported, including masturbation, sexual vocalizations, fondling, sexual intercourse with climax, sexual assault/rape, ictal sexual hyperarousal, ictal orgasm, and ictal automatism. Adverse physical and/or psychosocial effects from the sleepsex were present in all parasomnia and sleep related seizure cases, but pleasurable effects were reported by 5 bed partners and by 3 patients with sleep related seizures. Forensic consequences were common, occurring in 35.5% (11/31) of parasomnia cases, with most (9/11) involving minors. All parasomnias cases reported amnesia for the sleep-sex, in contrast to 28.6% (2/7) of sleep related seizure cases. Polysomnography (without penile tumescence monitoring), performed in 26 of 31 parasomnia cases, documented sexual moaning from slow wave sleep in 3 cases and sexual intercourse during stage 1 sleep/wakefulness in one case (with sex provoked by the bed partner). Confusional arousals (CAs) were diagnosed as the cause of "sleepsex" ("sexsomnia") in 26 cases (with obstructive sleep apnea [OSA] comorbidity in 4 cases), and sleepwalking in 2 cases, totaling 90.3% (28/31) of cases being NREM sleep parasomnias. REM behavior disorder was the presumed cause in the other 3 cases. Bedtime clonazepam therapy was effective in 90% (9/10) of treated parasomnia cases; nasal continuous positive airway pressure therapy was effective in controlling comorbid OSA and CAs in both treated cases. All five treated patients with sleep related sexual seizures responded to anticonvulsant therapy. The hypersexuality in KLS, which was twice as common in males compared to females, had no reported effective therapy. CONCLUSIONS A broad range of sleep related disorders associated with abnormal sexual behaviors and experiences exists, with major clinical and forensic consequences.
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Affiliation(s)
- Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, USA.
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Vetrugno R, Provini F, Plazzi G, Cortelli P, Montagna P. Propriospinal myoclonus: A motor phenomenon found in restless legs syndrome different from periodic limb movements during sleep. Mov Disord 2005; 20:1323-9. [PMID: 16007657 DOI: 10.1002/mds.20599] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Three patients presented with a 25-, 15-, and 5-year history of restless legs syndrome (RLS) and periodic limb movements during sleep (PLMS). For 1, 4, and 5 years, they reported additional involuntary trunk and limbs jerks preceding falling asleep and occasionally during intrasleep wakefulness. Videopolysomnography revealed jerks during relaxed wakefulness arising in axial muscles with a caudal and rostral propagation at a slow conduction velocity, characteristic of propriospinal myoclonus (PSM). Jerk-related EEG-EMG back-averaging did not disclose any preceding cortical potential. During relaxed wakefulness preceding falling asleep and during intrasleep wakefulness, PSM coexisted with motor restlessness and sensory discomfort in the limbs. PSM disappeared when spindles and K-complexes appeared on the EEG. At this time, typical PLMS appeared every 20 to 40 seconds, especially during light sleep stages. PLMS EMG activity was limited to leg, especially tibialis anterior muscles, and did not show propriospinal propagation. In one patient, alternating leg muscle activation was also present. Jerks with a PSM pattern represent another motor phenomenon associated with RLS and different from the more usual PLMS.
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Affiliation(s)
- Roberto Vetrugno
- Department of Neurological Sciences, University of Bologna, Bologna, Italy.
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Chervin RD, Consens FB, Kutluay E. Alternating leg muscle activation during sleep and arousals: a new sleep-related motor phenomenon? Mov Disord 2003; 18:551-9. [PMID: 12722169 DOI: 10.1002/mds.10397] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We describe a quickly alternating pattern of anterior tibialis activation, recorded during nocturnal polysomnography in 16 patients. Polysomnography, usually for sleep-disordered breathing, included surface electromyograms over the anterior tibialis of each leg. Cases were identified from approximately 1,500 studies reviewed in the course of standard clinical care. Patients were 12 men and 4 women (mean age, 41 +/- 15 years; range, 12-70 years). Brief activation of the anterior tibialis in one leg alternated with similar activation in the other leg. Activations occurred at a frequency of approximately 1 to 2 Hz, each lasted between 0.1 and 0.5 seconds, and sequences of alternating activations usually lasted between several and 20 seconds. The phenomenon occurred in all sleep stages but particularly during arousals. Ten of the 16 patients had periodic leg movements during sleep at a rate >/= 5.0 per hour, and 12 of the 16 patients were taking antidepressant medication. Alternating leg muscle activation (ALMA) during sleep, at this relatively high frequency, may be a newly described phenomenon. We speculate that ALMA could represent transient facilitation of a spinal central pattern generator for locomotion, perhaps due to serotonergic effects of antidepressant medication.
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Affiliation(s)
- Ronald D Chervin
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
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