Restless legs syndrome

Acupuncture and Moxibustion for restless legs syndrome: A systematic review and meta-analysis protocol

INTRODUCTION

Previous reviews indicate that the effect of acupuncture and moxibustion (AM) on restless legs syndrome (RLS) remains uncertainty. The results of trials published in the past 12 years may possibly change this situation, but an updated systematic review is not available. We therefore designed this study to systematically assess the effectiveness and safety of AM for treating RLS.

METHODS AND ANALYSIS

Nine online databases will be searched from inception to October 01 2019; there will be no language restrictions on the included trials. Randomized controlled trials that included patients with RLS receiving AM therapy versus a control group will be included. The selection of studies, risk of bias assessment and data extraction will be conducted by 2 independent researchers. Data synthesis will be performed by using RevMan V.5.2 software with fixed effects model or random effects model, according to the heterogeneity test. The dichotomous data will be presented as risk ratios with 95% confidence intervals (Cis) and the continuous data will be presented as weighted mean differences or standardized mean differences with 95% CIs. Evidence quality will be evaluated by using the grading of recommendations assessment (GRADE), development and evaluation system with low risk, unclear risk, and high risk.

ETHICS AND DISSEMINATION

This systematic review and meta-analysis is literature research which will not refer to private information and not impair one's health, so, ethical approval is not required. The results of this study will be published in a journal or concerned conferences.

PROSPERO REGISTRATION NUMBER

CRD42019148325.

Prevalence and clinical profile of restless legs syndrome in Parkinson's disease

Parkinson's disease (PD) and restless legs syndrome (RLS) have a dopaminergic link. More insight in the clinical profile of RLS in patients with PD may benefit our understanding of this link. The aims of this study were to evaluate the frequency and clinical profile of RLS in a large cohort of PD patients. In 269 nondemented Caucasian PD patients, the four diagnostic criteria for RLS were administered by a RLS trained researcher. In patients with definite RLS, the severity of these symptoms was assessed. Furthermore, in all patients, relevant motor and nonmotor symptoms in PD were evaluated. Definite RLS was present in 11% of the patients. RLS patients were more often female (69% vs. 32%, P < 0.001), but no other significant differences existed between PD patients with and without RLS. Within the PD patients with RLS, severity of RLS correlated positively with PD severity, motor fluctuations, depressive symptoms, daytime sleepiness, cognitive problems, autonomic symptoms, and psychotic symptoms. This study in a large PD cohort shows that prevalence of RLS is similar to that in the general population, which might be caused by underestimation of RLS due to dopaminergic treatment. No relations were found between the presence of RLS and PD symptoms, but the severity of RLS was related to the severity of PD-related, mainly nondopaminergic, symptoms. It is hypothesized that, nondopaminergic systems, such as the noradrenergic system may play a role in the possible link between PD and RLS.

Periodic limb movements in sleep exhibit a circadian rhythm that is maximal in the late evening/early night

OBJECTIVE

Periodic limb movements in sleep (PLMS) show a time-of-night pattern, with most movements at the beginning of the night. Our study aimed to determine whether this pattern is due to an endogenous circadian rhythm, like that in the related movement disorder Restless Legs Syndrome (RLS).

METHODS

Four healthy older adults with a screening PLMI>20 were studied in an inpatient forced desynchrony protocol with an imposed sleep-wake cycle of 20 h for 12 "nights," allowing separation of circadian and sleep homeostatic influences on leg movements. We recorded sleep polysomnographically throughout each scheduled episode, including left and right anterior tibialis EMG.

RESULTS

PLMS in Stage 2 showed both a significant time-within-sleep pattern and a significant circadian rhythm. The circadian rhythm in PLMS peaked at the circadian phases when usual sleep onset occurs, preceding the evening rise in melatonin secretion.

CONCLUSIONS

In our subjects, the circadian pattern of PLMs expression was very similar to that previously reported in patients with RLS. This evidence for a circadian rhythm in PLMS has implications for treatment and provides direction for future studies of the pathophysiology of this movement disorder.

Update on the management of restless legs syndrome: existing and emerging treatment options

Restless legs syndrome (RLS) is a sensorimotor disorder, characterized by a circadian variation of symptoms involving an urge to move the limbs (usually the legs) as well as paresthesias. There is a primary (familial) and a secondary (acquired) form, which affects a wide variety of individuals, such as pregnant women, patients with end-stage renal disease, iron deficiency, rheumatic disease, and persons taking medications. The symptoms reflect a circadian fluctuation of dopamine in the substantia nigra. RLS patients have lower dopamine and iron levels in the substantia nigra and respond to both dopaminergic therapy and iron administration. Iron, as a cofactor of dopamine production and a regulator of the expression of dopamine type 2-receptor, has an important role in the RLS etiology. In the management of the disease, the first step is to investigate possible secondary causes and their treatment. Dopaminergic agents are considered as the first-line therapy for moderate to severe RLS. If dopaminergic drugs are contraindicated or not efficacious, or if symptoms are resistant and unremitting, gabapentin or other antiepileptic agents, benzodiazepines, or opioids can be used for RLS therapy. Undiagnosed, wrongly diagnosed, and untreated RLS is associated with a significant impairment of the quality of life.

Acupuncture for restless legs syndrome

BACKGROUND

Restless legs syndrome (RLS) is a common movement disorder for which patients may seek treatment with acupuncture. However, the benefits of acupuncture in the treatment of RLS are unclear and have not been evaluated in a systematic review until now.

OBJECTIVES

To evaluate the efficacy and safety of acupuncture therapy in patients with RLS.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007), MEDLINE (January 1950 to February 2007), EMBASE (January 1980 to 2007 Week 8), Chinese Biomedical Database (CBM) (1978 to February 2007), China National Knowledge Infrastructure (CNKI) (1979 to February 2007), VIP Database (1989 to February 2007), Japana Centra Revuo Medicina (1983 to 2007) and Korean Medical Database (1986 to 2007). Four Chinese journals, relevant academic conference proceedings and reference lists of articles were handsearched.

SELECTION CRITERIA

Randomized controlled trials and quasi-randomized trials comparing acupuncture with no intervention, placebo acupuncture, sham acupuncture, pharmacological treatments, or other non-acupuncture interventions for primary RLS were included. Trials comparing acupuncture plus non-acupuncture treatment with the same non-acupuncture treatment were also included. Trials that only compared different forms of acupuncture or different acupoints were excluded.

DATA COLLECTION AND ANALYSIS

Two authors independently identified potential articles, assessed methodological quality and extracted data. Relative risk (RR) was used for binary outcomes and weighted mean difference for continuous variables. Results were combined only in the absence of clinical heterogeneity.

MAIN RESULTS

Fourteen potentially relevant trials were identified initially, but twelve of them did not meet the selection criteria and were excluded. Only two trials with 170 patients met the inclusion criteria. No data could be combined due to clinical heterogeneity between trials. Both trials had methodological and/or reporting shortcomings. No significant difference was detected in remission of overall symptoms between acupuncture and medications in one trial (RR 0.97, 95% CI 0.76 to 1.24). Another trial found that dermal needle therapy used in combination with medications and massage was more effective than medications and massage alone, in terms of remission of unpleasant sensations in the legs (RR 1.36, 95% CI 1.06 to 1.75; WMD -0.61, 95% CI -0.96 to -0.26) and reduction of RLS frequency (WMD -3.44, 95% CI -5.15 to -1.73). However, there was no significant difference for the reduction in either the longest or the shortest duration of RLS (WMD -2.58, 95% CI -5.92 to 0.76; WMD -0.38, 95% CI -1.08 to 0.32).

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether acupuncture is an efficacious and safe treatment for RLS. Further well-designed, large-scale clinical trials are needed.

Deficit of pericapillary oligodendrocytes in the prefrontal cortex in schizophrenia

OBJECTIVE

Our previous studies have shown a significant decrease of numerical density of oligodendrocytes in the prefrontal cortex in postmortem schizophrenic brains. Deficit of oligodendrocytes was associated with loss of oligodendroglial satellites of pyramidal neurons. In this study we tested the hypothesis that there might be a deficit and loss of pericapillary oligodendrocytes in the prefrontal cortex in schizophrenia.

METHOD

Autopsy samples from the prefrontal cortex (BA 10) were obtained from 12 normal controls and 12 chronic schizophrenic cases. Capillaries and oligodendrocytes were viewed in paraffin sections stained with a Luxol-fast blue and cresyl violet. Electron microscopy was applied to study the ultrastructure of oligodendrocytes. For morphometric analysis, an average of 100 rectilinear capillary segments from layer V was sampled for each individual. The number of oligodendrocytes visible along rectilinear segments was expressed as the number of oligodendrocytes per 0.01 mm of capillary length.

RESULTS

Subjects with schizophrenia had a significantly lower (-23%; P < 0.005) number of pericapillary oligodendrocytes compared to controls. Prominent ultrastructural dystrophic and degenerative alterations of pericapillary oligodendrocytes have been revealed in schizophrenic brains.

CONCLUSION

The present study provides evidence that there is a prominent reduction, damage and loss of pericapillary oligodendrocytes in the prefrontal cortex in schizophrenia. These changes may contribute to the pathophysiological basis for altered blood-brain barrier and lowered metabolic rates in subjects with schizophrenia.

Cutaneous silent period in patients with restless leg syndrome

OBJECTIVE

To investigate the pathophysiological relationship between RLS and small fiber neuropathy using the cutaneous silent period (CSP), which is a spinal reflex mediated by Adelta cutaneous afferents and is useful for the evaluation of small-diameter nerve function.

METHODS

The CSP was measured from the extensor digitorum brevis in 157 patients with RLS and 60 healthy controls. The CSP measurement was repeated in the RLS patients after dopamine agonist treatment for one month. The RLS rating scale for clinical severity was used to evaluate each patient before and after treatment. The measured CSP variables were compared between the patient group and the control group. In addition, the possible correlation between the CSP variables and the RLS rating scale score related to treatment was analyzed.

RESULTS

The mean CSP latencies did not differ between the RLS patients and the healthy controls; however, the mean CSP duration was significantly longer in the RLS patients than in the controls, and this prolonged CSP duration improved to the level of the control subjects after dopamine agonist treatment (p=0.003). The mean RLS rating scale score also significantly decreased after medication (p=0.000). However, the changes in the CSP variables did not correlate with the decrement in the RLS rating scale score.

CONCLUSIONS

Although our results do not support the role of Adelta fiber dysfunction in RLS, the observed change in CSP duration may be useful as a clinical measure of the improvement with dopamine agonist treatment in patients with RLS.

SIGNIFICANCE

Further study is needed to elucidate the exact mechanism involved in the prolonged CSP duration in response to treatment.

Restless legs syndrome: diagnostic assessment and the advantages and risks of dopaminergic treatment

In the past few years, major advances have been made in the field of restless legs syndrome (RLS). New tools have been developed to assess the presence and severity of RLS and its complications. Furthermore new concepts of the phenotype are emerging.With a high likelihood a slight dopaminergic hypofunction contributes essentially to the pathophysiology of most phenotypes of RLS. Dopaminergic substitution either with L-DOPA or with dopamine agonists ameliorates symptoms in the large majority of patients. Too high of doses of either type of drug may be involved in the development of augmentation caused by treatment-induced alterations in dopaminergic neurotransmission. Dopaminergic agents are currently the agents of first choice to treat RLS, and large multicenter trials support the evidence of efficacy. Very careful tailoring of the dose is required to avoid the development of treatment complications, specifically augmentation.