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Menzler K, Belke M, Heverhagen J, Keil B, Oertel W, Rosenow F, Stiasny-Kolster K, Knake S. Diffusions Tensor Bildgebung zeigt Veränderungen der weißen Substanz bei Patienten mit Restless legs Syndrom. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mayer G, Kesper K, Oertel W, Stiasny-Kolster K, Höffken H, Tsintaris A. REM Schlafverhaltensstörung (RBD) bei Narkolepsie als Prädiktor einer Neurodegeneration: Ergebnisse klinischer und bildgebender prospektiver Untersuchungen. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Postuma RB, Montplaisir JY, Pelletier A, Dauvilliers Y, Oertel W, Iranzo A, Ferini-Strambi L, Arnulf I, Hogl B, Manni R, Miyamoto T, Mayer G, Stiasny-Kolster K, Puligheddu M, Ju Y, Jennum P, Sonka K, Santamaria J, Fantini ML, Zucconi M, Leu-Semenescu S, Frauscher B, Terzaghi M, Miyamoto M, Unger MM, Cochen De Cock V, Wolfson C. Environmental risk factors for REM sleep behavior disorder: a multicenter case-control study. Neurology 2012; 79:428-34. [PMID: 22744670 DOI: 10.1212/wnl.0b013e31825dd383] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Idiopathic REM sleep behavior disorder is a parasomnia characterized by dream enactment and is commonly a prediagnostic sign of parkinsonism and dementia. Since risk factors have not been defined, we initiated a multicenter case-control study to assess environmental and lifestyle risk factors for REM sleep behavior disorder. METHODS Cases were patients with idiopathic REM sleep behavior disorder who were free of dementia and parkinsonism, recruited from 13 International REM Sleep Behavior Disorder Study Group centers. Controls were matched according to age and sex. Potential environmental and lifestyle risk factors were assessed via standardized questionnaire. Unconditional logistic regression adjusting for age, sex, and center was conducted to investigate the environmental factors. RESULTS A total of 694 participants (347 patients, 347 controls) were recruited. Among cases, mean age was 67.7 ± 9.6 years and 81.0% were male. Cases were more likely to smoke (ever smokers = 64.0% vs 55.5%, adjusted odds ratio [OR] = 1.43, p = 0.028). Caffeine and alcohol use were not different between cases and controls. Cases were more likely to report previous head injury (19.3% vs 12.7%, OR = 1.59, p = 0.037). Cases had fewer years of formal schooling (11.1 ± 4.4 years vs 12.7 ± 4.3, p < 0.001), and were more likely to report having worked as farmers (19.7% vs 12.5% OR = 1.67, p = 0.022) with borderline increase in welding (17.8% vs 12.1%, OR = 1.53, p = 0.063). Previous occupational pesticide exposure was more prevalent in cases than controls (11.8% vs 6.1%, OR = 2.16, p = 0.008). CONCLUSIONS Smoking, head injury, pesticide exposure, and farming are potential risk factors for idiopathic REM sleep behavior disorder.
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Affiliation(s)
- R B Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada.
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Abstract
Pain in the legs belongs to the five most frequent regional pain symptoms. Restless legs syndrome (RLS) presents a particular differential diagnosis for pain in the legs, which is characterized by a nocturnal urge to move the legs often associated with painful sensations in the legs. It is one of the most common neurological disorders and probably the leading cause of nocturnal pain in the legs. In this overview, the diagnosis and therapy of RLS as well as aspects of pain therapy of the disorder are presented. In addition, the differential diagnoses for exclusion of other specific causes of nocturnal pain in the legs are discussed.
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Affiliation(s)
- M Hornyak
- Interdisziplinäres Schmerzzentrum, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland.
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Menzler K, Teepker M, Haag A, Belke M, Oertel W, Stiasny-Kolster K, Knake S. Patients with cluster headache can show clinical signs of olfactory dysfunction. KLIN NEUROPHYSIOL 2011. [DOI: 10.1055/s-0031-1272735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cassel W, Kesper K, Ploch T, Knecht G, Stiasny-Kolster K. Der Schlafstörungsindex bei Gesunden, Patienten mit Schlafapnoe und Patienten mit Restless-Legs-Syndrom. Pneumologie 2010. [DOI: 10.1055/s-0030-1267750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Belke M, Unger MM, Hattemer K, Heverhagen JT, Keil B, Stiasny-Kolster K, Rosenow F, Diederich NJ, Mayer G, Möller JC, Oertel WH, Knake S. Diffusion Tensor Imaging (DTI) in idiopathic REM sleep behaviour disorder (iRBD). KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bodden M, Krost M, Stiasny-Kolster K, Eggert K, Dodel R, Kalbe E. Affektive Theory of Mind – Leistungen und Interpretation sozialer Emotionen: Vergleich von Parkinson Patienten und Patienten mit Restless-Legs-Syndrom. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mayer G, Kesper K, Stiasny-Kolster K. 28. Quantification of muscle tone in patients with REM sleep behavior disorder. Clin Neurophysiol 2009. [DOI: 10.1016/j.clinph.2008.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mylius V, Engau I, Teepker M, Stiasny-Kolster K, Schepelmann K, Oertel WH, Lautenbacher S, Möller JC. Pain sensitivity and descending inhibition of pain in Parkinson's disease. J Neurol Neurosurg Psychiatry 2009; 80:24-8. [PMID: 18653553 DOI: 10.1136/jnnp.2008.145995] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients suffering from Parkinson's disease (PD) often complain about painful sensations. Recent studies detected increased subjective pain sensitivity and increased spinal nociception, which appeared to be reversible by dopaminergic treatment. Possibly, reduced descending pain inhibition contributes to this finding. OBJECTIVE Subjective pain thresholds as well as nociceptive reflex thresholds were investigated to isolate potential loci of the pathophysiological changes within the pain pathway. In addition, the diffuse noxious inhibitory control (DNIC) system as one form of descending control was assessed. METHOD 15 patients with PD and 18 controls participated in the study. Electrical and heat pain thresholds as well as the nociceptive flexion reflex (NFR) thresholds were determined. Thereafter, the electrical pain thresholds were measured once during painful heat stimulation (conditioning stimulation) and twice during innocuous stimulation (control stimulation). RESULTS Patients with PD exhibited lower electrical and heat pain thresholds as well as lower NFR thresholds. Suppression of the electrical pain thresholds during painful heat stimulation (conditioning stimulation) compared with control stimulation did not differ significantly between the groups. No differences in the thresholds between patients with PD with and without clinical pain were seen. CONCLUSIONS Finding the NFR threshold to be decreased in addition to the decreased electrical and heat pain thresholds indicates that the pathophysiological changes either already reside at or reach down to the spinal level. Reduced activation of the DNIC system was apparently not associated with increased pain sensitivity, suggesting that DNIC-like mechanisms do not significantly contribute to clinical pain in PD.
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Affiliation(s)
- V Mylius
- Department of Neurology, Philipps University of Marburg, Rudolf-Bultmann-Str 8, 35033 Marburg, Germany.
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Trenkwalder C, Stiasny-Kolster K, Garcia-Borreguero D, Högl B, Keffel J, Schollmayer E, Oertel W. Rotigotin transdermales Pflaster in der Therapie des RLS: Langzeitergebnisse einer multizentrischen, multinationalen 2-jährigen follow-up Studie. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reese J, Happe S, Peglau I, Mayer G, Wasem J, Giani G, Geraedts M, Trenkwalder C, Stiasny-Kolster K, Dodel R. Economic burden and health-related quality of life in restless legs syndrome. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Krost M, Bodden M, Stiasny-Kolster K, Dodel R, Kalbe E. Theory of Mind-Leistungen bei Patientinnen mit Restless-Legs-Syndrom. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mayer G, Kesper K, Stiasny-Kolster K. Quantification of muscle tone in patients with REM sleep behavior disorder. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1072823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stiasny-Kolster K, Magerl W, Oertel W, Treede RD. 114 NEUROPATHIC PAIN IN RESTLESS LEGS SYNDROME - A DISORDER OF PAIN CONTROL. Eur J Pain 2007. [DOI: 10.1016/j.ejpain.2007.03.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stiasny-Kolster K, Clever SC, Möller JC, Oertel WH, Mayer G. Olfactory dysfunction in patients with narcolepsy with and without REM sleep behaviour disorder. Brain 2007; 130:442-9. [PMID: 17235125 DOI: 10.1093/brain/awl343] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Patients with idiopathic rapid eye movement sleep behaviour disorder (RBD) frequently develop Parkinson's disease and the majority present with hyposmia, which is a potential preclinical non-motor sign of Parkinson's disease. Accordingly, it has been proposed that the clinical symptoms of hyposmia and RBD in combination have to be considered as very early symptoms of Parkinson's disease. Since not only patients with idiopathic RBD but also patients in whom RBD is associated with narcolepsy present with an olfactory dysfunction we investigated if hyposmia in RBD patients with concomitant narcolepsy is RBD specific or if narcolepsy per se is associated with olfactory dysfunction. We studied olfactory function in 20 narcoleptic patients each with RBD (9 male and 11 female; mean age 45.4 +/- 14.0 years, range 20-75 years) and without associated RBD (8 male and 12 female; mean age 44.4 +/- 13.40 years, range 20-70 years) and 40 age- and gender-matched healthy control subjects using standardized 'Sniffin' Sticks'. Both, narcoleptics with (Narc/+RBD) and without RBD (Narc/-RBD) had a significantly higher olfactory threshold (Narc/+RBD, P = 0.0001; Narc/-RBD, P = 0.0001), lower discrimination scores (P = 0.001; P = 0.014) and lower identification scores (P = 0.057; P = 0.003) than controls. There were no symptoms or signs for early parkinsonism in both patient groups. Our results show for the first time that narcolepsy per se is associated with olfactory dysfunction. In contrast to patients with idiopathic RBD, hyposmia in patients with RBD associated with narcolepsy is unlikely to be a predictor for developing parkinsonism.
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Affiliation(s)
- K Stiasny-Kolster
- Department of Neurology, Center of Nervous Diseases, Philipps-University of Marburg, Schwalmstadt-Treysa, Germany.
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Trenkwalder C, Stiasny-Kolster K, Kupsch A, Oertel W, Koester J. P0019 Effect of pramipexole on quality of life in restless legs syndrome: results spanning 9 months. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stiasny-Kolster K, Oertel W, Bergtholdt B, Hallström Y, Albo J, Leissner L, Schindler T. P0009 Sleep self-assessment by visual analogue scales (VASs) in a 6-week European trial of pramipexole for restless legs syndrome (RLS). Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70270-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trenkwalder C, Stiasny-Kolster K, Poewe W, Schollmayer E, Oertel W. O0027 Rotigotine transdermal patch provides continuous efficacy in patients with moderate to severe idiopathic restless legs syndrome – 24 month results from a multi-national, multi-centre, open-label, follow-up trial. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mylius V, Engau I, Kunz M, Eggert K, Stiasny-Kolster K, Lautenbacher S, Schepelmann K, Oertel WH, Möller JC. Subjective pain perception, spinal nociception and descending inhibition of experimentally induced pain in Parkinson's disease. Akt Neurol 2007. [DOI: 10.1055/s-2007-987577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dodel R, Stiasny-Kolster K, Peglau I, Mayer G, Giani G, Geraedts M, Trenkwalder C, Happe S. The Economic Impact of Restless Legs Syndrome. Pneumologie 2007. [DOI: 10.1055/s-2007-973405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Winkelmann J, Lichtner P, Kemlink D, Polo O, Montagna P, Högl B, Stiasny-Kolster K, Hadjigeorgiou G, Pütz B, Trenkwalder C, Strom T, Meitinger T, Müller-Myhsok B. New loci for restless legs syndrome map to chromosome 4q and 17p. Akt Neurol 2006. [DOI: 10.1055/s-2006-952980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Oertel WH, Benes H, Bodenschatz R, Peglau I, Warmuth R, Happe S, Geisler P, Cassel W, Leroux M, Kohnen R, Stiasny-Kolster K. Efficacy of cabergoline in restless legs syndrome: A placebo-controlled study with polysomnography (CATOR). Neurology 2006; 67:1040-6. [PMID: 16931508 DOI: 10.1212/01.wnl.0000237742.08297.22] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of the dopamine agonist cabergoline in the treatment of patients with idiopathic restless legs syndrome (CATOR study). METHODS Patients with moderate to severe restless legs syndrome (RLS) were randomly assigned to cabergoline (single evening dose: 2 mg) or placebo and treated for 5 weeks in a double-blind, multicenter polysomnography (PSG) trial. The primary efficacy measures were the periodic leg movements during sleep arousal index (PLMS-AI) and sleep efficiency. These and further PSG variables were monitored by centrally evaluated PSG. Severity of RLS was assessed using the International RLS Study Group Severity Scale (IRLS), the RLS-6 scales, the Sleep Questionnaire Form A (SF-A; quality of sleep), and the Quality of Life for RLS questionnaire. RESULTS Forty-three patients were treated and 40 patients were evaluated with PSG (age 56 +/- 10 years, 73% women). Cabergoline was superior to placebo in terms of the PLMS-AI (-17.7 +/- 16.4 vs -4.5 +/- 20.0 placebo; p = 0.0024), sleep efficiency (+6.2 +/- 13.9% vs +3.3 +/- 11.7%; p = 0.0443), PLMS index (p = 0.0014), PLM index (p = 0.0012), and total sleep time (p = 0.0443). Improvements in IRLS total score (-23.7 +/- 11.2 vs -7.9 +/- 11.0 placebo; p = 0.0002), RLS-6 severity scales during the night (p = 0.0010) and during the day (p = 0.0018), Clinical Global Impressions severity item (p = 0.0003), sleep quality (p = 0.0180), SF-A sleep quality (p = 0.0371), and QoL-RLS (p = 0.0247) were larger in patients treated with cabergoline compared with the placebo group. Adverse events were only mild and well-known side effects of dopamine agonists. CONCLUSION Single-evening cabergoline is an efficacious and well-tolerated short-term therapy for sensorimotor symptoms of restless legs syndrome and associated sleep disturbances.
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Affiliation(s)
- W H Oertel
- Department of Neurology, Center of Nervous Diseases, Philipps-University Marburg, Rudolf-Bultmann-Str. 8, D-35033 Marburg, Germany.
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Möller J, Cassel W, Stiasny-Kolster K, Körner Y, Krüger H, Becker H, Oertel W. „Sleep attacks“ in patients with sleep-disordered breathing. Akt Neurol 2005. [DOI: 10.1055/s-2005-919539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Oertel W, Stiasny-Kolster K. Erfolgreiche Behandlung von RLS (Restless Legs Syndrome) mit Pramipexole (PPX) - Ergebnisse einer placebo-kontrollierten 6-wöchigen Studie im Parallelgruppen-Design. Akt Neurol 2005. [DOI: 10.1055/s-2005-919218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mayer G, Stiasny-Kolster K, Leonhardt E. Muskeltonusanalyse bei Patienten mit Verhaltensstörung im REM Schlaf. Akt Neurol 2005. [DOI: 10.1055/s-2005-919540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stiasny-Kolster K, Oertel W. Pramipexol ist eine wirksame Behandlungsoption der depressiven Verstimmungen beim Restless Legs Syndrom (RLS). Akt Neurol 2005. [DOI: 10.1055/s-2005-919535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stiasny-Kolster K, Oertel WH. REM-Schlafverhaltensstörung und α-Synukleinopathien. Akt Neurol 2005. [DOI: 10.1055/s-2005-866646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Möller JC, Körner Y, Dodel RC, Meindorfner C, Stiasny-Kolster K, Spottke A, Krüger HP, Oertel WH. Pharmacotherapy of Parkinson’s disease in Germany. J Neurol 2005; 252:926-35. [PMID: 15765268 DOI: 10.1007/s00415-005-0784-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Revised: 11/24/2004] [Accepted: 12/02/2004] [Indexed: 11/24/2022]
Abstract
Treatment standards or guidelines have been developed for most features of Parkinson's disease (PD). However, data on the actual treatment that is put into practice are scarce. In 2000, a nationwide survey on the topic of sudden onset of sleep (SOS) in PD was initiated among the members of the German patient support group (deutsche Parkinson-Vereinigung, dPV). A part of this mailed questionnaire survey covering the antiparkinsonian and concomitant medication of the participants is presented here. This study analyses data sets from more than 6,500 PD patients. The mean dopaminergic dose was equivalent to 599 +/- 387 mg levodopa/die. The most frequently administered drugs were levodopa (94.2 %), dopamine agonists (DA) (71.7 %), amantadine (40.1 %), selegiline (27.6 %), entacapone (20.4 %), budipine (12.3 %), and anticholinergics (11.8 %). Costs of pharmacotherapy were estimated to be approximately <euro> 399 million/year in Germany. PD drug therapy in general strongly depended on age, disease duration, and the level of care. The treatment guidelines were apparently not consistently followed underlining the need for their continuous propagation throughout the medical community. In addition our data suggest that non-motor symptoms in PD are not adequately treated and that concomitant sedative medication contributes to the occurrence of SOS.
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Affiliation(s)
- J C Möller
- Dept. of Neurology, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany.
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Stiasny-Kolster K, Benes H, Peglau I, Hornyak M, Holinka B, Wessel K, Emser W, Leroux M, Kohnen R, Oertel WH. Effective cabergoline treatment in idiopathic restless legs syndrome. Neurology 2004; 63:2272-9. [PMID: 15623686 DOI: 10.1212/01.wnl.0000147297.51023.c8] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of the dopamine agonist cabergoline (CAB) in patients with restless legs syndrome (RLS). METHODS Patients with moderate to severe RLS were randomized into four groups receiving placebo, 0.5 mg, 1 mg, or 2 mg CAB once daily in a double-blind, placebo-controlled, multicenter dose-finding trial followed by an open long-term extension trial of 47 weeks. Efficacy was assessed with the RLS-6 scales and International RLS Study Group severity scale (IRLS). RESULTS A total of 85 patients (age 56 +/- 10 years, 71% females) were treated. Severity of RLS-6 scale symptoms during the night (the primary endpoint) was markedly improved by all CAB doses compared to placebo (placebo: -1.4 +/- 3.1, 0.5 mg CAB: -4.2 +/- 3.0 [p = 0.0082], 1.0 mg CAB: -4.0 +/- 2.9 [p = 0.0040], 2.0 mg CAB: -4.8 +/- 3.7 [p = 0.0026]). Similar results were found for the RLS severity at bedtime and during the day, IRLS, and satisfaction with sleep. A stable, clinically relevant improvement was achieved in all efficacy measures (severity during the night: change between last assessment and baseline: -5.6 +/- 2.5, rate of remission: 71.2%) throughout 1 year with a mean CAB dose of 2.2 mg per day. During long-term treatment, 6 of 66 treated patients were affected (n = 2) or possibly affected (n = 4) by mild augmentation. Under CAB therapy up to 1 year, 11 of 85 patients discontinued treatment due to a drug-related adverse event. CONCLUSIONS Cabergoline is an efficacious and well-tolerated option for the treatment of restless legs symptoms during the night and the day.
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Stiasny-Kolster K, Doerr Y, Möller JC, Höffken H, Behr TM, Oertel WH, Mayer G. Combination of 'idiopathic' REM sleep behaviour disorder and olfactory dysfunction as possible indicator for -synucleinopathy demonstrated by dopamine transporter FP-CIT-SPECT. Brain 2004; 128:126-37. [PMID: 15548552 DOI: 10.1093/brain/awh322] [Citation(s) in RCA: 314] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
REM sleep behaviour disorder (RBD) and olfactory dysfunction are common and very early features of alpha-synucleinopathies, in particular Parkinson's disease. To investigate the hypothesis that these two clinical features in combination are an indicator of evolving alpha-synucleinopathy, olfactory function was assessed in RBD. We studied 30 patients (18 male, 12 female; mean age 48 +/- 14 years, range 19-78 years) with clinical (idiopathic, n = 6; symptomatic, n = 13, mostly associated with narcolepsy) or subclinical (n = 11, associated with narcolepsy) RBD according to standard criteria and 30 age- and gender-matched healthy control subjects using standardized 'Sniffin' Sticks'. RBD patients had a significantly higher olfactory threshold (P = 0.0001), lower discrimination score (P = 0.003), and lower identification score (P = 0.001). Compared with normative data, 97% of the RBD patients had a pathologically increased olfactory threshold, 63% an impaired odour discrimination score, and 63% a decreased identification score. On neurological examination, signs of parkinsonism were newly found in five patients with clinical RBD (not associated with narcolepsy), who usually had a long history of 'idiopathic' RBD. Four of the five patients fulfilled the UK Brain Bank criteria for the clinical diagnosis of Parkinson's disease. The underlying nigrostriatal degeneration of clinical Parkinson's disease was confirmed by I-123-FP-CIT SPECT in one patient and early nigrostriatal degeneration was identified by SPECT in a further two patients with 'idiopathic' clinical RBD out of 11 RBD patients who agreed to undergo SPECT studies. Our study shows that RBD patients have a profound impairment of olfactory function. Five patients with clinical RBD not associated with narcolepsy had clinical or imaging signs of nigrostriatal degeneration. This new clinical finding correlates with the neuropathological staging of Parkinson's disease (stages 1-3) as proposed by Braak. In stage 1, the anterior olfactory nucleus or the olfactory bulb is affected (along with the dorsal motor nucleus of the glossopharyngeal and vagal nerves). In stage 2, additional lesions consistently remain confined to the medulla oblongata and pontine tegmentum, which are critical areas for RBD. Midbrain lesions are found only in stage 3, in particular degeneration of dopaminergic neurons in the substantia nigra pars compacta. Thus, 'idiopathic' RBD patients with olfactory impairment might present with stage 2 preclinical alpha-synucleinopathy. Since narcoleptic patients are not known to have an increased risk of developing parkinsonism, the pathophysiology and clinical relevance of hyposmia in RBD/narcolepsy patients requires further research.
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Affiliation(s)
- K Stiasny-Kolster
- Department of Neurology, Center of Nervous Diseases, Philipps University of Marburg, Germany.
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Stiasny-Kolster K, Trenkwalder C, Fogel W, Greulich W, Hahne M, Lachenmayer L, Oechsner M, Oertel WH. Restless legs syndrome?new insights into clinical characteristics, pathophysiology, and treatment options. J Neurol 2004; 251 Suppl 6:VI/39-43. [PMID: 15675724 DOI: 10.1007/s00415-004-1609-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We summarize recent advances in the clinical definition of restless legs syndrome (RLS), in understanding the basic mechanisms, and the successful treatments of RLS. New diagnostic instruments and severity scales have been developed for better phenotyping of the individual patient. Iron metabolism related components and the dopaminergic system have been extensively investigated in respect to the pathophysiology of RLS. The presence of mechanical hyperalgesia to pin-prick points towards an involvement of the nociceptive system. Genetic research has reported loci on chromosome 12q and 14q to play a role in the vulnerability to RLS. Placebo-controlled large-scale phase II and III treatment trials have shown that dopamine agonists are safe and efficacious agents for the treatment of this disorder.
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Affiliation(s)
- K Stiasny-Kolster
- Department of Neurology, Philipps University Marburg, Rudolf-Bultmann-Strasse 8, 35033 Marburg, Germany.
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Stiasny-Kolster K, Magerl W, Oertel WH, Möller JC, Treede RD. Static mechanical hyperalgesia without dynamic tactile allodynia in patients with restless legs syndrome. Brain 2004; 127:773-82. [PMID: 14985260 DOI: 10.1093/brain/awh079] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pain sensitivity was assessed in 11 patients (age 60 +/- 10 years) with 'primary' restless leg syndrome (RLS) (disease duration 18 +/- 15 years) and 11 age- and gender-matched healthy control subjects. Stimulus-response functions for pricking pain were obtained with seven calibrated punctate mechanical stimulators activating Adelta-high threshold mechano-nociceptors. Stimuli at the foot were significantly more painful than at the hand in both patients and healthy control subjects both in the morning and evening. Generally, pin-prick pain ratings in RLS patients were significantly elevated, by a factor of 5.3 in the upper limb and by a factor of 6.4 in the lower limb indicating a significant generalized static hyperalgesia more pronounced in the lower limb. In contrast, pain to light touch (allodynia = dynamic mechanical hyperalgesia) as tested by a battery of three gentle tactile stimuli was never reported. Acute single-dose dopaminergic treatment with 100 mg levodopa + 25 mg benserazide, 90 min prior to the evening measurements, largely resolved patients' RLS symptoms, but had no effect on pin-prick pain. Static hyperalgesia to pin-prick, however, was significantly reversed (median reduction -74%) by long-term individually tailored dopaminergic treatment. Our study shows that patients with RLS exhibit a profound static mechanical hyperalgesia to pin-prick stimuli, but no dynamic mechanical hyperalgesia (allodynia). This type of hyperalgesia is probably mediated by central sensitization to Adelta-fibre high-threshold mechanoreceptor input, a hallmark sign of the hyperalgesia type of neuropathic pain. The reduction of hyperalgesia in RLS patients by long-term dopaminergic treatment suggests that the pathophysiology of RLS includes disturbed supraspinal pain modulation involving the basal ganglia and/or descending dopaminergic pathways.
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Affiliation(s)
- K Stiasny-Kolster
- Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany.
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Abstract
CSF hypocretin-1 levels at 6 pm did not significantly differ between patients with restless legs syndrome (RLS) and control subjects as measured by direct radioimmunoassay and after acid extraction. The authors did not observe significant differences between early onset and late onset RLS. Hypocretin-1 levels did not correlate with RLS severity or polysomnographic measures. These results contrast with previous findings reporting significantly increased CSF hypocretin-1 in the late evening and mostly in early onset RLS.
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Stiasny-Kolster K, Haeske H, Tergau F, Müller HH, Braune HJ, Oertel WH. Chapter 38 Cortical silent period is shortened in restless legs syndrome independently from circadian rhythm. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, Proceedings of the 2nd International Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) Symposium 2003; 56:381-9. [PMID: 14677414 DOI: 10.1016/s1567-424x(09)70241-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- K Stiasny-Kolster
- Department of Neurology, Center of Nervous Diseases, Philipps-University of Marburg, Rudolf-Bultmann-Strasse 8, D-35033 Marburg, Germany.
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