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           Results of MEDLINE Search on Treatment of Patients with 
                         Restless Legs Syndrome

                          By, Ivan Goldberg, MD
1
UI  - 95306509
AU  - Staedt J
AU  - Stoppe G
AU  - Kogler A
AU  - Riemann H
AU  - Hajak G
AU  - Munz DL
AU  - Emrich D
AU  - Ruther E
TI  - Nocturnal myoclonus syndrome (periodic movements in sleep) related
      to central dopamine D2-receptor alteration.
SO  - European Archives of Psychiatry & Clinical Neuroscience 
1995;245(1):8-10
AB  - The nocturnal myoclonus syndrome (NMS) consists of stereotyped,
      repetitive jerks of the lower limbs that occur during sleep or
      wakefulness. NMS is often related with restless-legs syndrome 
(RLS)
      and can cause severe sleep disturbances and daytime sleepiness. 
The
      efficacy of dopamine agonists in the treatment points to a
      dopaminergic dysfunction in NMS. We investigated the central
      dopamine D2-receptor occupancy with [123I] labeled
      (S)-2-hydroxy-3-iodo-6-methoxy-([1-ethyl-2-pyrrolidinyl]methyl)
      benzamide (IBZM) (a highly selective CNS D2 dopamine receptor
      ligand) ([123I]IBZM) and single photon emission tomography (SPET) 
in
      20 patients with NMS and in 10 healthy controls. In most of the
      patients with NMS there was a lower [123I]IBZM binding in the
      striatal structures compared to controls. The results indicate 
that
      NMS is related to a decrease of central D2-receptor occupancy.

2
UI  - 95287679
AU  - Diaz Guzman J
AU  - Lopez Valdes E
AU  - Benito J
TI  - [The treatment of the restless legs syndrome and periodic sleep
      movements (letter)]. [Spanish]
OT  - Tratamiento del sindrome de piernas inquietas y movimientos
      periodicos del sueno.
SO  - Medicina Clinica 1995 Apr 22;104(15):597

3
UI  - 95092950
AU  - Vahedi H
AU  - Kuchle M
AU  - Trenkwalder C
AU  - Krenz CJ
TI  - [Peridural morphine administration in restless legs status
      (published erratum appears in Anasthesiol Intensivmed Notfallmed
      Schmerzther 1994 Dec;29(8):521)]. [German]
OT  - Peridurale Morphiumanwendung bei Restless-Legs-Status.
SO  - Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie 
1994
      Oct;29(6):368-70
AB  - The restless-legs syndrome is known to occur in a familial form. 
The
      paraesthesias, which are hard to define, are sometimes compared to 
a
      painful sensation that can be alleviated only by movement. The
      pathomechanism of the syndrome and its aetiology are still 
unknown.
      A 67-year old patient was admitted as an emergency with most 
severe
      pain in her legs. In her family the syndrome occurred in an
      autosomal dominant form. A long-standing history of abuse of 
various
      analgesics was known. Initially the symptoms could not be 
influenced
      by any of the various drugs given; even epidural bupivacaine 
showed
      no effect. Dramatic relief, however, was obtained by epidural
      morphine. The maintenance therapy with oral morphine sulfate
      provided equally good results.

4
UI  - 95245713
AU  - Kanter AH
TI  - The effect of sclerotherapy on restless legs syndrome.
SO  - Dermatologic Surgery 1995 Apr;21(4):328-32
AB  - BACKGROUND. Restless Legs syndrome (RLS) is a disorder of unknown
      etiology characterized by relentless leg discomfort when 
stationary,
      which compels voluntary leg movement to obtain temporary relief. 
We
      have received anecdotal reports of coincidental relief from 
symptoms
      of RLS in patients following sclerotherapy for varicose vein
      disease. OBJECTIVE. To prospectively evaluate the concomitant
      occurrence of RLS and varicose veins in a population seeking
      treatment for varicose veins, and to assess the therapeutic 
response
      of RLS to sclerotherapy. METHODS. One thousand three hundred and
      ninety-seven patients were screened for RLS symptoms by
      questionnaire and interview, and for saphenous vein disease by
      clinical examination, including continuous-wave Doppler.
      Sclerotherapy with sodium tetradecyl sulphate was performed on 113
      RLS patients. RESULTS. RLS symptoms were present in 22% 
(312/1,397),
      with a Doppler-negative to Doppler-positive ratio of 3:2. One
      hundred and eleven of the 113 treated patients (98%) reported
      initial relief from RLS symptoms. Follow-up thus far shows a
      recurrence rate of 8% and 28% at 1 and 2 years, respectively.
      CONCLUSIONS. RLS is common in patients with both saphenous and
      nontruncal varicose vein disease, and can respond frequently and
      rapidly to sclerotherapy. This subpopulation of RLS sufferers 
should
      be considered for phlebological evaluation and possible treatment
      before being consigned to chronic drug therapy.

5
UI  - 95191551
AU  - Iannaccone S
AU  - Zucconi M
AU  - Marchettini P
AU  - Ferini-Strambi L
AU  - Nemni R
AU  - Quattrini A
AU  - Palazzi S
AU  - Lacerenza M
AU  - Formaglio F
AU  - Smirne S
TI  - Evidence of peripheral axonal neuropathy in primary restless legs
      syndrome.
SO  - Movement Disorders 1995 Jan;10(1):2-9
AB  - Restless legs syndrome (RLS) is a well-defined clinical entity
      characterized by an unpleasant creeping sensation arising in the
      legs with an irresistible need to move them. The trouble is more
      pronounced when the affected people lie in a prolonged rest 
position
      and try to fall asleep. It is known that RLS may be consequent to
      systemic disorders and to diseases affecting the central or
      peripheral nervous system. The International Classification of 
Sleep
      Disorders states that peripheral neuropathy should be ruled out by
      medical history and clinical grounds before diagnosing primary RLS
      (pRLS). The present study extended peripheral nerve investigation 
in
      eight consecutive pRLS patients with normal neurological 
examination
      results and showed that all patients exhibited two or more
      electrical, psychophysiological, and/or morphological features of
      peripheral axonal neuropathy. Morphometric analysis of sural nerve
      showed a significant reduction in myelinated fiber density and g
      ratio (axon diameter/fiber diameter) in the pRLS group compared 
with
      eight control biopsy specimens. These results suggest that axonal
      neuropathy is often present in patients with RLS. A comprehensive
      peripheral nerve investigation should be considered in RLS 
patients.

6
UI  - 95036781
AU  - Zoe A
AU  - Wagner ML
AU  - Walters AS
TI  - High-dose clonidine in a case of restless legs syndrome. [Review]
SO  - Annals of Pharmacotherapy 1994 Jul-Aug;28(7-8):878-81
AB  - OBJECTIVE: To describe a patient with idiopathic restless legs
      syndrome (RLS). CASE SUMMARY: A 37-year-old man developed severe
      symptoms of RLS. Treatment using combinations of levodopa, 
opioids,
      benzodiazepines, and baclofen provided only partial benefit or
      resulted in intolerable adverse effects. Higher dosages of 
clonidine
      than previously reported in the literature (0.9 mg/d in divided
      doses) were needed to completely relieve his RLS symptoms. The 
only
      prominent adverse effect was dry mouth. The RLS symptoms returned
      after subsequent reductions in the dosage. After the dosage of
      clonidine was again increased, complete relief of the symptoms was
      achieved again. After several months, clonidine was tapered to 
zero
      and the patient entered a period of spontaneous remission. When 
his
      symptoms returned four months after clonidine had been 
discontinued,
      clonidine therapy was restarted. DISCUSSION: Clonidine alleviated
      RLS symptoms in 30 of 41 patients reported in the literature,
      indicating that the adrenergic nervous system may play a role in
      RLS. CONCLUSIONS: High-dose clonidine appears to be useful in
      treating RLS when other therapies fail. However, well-controlled,
      polysomnographic studies are needed. [References: 26]

7
UI  - 95003332
AU  - Mullan E
AU  - Katona C
AU  - Bellew M
TI  - Patterns of sleep disorders and sedative hypnotic use in seniors.
      [Review]
SO  - Drugs & Aging 1994 Jul;5(1):49-58
AB  - Adequate sleep is required for good physical and psychological
      health. Sleep disturbance is common and its prevalence increases
      with advancing age. Physiologically, sleep in elderly adults 
differs
      from that in younger adults, both in terms of quantity and 
quality.
      Sleep disturbance in old age may be associated with many physical
      and psychological conditions, and less commonly can occur as a
      primary disturbance. It must be distinguished from the
      understandable but unrealistic expectations of many elderly people
      that they will sleep for as long and as soundly as when they were
      younger. The evaluation of a patient with a sleep disorder 
requires
      full medical psychiatric and social histories, mental state and
      physical examinations and appropriate investigations. If present, 
an
      underlying condition should be treated. Management strategies for
      sleep disorders include attention to sleep hygiene, behavioural
      treatment and hypnotics. Ideally, a hypnotic should be prescribed
      for a limited period and then in the smallest effective dose.
      [References: 50]

8
UI  - 94367757
AU  - O'Keeffe ST
AU  - Gavin K
AU  - Lavan JN
TI  - Iron status and restless legs syndrome in the elderly.
SO  - Age & Ageing 1994 May;23(3):200-3
AB  - The relationship between iron status and the restless legs 
syndrome
      (RLS) was examined in 18 elderly patients with RLS and in 18 
matched
      control subjects. A rating scale with a maximum score of 10 was 
used
      to assess the severity of RLS symptoms. Serum ferritin levels were
      reduced in the RLS patients compared with control subjects (median
      33 micrograms/l vs. 59 micrograms/l, p < 0.01, Wilcoxon signed 
rank
      test); serum iron, vitamin B12 and folate levels and haemoglobin
      levels did not differ between the two groups. Serum ferritin 
levels
      were inversely correlated with the severity of RLS symptoms
      (Spearman's rho -0.53, p < 0.05). Fifteen patients with RLS were
      treated with ferrous sulphate for 2 months. RLS severity score
      improved by a median value of 4 points in six patients with an
      initial ferritin < or = 18 micrograms/l, by 3 points in four
      patients with ferritin > 18 micrograms/l, < or = 45 micrograms/l 
and
      by 1 point in five patients with ferritin > 45 micrograms/l, < 100
      micrograms/l. Iron deficiency, with or without anaemia, is an
      important contributor to the development of RLS in elderly 
patients,
      and iron supplements can produce a significant reduction in
      symptoms.

9
UI  - 94261080
AU  - Montplaisir J
AU  - Lapierre O
AU  - Lavigne G
TI  - [The restless leg syndrome: a condition associated with periodic 
or
      aperiodic slowing of the EEG]. [Review] [French]
OT  - Le syndrome d'impatiences musculaires: une maladie associee au
      ralentissement periodique ou aperiodique de l'EEG.
SO  - Neurophysiologie Clinique 1994 Apr;24(2):131-40
AB  - There are several new developments with regard to semiology,
      diagnosis, physiopathology and the treatment of restless leg
      syndrome (RLS). We present here the hypothesis that motor
      manifestations of the RLS are synchronous to slowing of the 
cortical
      activity as measured by the spectral analysis of the EEG. When the
      subject is resting in bed with his leg outstretched, slowing of 
the
      EEG is observed, which could be periodic at the frequency of
      approximately 1 every 20 seconds or sustained. Leg movements can 
be
      periodic at the frequency of approximately 1 every 20 seconds or
      sustained. Leg movements can be periodic or aperiodic accordingly.
      On the contrary, periodic leg movements in sleep (PLMS) occur in
      close temporal relationship with periodic arousal. These results
      raised the hypothesis that leg movements (RLS and PLMS) may appear
      at a critical level of cortical activation. This level is reached
      during sleepiness in the awake subject or during periodic
      micro-arousal when the subject is asleep. Other results suggest 
that
      these periodic changes in the level of cortical activation may 
also
      modulate other abnormal motor behavior in sleep such as rhythmic
      masticatory muscles activity as seen in sleep bruxism. The same
      mechanism may also be involved in setting the duration of apneic
      episodes during slow-wave sleep. [References: 32]

10
UI  - 94237522
AU  - Staedt J
AU  - Stoppe G
AU  - Kogler A
AU  - Munz DL
AU  - Hajak G
AU  - Staedt U
AU  - Riemann H
AU  - Ruther E
TI  - [Nightly myoclonus syndrome (NMS) and restless legs syndrome
      (RLS)--review and case report]. [Review] [German]
OT  - Nachtliches Myoklonie-Syndrom (NMS) und Restless-Legs-Syndrom
      (RLS)--Ubersicht und Fallbeschreibung.
SO  - Fortschritte der Neurologie-Psychiatrie 1994 Mar;62(3):88-93
AB  - The paper gives a brief review of the existing literature 
concerning
      the nocturnal myoclonus syndrome (NMS). The clinical 
symptomatology,
      criteria for differential diagnosis and the relation to the 
restless
      legs syndrome (RLS) are discussed. Recently we investigated 
central
      dopamine receptor density with 123I-labeled
      3'-iodo-6-methoxybenzamide (IBZM) (a highly selective CNS D2
      dopamine receptor ligand) and single photon emission tomography
      (SPECT) in patients with NMS and found a reduced density of 
dopamine
      D2-receptors in the striatal structures, indicating a dopaminergic
      dysfunction in NMS and RLS. We present a report concerning a 58-
year
      old female with NMS-associated insomnia and present IBZM SPECTs 
and
      hypnograms before and after a 3-month treatment with L-dopa and
      discuss the results with regard to pathophysiological theories.
      [References: 37]

11
UI  - 94218619
AU  - Becker PM
AU  - Jamieson AO
AU  - Brown WD
TI  - Dopaminergic agents in restless legs syndrome and periodic limb
      movements of sleep: response and complications of extended 
treatment
      in 49 cases.
SO  - Sleep 1993 Dec;16(8):713-6
AB  - Restless legs syndrome (RLS) is a common neurosensorimotor 
disorder
      that presents with paresthesias, sleep disturbances and, in most
      cases, periodic limb movements of sleep (PLMS). Although many
      treatments have been described, interest has recently been focused
      on dopaminergic mechanisms of etiology and treatment. The dopamine
      agonists L-dopa/carbidopa, bromocriptine mesylate or both were
      initiated in 49 patients with RLS/PLMS who sought consultation at 
a
      sleep disorders center. This retrospective study describes the
      symptoms, time course of response and complications in 36 men and 
13
      women with a mean age of 53.9 years. Only 47 of the patients were
      available for extended follow-up. The most common presenting
      complaints were the sensation of restless legs and sleep 
maintenance
      insomnia lasting over 20 years. In the extended follow-up group of
      47, four failed to respond to L-dopa or bromocriptine, five
      discontinued treatment because of side effects and two reported 
loss
      of therapeutic effect within the first month. Between month one 
and
      six, only three additional subjects discontinued treatment. At a
      mean follow-up of 283 days (SD 316), 33 patients continued on
      L-dopa/carbidopa at a mean bedtime dose of 160 mg L-dopa (SD 300).
      Treatment-emergent morning leg restlessness developed in eight
      patients, seven of whom required daytime medication for relief.
      Other side effects, generally nausea, occurred in only eight of 43
      patients. Psychiatric side effects of dyskinesia were not seen. 
The
      > 70% long-term response is comparable to other studies in the
      literature.

12
UI  - 93391850
AU  - Schenck CH
AU  - Hurwitz TD
AU  - O'Connor KA
AU  - Mahowald MW
TI  - Additional categories of sleep-related eating disorders and the
      current status of treatment.
SO  - Sleep 1993 Aug;16(5):457-66
AB  - Sleep-related eating disorders distinct from daytime eating
      disorders have recently been shown to be associated with
      sleepwalking (SW), periodic limb movement (PLM) disorder and
      triazolam abuse in a series of 19 adults. We now report eight 
other
      primary or combined etiologies identified by clinical evaluations
      and polysomnographic monitoring of 19 additional adults (mean age 
40
      years; 58% female): i) obstructive sleep apnea (OSA), with eating
      during apnea-induced confusional arousals (n = 3); ii) OSA-PLM
      disorder (n = 1); iii) familial SW and sleep-related eating (n = 
2);
      iv) SW-PLM disorder (n = 1); v) SW-irregular sleep/wake pattern
      disorder (n = 1); vi) familial restless legs syndrome and
      sleep-related eating (n = 2); vii) anorexia nervosa with nocturnal
      bulimia (n = 2) and viii) amitriptyline treatment of migraines (n 
=
      1). In our cumulative series of 38 patients (excluding six with
      simple obesity from daytime overeating), 44% were overweight (i.e. 
>
      20% excess weight) from sleep-related eating. Nightly sleep-
related
      binge eating (without hunger or purging) had occurred in 84% of
      patients. Onset of sleep-related eating was also closely linked 
with
      i) acute stress involving reality-based concerns about the safety 
of
      family members or about relationship problems (n = 6), ii)
      abstinence from alcohol and opiate/cocaine abuse (n = 2) and iii)
      cessation of cigarette smoking (n = 2). Current treatment data
      indicate a primary role of dopaminergic agents (carbidopa/L-dopa;
      bromocriptine), often combined with codeine and clonazepam, in
      controlling most cases involving SW and/or PLM disorder. 
Fluoxetine
      was effective in two of three patients. Nasal continuous positive
      airway pressure therapy controlled sleep-related eating in two OSA
      patients.

13
UI  - 93173330
AU  - Guilleminault C
AU  - Cetel M
AU  - Philip P
TI  - Dopaminergic treatment of restless legs and rebound phenomenon.
SO  - Neurology 1993 Feb;43(2):445

14
UI  - 94218620
AU  - Kaplan PW
AU  - Allen RP
AU  - Buchholz DW
AU  - Walters JK
TI  - A double-blind, placebo-controlled study of the treatment of
      periodic limb movements in sleep using carbidopa/levodopa and
      propoxyphene.
SO  - Sleep 1993 Dec;16(8):717-23
AB  - We studied the relative benefits of carbidopa/levodopa (25/100 mg
      and 50/200 mg) and propoxyphene (100 mg and 200 mg) in six 
subjects
      with periodic limb movements (PLM) using a randomized, double-
blind,
      placebo-controlled, cross-over design with a 4-day placebo wash-
out
      period between test medications. Each subject received, for
      successive 2-week periods, 4 days of placebo followed by 5 days of
      low-dose and then 5 days of high-dose medication. Outcome was


                         

      measured with polysomnograms and sleep latency tests on the last
      night of the high dose, and leg activity was monitored for each
      night of the study. Carbidopa/levodopa normalized PLM and improved
      sleep, particularly in the first 3 hours in most subjects.
      Propoxyphene had marginal benefit and significantly decreased
      arousals and mildly decreased leg movements for leg activity
      monitoring, but not for PLM on the polysomnograms. Subjects 
reported
      better sleep and alertness on carbidopa/levodopa than on
      propoxyphene or placebo. Our results support the premise of a
      central dopaminergic abnormality in PLM.

15
UI  - 94204957
AU  - Bassetti C
AU  - Hess CW
TI  - [Parasomnias]. [German]
OT  - Parasomnien.
SO  - Therapeutische Umschau 1993 Oct;50(10):692-7
AB  - Parasomnias are frequent. They usually represent either the
      exaggeration of a physiological phenomenon (e.g. sleep starts) or 
a
      non-disturbing, idiopathic and usually benign sleep disorder (e.g.
      sleep talking and bruxism), which need only counseling and
      improvement of sleep hygiene. However, occasionally parasomnias 
are
      of clinical relevance. They can cause insomnia or hypersomnia 
(e.g.
      'myoclonus nocturnus'), psychosocial stress (e.g. sleep-related
      enuresis and sleep walking) and injuries to oneself and others 
(e.g.
      REM-parasomnia). Finally, they can be symptomatic of neurological
      and medical disorders (e.g. sleep paralysis and 'myoclonus
      nocturnus'). In these cases special investigations including
      video-polysomnography can establish a correct diagnosis and allow 
a
      specific treatment.

16
UI  - 94167993
AU  - Aver'ianov IuN
AU  - Zenkov LR
AU  - Golubev VL
AU  - Toropina GG
TI  - [The painful leg and moving toe syndrome]. [Review] [RUSSIAN]
OT  - Sindrom boleznennykh nog i dvizhushchikhsia pal'tsev stop.
SO  - Zhurnal Nevropatologii i Psikhiatrii Imeni S - S - Korsakova
      1993;93(4):93-6
AB  - The paper reports a case of painful-legs-and-moving-toes syndrome 
in
      a 75-year-old woman who developed it after a paralytic ischias
      attack at the age of 70. The syndrome was characterized by
      persistent pains in distal parts of the legs and feet and constant
      involuntary flexion-extension wave-like toe movements. SSEP 
studies
      revealed a defect of conduction in high-speed myelinated fibers of
      the lumbo-sacral radices of both sides. A cortical motor potential
      corresponding to the toe hyperkinetic movement was present. It the
      base of the hyperkinesis a reflectory mechanism may underlie
      initiated from radiculo-spinal nociceptive systems disinhibited in
      consequence of the deficiency of inhibitory control from high 
speed
      rear column afferents. Neurophysiological data suggest 
participation
      of cerebral mechanisms in realization of the hyperkinesis.
      [References: 14]

17
UI  - 94082240
AU  - Grandjean P
TI  - [Restless legs syndrome. Report of experience]. [German]
OT  - Restless-legs-Syndrom. Ein Erfahrungsbericht.
SO  - Schweizerische Rundschau fur Medizin Praxis 1993 Oct 
26;82(43):1195-7
AB  - Clinical presentation and therapy of the Restless-Leg-Syndrome are
      featured using the report of the author's own case. Although this 
is
      a harmless disease, it can considerably reduce the quality of 
life.
      The syndrome is not rare (1 to 5% of prevalence). Effective
      therapeutic means have only been known for a few years. In the
      presented report, an alternating therapy with L-Dopa and Codeine,
      given in a rhythm of 2 months, produced very good results. No
      addiction to the drugs, and in particular no need of a dosage
      increase was observed during the whole period of 18 months.

18
UI  - 93342293
AU  - Walters AS
AU  - Wagner ML
AU  - Hening WA
AU  - Grasing K
AU  - Mills R
AU  - Chokroverty S
AU  - Kavey N
TI  - Successful treatment of the idiopathic restless legs syndrome in a
      randomized double-blind trial of oxycodone versus placebo.
SO  - Sleep 1993 Jun;16(4):327-32
AB  - In a double-blind randomized crossover trial, oxycodone or placebo
      was given in divided night-time doses to 11 patients with 
idiopathic
      restless legs syndrome (RLS) for 2 weeks prior to appropriate
      polysomnographic studies. Under double-blinded conditions, 
patients
      were asked to do daily ratings of their leg sensations, motor
      restlessness and daytime alertness on a 1-4 scale for the 2 weeks
      prior to the polysomnographic studies and for the nights of the
      polysomnographic studies as well. Leg sensations (p < 0.009), 
motor
      restlessness (p < 0.006) and daytime alertness (p < 0.03) were
      significantly improved on oxycodone as compared to baseline or
      placebo. Patients were studied polysomnographically under
      double-blinded conditions for 2 nights in each phase of the
      protocol. On an average dose of 15.9 mg oxycodone (equivalent to
      approximately three 5-mg tablets of commercial preparation), there
      was a statistically significant reduction in the number of 
periodic
      limb movements in sleep [(PLMS)/hour sleep (p < 0.004)] and in the
      number of arousals/hour sleep (p < 0.009) on drugs as compared to
      baseline or placebo. A statistically significant improvement was
      also noted in sleep efficiency (p < 0.006) and 10 of the 11 
patients
      preferred oxycodone over placebo. We conclude that oxycodone is an
      effective treatment for RLS and PLMS.

19
UI  - 93252028
AU  - Trenkwalder C
AU  - Bucher SF
AU  - Oertel WH
AU  - Proeckl D
AU  - Plendl H
AU  - Paulus W
TI  - Bereitschaftspotential in idiopathic and symptomatic restless legs
      syndrome.
SO  - Electroencephalography & Clinical Neurophysiology 1993 
Apr;89(2):95-103
AB  - Patients with idiopathic and symptomatic restless legs syndrome
      (RLS) suffer from "dyskinesia while awake" or "daytime myoclonus"
      when at rest preceded by sensory symptoms. In order to 
characterise
      the RLS either as reflex movement or as voluntary movement we
      measured movement-related cortical potentials in 5 idiopathic and 
8
      uraemic RLS patients. Movements from both legs were 
polygraphically
      recorded concomitantly with cortical activity 2000 msec before to
      500 msec after onset of EMG activity. These data were compared 
with
      a voluntary simulation of each patient's movement pattern and with 
5
      age-matched controls performing dorsiflexion of the right, left 
and
      both feet. Cortical activity preceding daytime myoclonus was 
absent
      in RLS patients whereas self-initiated leg movements in patients
      elicited onset times (1180-1380 msec) and amplitudes of
      Bereitschaftspotential (readiness potential) not significantly
      different from readiness potentials in control subjects (P > 
0.05).
      Lack of movement-related potentials in myoclonus and/or 
dyskinesias
      during daytime in RLS patients is compatible with an involuntary
      mechanism of induction and points towards a subcortical or spinal
      origin of RLS.

20
UI  - 93188791
AU  - Guilleminault C
AU  - Stoohs R
AU  - Clerk A
TI  - Daytime somnolence: therapeutic approaches. [Review]
SO  - Neurophysiologie Clinique 1993 Jan;23(1):23-33
AB  - Excessive daytime somnolence is a major neurological problem
      involving about 4% of the general population. Its treatment is 
based
      on accurate etiological dissection. Sleep-disordered breathing is 
a
      major cause of EDS. Stimulant medication is helpful in many other
      instances. [References: 37]

21
UI  - 93087917
AU  - Montplaisir J
AU  - Lapierre O
AU  - Warnes H
AU  - Pelletier G
TI  - The treatment of the restless leg syndrome with or without 
periodic
      leg movements in sleep. [Review]
SO  - Sleep 1992 Oct;15(5):391-5
AB  - There are presently three main treatments for restless leg
      syndrome-periodic leg movements in sleep (RLS-PLMS). The
      benzodiazepines (especially clonazepam) are considered by most
      clinicians to be the treatment of choice in mild cases, especially
      in young subjects. In our experience, however, L-dopa and
      bromocriptine are more effective treatments, although no 
controlled
      studies have ever been conducted to compare their therapeutic
      benefits and the side effects of benzodiazepines and dopaminergic
      drugs. The use of opioids should be restricted to patients who 
have
      severe symptoms and who fail to respond to benzodiazepines or
      L-dopa. Propoxyphene was found less effective than L-dopa in
      decreasing PLMS, but some patients resistant to L-dopa may exhibit 
a
      masked therapeutic response to opioids. However, there is 
currently
      no method to predict the response to any treatment modality.
      [References: 70]

22
UI  - 92380527
AU  - Bachman DL
TI  - Sleep disorders with aging: evaluation and treatment.
SO  - Geriatrics 1992 Sep;47(9):53-6, 59-61
AB  - Sleep disorders are especially common among elderly patients and 
may
      be the result of psychiatric illness, a medical problem, poor 
sleep
      habits, or a primary sleep disorder. Because a sleep complaint
      (especially insomnia) is only a symptom, the physician must
      undertake a careful evaluation in an attempt to identify a 
specific
      treatable cause. Although some patients may require referral to a
      psychiatrist or sleep disorders clinic, many patients may benefit
      from behavioral strategies, such as improved sleep hygiene. In
      general, hypnotics should be prescribed for only a limited period 
of
      time and should be combined with other therapeutic approaches in
      patients with chronic insomnia.

23
UI  - 93140255
AU  - Horiguchi J
AU  - Inami Y
AU  - Sasaki A
AU  - Nishimatsu O
AU  - Sukegawa T
TI  - Periodic leg movements in sleep with restless legs syndrome: 
effect
      of clonazepam treatment.
SO  - Japanese Journal of Psychiatry & Neurology 1992 Sep;46(3):727-32
AB  - Fifteen patients with restless legs syndrome underwent whole-night
      polysomnographic recordings before and during clonazepam 
treatment.
      The treatment with 0.5 to 1.5 mg clonazepam improved subjective
      complaints of all the 15 patients. All the patients presented
      periodic leg movements on the polysomnograms before the treatment.
      The clonazepam treatment significantly decreased the total numbers
      of leg movements and the numbers of leg movements per hour without
      affecting the mean intermovement interval.

24
UI  - 92320174
AU  - Hertz G
AU  - Fast A
AU  - Feinsilver SH
AU  - Albertario CL
AU  - Schulman H
AU  - Fein AM
TI  - Sleep in normal late pregnancy.
SO  - Sleep 1992 Jun;15(3):246-51
AB  - Twelve women in their third trimester of pregnancy and 10
      age-matched nonpregnant controls underwent complete 
polysomnography
      for one night in the laboratory. Seven of the original women
      returned for a second study 3-5 months postpartum. During late
      pregnancy, women showed increased wake after sleep onset (WASO) 
and
      a lower sleep efficiency in comparison with the control group. The
      percentage of rapid eye movement (REM) sleep was significantly
      decreased and the percentage of stage 1 significantly increased
      compared to the nonpregnant group. At 3-5 months postpartum, a
      significant reduction in WASO and increased sleep efficiency were
      noted. However, only a slight increase was noted in REM sleep 
during
      the postpartum period compared to the prepartum period. The most
      frequent sleep complaints in the pregnant group were restless 
sleep,
      low back pain, leg cramps and frightening dreams. In summary, in
      accordance with their complaints, women in their third trimester
      demonstrated polysomnographic patterns of sleep maintenance
      insomnia.

25
UI  - 92270180
AU  - Milne IK
TI  - Akathisia associated with carbamazepine therapy [letter].
SO  - New Zealand Medical Journal 1992 May 13;105(933):182

26
UI  - 92053948
AU  - Walters AS
AU  - Hening W
AU  - Rubinstein M
AU  - Chokroverty S
TI  - A clinical and polysomnographic comparison of neuroleptic-induced
      akathisia and the idiopathic restless legs syndrome.
SO  - Sleep 1991 Aug;14(4):339-45
AB  - Neuroleptic-induced akathisia (NIA) is motor restlessness caused 
by
      dopamine receptor blocking antipsychotic agents. Nine patients 
with
      NIA and 11 patients with idiopathic restless legs syndrome (RLS)
      were studied polysomnographically. The sleep disturbances were
      milder in NIA than idiopathic RLS but increased numbers of
      awakenings and decreased sleep efficiencies were common to both
      groups. In addition, RLS patients demonstrated prolonged sleep
      latencies. Periodic movements in sleep (PMS) were present in only 
5
      of 9 patients with NIA but in all 11 patients with idiopathic RLS.
      In no NIA patient did we see the multiple, large amplitude, 
violent,
      resting myoclonic jerks of the legs that we saw during wakefulness
      in some of our more severe cases of idiopathic RLS. NIA patients
      tended to experience inner restlessness and idiopathic RLS 
patients
      tended to experience leg paresthesias as an antecedent to motor
      restlessness. Idiopathic RLS patients had symptoms that were worse
      at night and in repose far more frequently than patients with NIA.
      NIA and idiopathic RLS have similarities and differences. Because
      both NIA and idiopathic RLS are characterized by motor 
restlessness
      and sleep disturbances, the pharmacodynamics of antipsychotic
      medications may give clues as to both the cause and treatment of
      idiopathic RLS.

27
UI  - 91278889
AU  - Walters AS
AU  - Hening WA
AU  - Chokroverty S
TI  - Review and videotape recognition of idiopathic restless legs
      syndrome. [Review]
SO  - Movement Disorders 1991;6(2):105-10
AB  - The motor phenomena associated with idiopathic restless legs
      syndrome (RLS) are infrequently seen in the physician's office
      because they are present only after prolonged sitting or lying and
      usually at night. These motor phenomena are captured on videotape 
in
      four unrelated patients with idiopathic RLS. The clinical features
      of idiopathic RLS are reviewed in detail, and therapeutic advances
      in its treatment are summarized. [References: 39]

28
UI  - 92056717
AU  - Oboler SK
AU  - Prochazka AV
AU  - Meyer TJ
TI  - Leg symptoms in outpatient veterans [see comments].
CM  - Comment in: West J Med 1992 Feb;156(2):211
SO  - Western Journal of Medicine 1991 Sep;155(3):256-9
AB  - In a survey of outpatients at the Denver Veterans Affairs Medical
      Center for common leg symptoms--515 questionnaires returned in a
      3-week period--56% reported nocturnal leg cramps, 29% reported the
      restless leg syndrome, and 49% reported symptoms of peripheral
      neuropathy. Only 33% of patients had no symptoms relating to their
      legs. Patients often did not report these symptoms to their
      physician but were more likely to do so if the symptoms were
      frequent. Conditions especially related to leg symptoms were
      hypertension, peripheral vascular disease, coronary artery 
disease,
      cerebrovascular disease, kidney disease, and hypokalemia. Most
      patients did not receive effective therapy for these symptoms.

29
UI  - 93042050
AU  - Bonnet MH
AU  - Arand DL
TI  - Chronic use of triazolam in patients with periodic leg movements,
      fragmented sleep and daytime sleepiness.
SO  - Aging 1991 Dec;3(4):313-24
AB  - Many studies have shown a relationship between fragmented 
nocturnal
      sleep and daytime sleepiness. In the current study, 9 patients, 
aged
      55-79, with fragmented nocturnal sleep secondary to periodic leg
      movements and objective daytime sleepiness, as verified by 
Multiple
      Sleep Latency Test (MSLT), had 12 weeks of treatment with 0.125 mg
      of triazolam following 2 screening nights and 2 placebo baseline
      nights; 2 final placebo nights were placed 5 nights following the
      last medication night. The medication increased total sleep time 
and
      sleep efficiency throughout the administration period, as compared
      to average placebo values; total leg movements were not changed.
      Generally, daytime performance, as measured by a vigilance task, 
and
      objective alertness, as measured by MSLT, were improved following
      the use of triazolam. No adverse reactions or significant side
      effects were noted. It was concluded that 0.125 mg triazolam, when
      used for up to 3 months, could improve sleep and daytime function 
in
      older patients with periodic leg movements, fragmented sleep, and
      daytime sleepiness.

30
UI  - 92268306
AU  - Okeson JP
AU  - Phillips BA
AU  - Berry DT
AU  - Cook YR
AU  - Cabelka JF
TI  - Nocturnal bruxing events in subjects with sleep-disordered 
breathing
      and control subjects.
SO  - Journal of Craniomandibular Disorders 1991 Fall;5(4):258-64
AB  - Nocturnal bruxing events were recorded during a single night of
      sleep for 12 subjects with sleep-disordered breathing and 12 age-
      and sex-matched controls. The results suggest that bruxing events
      are very common in both groups and are closely associated with 
sleep
      arousals. There were few differences in the number, duration, or
      type of bruxing events between these two groups. Bruxing events 
were
      common during stage 1, stage 2, and REM sleep, while they rarely
      occurred during stage 3 and 4 sleep. The average duration of 
bruxing
      events ranged from 3.82 to 6.68 seconds. There was a trend toward
      more bruxing events occurring while sleeping on the back than on 
the
      side.

31
UI  - 92113100
AU  - Doghramji K
AU  - Browman CP
AU  - Gaddy JR
AU  - Walsh JK
TI  - Triazolam diminishes daytime sleepiness and sleep fragmentation in
      patients with periodic leg movements in sleep.
SO  - Journal of Clinical Psychopharmacology 1991 Oct;11(5):284-90
AB  - Fifteen subjects (9 men and 6 women) exhibiting objective evidence
      of excessive daytime somnolence and periodic leg movements in 
sleep
      underwent 4-7 days of treatment with triazolam (0.25 or 0.50 mg) 
and
      placebo in a double-blind crossover design. One night of
      polysomnography followed by daytime multiple sleep latency testing
      were conducted on the first and last days of each treatment block.
      By the last day of treatment, the mean multiple sleep latency test
      score after triazolam (9.0 minutes) was significantly greater than
      that after placebo (5.7 minutes). Thus, triazolam treatment led to 
a
      decrease in daytime somnolence. Triazolam also improved sleep
      architecture and continuity; it increased total sleep time,
      decreased the number of awakenings and arousals, and decreased 
stage
      1 and increased stage 2 percentages. Although the frequency of
      periodic electromyographic bursts remained unchanged, the 
frequency
      of associated arousals decreased after treatment. Short-term
      treatment with triazolam is thus effective in diminishing daytime
      sleepiness and in improving sleep architecture, continuity and
      duration in patients with periodic leg movements in sleep. These
      effects do not seem to be mediated through a decrease in periodic
      leg movement activity.

32
UI  - 91375358
AU  - Ambrogetti A
AU  - Olson LG
AU  - Saunders NA
TI  - Disorders of movement and behaviour during sleep. [Review]
SO  - Medical Journal of Australia 1991 Sep 2;155(5):336-40
AB  - OBJECTIVE: To outline recently described movement disorders during
      sleep which are common and poorly recognised. DATA SOURCES:
      Computer-based literature search up to July 1990 (with the index


       

      terms sleep disorders, sleep myoclonus, nocturnal myoclonus,
      periodic movements in sleep, REM behaviour disorder and 
parasomnias)
      supplemented by a manual search through the references of papers
      obtained by computer search and a manual search through contents 
of
      the following journals: Sleep, Sleep Research, Neurology and 
Brain.
      DATA SYNTHESIS AND CONCLUSION: There is a group of common and 
poorly
      recognised movement disorders during sleep. The patient usually
      presents complaining of disturbed sleep, daytime somnolence and
      abnormal nocturnal behaviour. These conditions are susceptible to
      precise diagnosis and effective treatment. [References: 27]

33
UI  - 91375350
AU  - Johns MW
TI  - Polysomnography at a sleep disorders unit in Melbourne.
SO  - Medical Journal of Australia 1991 Sep 2;155(5):303-8
AB  - OBJECTIVE: To outline the procedure of polysomnography as carried
      out in a sleep disorders unit in Melbourne and to describe the
      patients undergoing polysomnography in terms of their age and sex
      and the sleep disorder diagnosed. DESIGN: A retrospective survey 
of
      consecutive patients who required diagnostic polysomnography.
      SETTING: The Sleep Disorders Unit at Epworth Hospital, a large
      private hospital in Melbourne. PATIENTS: Two hundred consecutive
      patients who underwent polysomnography over a seven-month period.
      Their ages ranged from 19 to 77 years. INTERVENTIONS: All patients
      had diagnostic polysomnography for one night in the sleep
      laboratory. This involved 12 to 14 physiological variables being
      monitored continuously overnight by means of a new digital 
recording
      and sleep analysis system. MAIN OUTCOME MEASURES: Patients were
      categorised according to their main sleep disorder or primary
      diagnosis. Additional sleep disorders in some patients were
      categorised as secondary diagnoses. RESULTS: The commonest age 
group
      among both male and female patients was 40-49 years. Overall, men
      outnumbered women three to one. Almost two-thirds of all patients
      had as their primary diagnosis some degree of obstructive sleep
      apnoea syndrome or simple snoring. The next most common diagnosis
      was periodic limb movement disorder. The remaining diagnoses
      included a variety of sleep disorders, from narcolepsy to sleep
      terrors. CONCLUSIONS: Despite its complexity and time-consuming
      nature, polysomnography is an essential procedure for the 
diagnosis
      and treatment of a wide range of sleep disorders. More sleep
      laboratories and a greater emphasis on the multidisciplinary
      teaching of sleep disorders medicine will be required in 
Australia.

34
UI  - 91332554
AU  - Sachdev P
AU  - Longragan C
TI  - The present status of akathisia [see comments]. [Review]
CM  - Comment in: J Nerv Ment Dis 1992 Mar;180(3):208-10
SO  - Journal of Nervous & Mental Disease 1991 Jul;179(7):381-91
AB  - Akathisia is a common and distressing side effect of antipsychotic
      and some other psychotropic medications. This paper reviews the
      current state of knowledge of its clinical features,
      pathophysiology, and treatment. Restless legs syndrome and 
akathisia
      associated with Parkinson's disease are discussed in so far as 
they
      help understand drug-induced akathisia. The complexity of the
      disorder, and the difficulty in characterizing and quantifying it,
      may explain why researchers have relatively neglected akathisia 
for
      so long. The recent upsurge of research interest promises the hope
      of a better understanding of its pathophysiology so that effective
      therapy may result. [References: 132]

35
UI  - 91292781
AU  - Walton T
AU  - Kolb KW
TI  - Treatment of nocturnal leg cramps and restless leg syndrome.
      [Review]
SO  - Clinical Pharmacy 1991 Jun;10(6):427-8

36
UI  - 91282611
AU  - Kovacevic-Ristanovic R
AU  - Cartwright RD
AU  - Lloyd S
TI  - Nonpharmacologic treatment of periodic leg movements in sleep.
SO  - Archives of Physical Medicine & Rehabilitation 1991 May;72(6):385-
9
AB  - The effects of a 30-minute stimulation of the dorsiflexors of the
      feet and toes before bedtime were investigated in eight patients
      with periodic leg movements in sleep (PLMS). None were taking
      medications at the time of the investigation. All subjects were
      treated with the EMS-250 Neuromuscular Stimulator, which has a
      maximum output per channel of 1.5mA and a frequency of 47Hz. 
Stimuli
      were delivered via a pulse train (on for 1.5sec and off for 
1.8sec).
      A single all-night polysomnogram after this stimulation showed 
that
      all patients responded to stimulation, with reduction of leg
      movements from an average pretreatment PLMS index of 44.6 per hour
      to a posttreatment PLMS index of 14 per hour (p less than .01).
      Nocturnal leg movements were primarily reduced during the non-REM
      sleep. Multiple indices of sleep continuity did not change
      significantly, although there was a trend toward better sleep
      consolidation.

37
UI  - 91273637
AU  - Lavie P
AU  - Nahir M
AU  - Lorber M
AU  - Scharf Y
TI  - Nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis
      patients. Lack of association between clinical improvement and
      effects on sleep [see comments].
CM  - Comment in: Arthritis Rheum 1992 Apr;35(4):487
SO  - Arthritis & Rheumatism 1991 Jun;34(6):655-9
AB  - Thirteen patients with rheumatoid arthritis (mean +/- SD age 55.8
      +/- 10.5 years) received 20 mg of tenoxicam daily for 90 days
      following a 3-7 day "washout" period and 4 days of placebo
      treatment. Clinical evaluations were conducted at the end of the
      washout period and at monthly intervals thereafter. All-night
      polysomnography was performed in a sleep laboratory during the 
last
      2 days of placebo treatment and on days 13, 14, 89, and 90 of
      tenoxicam treatment. Although there was improvement in the 
patients'
      clinical condition, there were no treatment-related changes in any
      of the sleep parameters. Eight of the 13 patients, however, were
      found to have primary sleep disorders. Four had periodic leg
      movements during sleep, 3 had sleep apneas, and 1 had a 
combination
      of both disorders. The implications of these findings in the
      treatment of sleep disorders in patients with rheumatoid arthritis
      are discussed.

38
UI  - 91260904
AU  - van Dijk JG
AU  - Bollen EL
AU  - Slootweg J
AU  - van der Meer CM
AU  - Durian FW
AU  - Zwinderman AH
TI  - [No difference in efficacy of hydroquinine and placebo in restless
      legs syndrome]. [Dutch]
OT  - Geen verschil in werkzaamheid tussen hydrokinine en placebo bij 
het
      'restless legs'-syndroom.
SO  - Nederlands Tijdschrift voor Geneeskunde 1991 Apr 27;135(17):759-63
AB  - OBJECTIVE. Determination of the efficacy of hydroquinine treatment
      of the restless legs syndrome. DESIGN. Double blind cross-over
      trial. SETTING. University Hospital Leiden. PATIENTS AND METHODS.
      Selection through an announcement in the press and followed by
      structured interview. Inclusion criteria according to the
      international classification of sleep disorders. Exclusion 
criteria
      defined by medication risks. Patients used either hydroquinine 
(200
      mg in the evening and 200 mg before going to bed) or placebo in 
the
      second and fourth of four periods of two weeks duration. Severity 
of
      complaints was assessed using a daily questionnaire and a 
Suggested
      Immobilization Test (SIT) twice weekly, in which they noted the
      severity of complaints as experienced during a 15-minute period of
      immobilization. RESULTS. The study was completed by 59 out of 68
      patients. Analysis of variance showed no significant differences
      between the two groups of patients (those starting with placebo 
and
      those starting with hydroquinine) for any of the questions of the
      daily questionnaire or of the SIT. McNemar's test showed no
      significant differences between the proportions of patients who
      wished to continue the use of either placebo or hydroquinine.
      CONCLUSION. This study showed no significant differences between 
the
      efficacy of placebo or hydroquinine in the restless legs syndrome.

39
UI  - 91053825
AU  - von Scheele C
AU  - Kempi V
TI  - Long-term effect of dopaminergic drugs in restless legs. A 2-year
      follow-up.
SO  - Archives of Neurology 1990 Nov;47(11):1223-4
AB  - Thirty patients with restless legs syndrome, who initially had all
      responded well to treatment with levodopa and benserazide, were
      studied as to the long-term effect of the drugs (at least 2 
years).
      During the 2-year period, two patients were switched from levodopa
      to bromocriptine. Two patients no longer needed levodopa; one of
      them had developed paraplegia and in the other the symptoms of
      restless legs syndrome had disappeared completely. The remaining 
26
      patients continued to use levodopa. Eight patients maintained the
      original dose, nine had to use an increased dose, and nine found a
      decreased dose to be sufficient. The only side effect was 
transient
      nausea reported by two of the 30 patients. The study showed that 
the
      relief of symptoms of restless legs syndrome by dopaminergic drugs
      does not wear off with the passage of time, that side effects are
      minimal even with long-term use, and that the dose needed to 
obtain
      relief may increase as well as decrease.

40
UI  - 90331500
AU  - Krueger BR
TI  - Restless legs syndrome and periodic movements of sleep. [Review]
SO  - Mayo Clinic Proceedings 1990 Jul;65(7):999-1006
AB  - Two entities of special interest in sleep disorders medicine are
      restless legs syndrome and periodic movements of sleep. Most
      patients with restless legs syndrome have periodic movements of
      sleep, but most patients with the nocturnal disorder do not have
      restless legs when awake. In both conditions, the underlying cause
      is obscure, and the frequency of occurrence increases with 
advancing
      age. In most patients with restless legs syndrome, the results of
      complete blood cell counts and iron, ferritin, folate, and vitamin
      B12 levels are normal. No hematologic or chemical abnormalities 
have
      been reported in patients with periodic movements of sleep who do
      not also have restless legs syndrome. Various pharmacologic 
agents,
      including benzodiazepines, opiates, and levodopa, have been 
proposed
      for the treatment of both disorders. Although some patients 
respond
      to a single drug for long periods, in many patients tolerance
      develops and the efficacy diminishes. In such circumstances, a
      reasonable approach is to alternate chemically unrelated agents on 
a
      weekly or biweekly schedule. Transcutaneous electric nerve
      stimulation may be beneficial. [References: 81]

41
UI  - 90305165
AU  - McParland P
AU  - Pearce JM
TI  - Restless legs syndrome in pregnancy. Case reports. [Review]
SO  - Clinical & Experimental Obstetrics & Gynecology 1990;17(1):5-6
AB  - Restless legs syndrome is a common complaint in pregnancy 
affecting
      up to one in every three women. The exact pathophysiology is 
poorly
      understood. The majority of patients respond to simple explanation
      and reassurance, however, a small proportion may suffer 
debilitating
      symptoms requiring drug therapy. We describe two such cases.
      [References: 11]

42
UI  - 90185502
AU  - von Albert HH
TI  - [Treatment of restless legs]. [German]
OT  - Die Behandlung von restless legs.
SO  - Fortschritte der Medizin 1990 Jan 20;108(2):40-4

43
UI  - 90089791
AU  - Newton JR
AU  - Shapiro C
AU  - Stewart A
TI  - Thirty years' war: a battle with insomnia.
SO  - British Journal of Psychiatry 1989 May;154:691-6
AB  - A 72-year-old man with a 30-year complaint of intractable insomnia
      had a positive family history of depression. He first came to
      psychiatric attention in 1958, after attacking his wife. He was
      prescribed barbiturates, and later was given meprobamate and
      nitrazepam, but with no effect on his complaint. The patient 
tended
      to increase the dosage of any drug given, of his own accord. EEG
      sleep recording confirmed the diagnosis of nocturnal myoclonus. It
      was hoped that at the case conference further treatment stratagems
      would be suggested.

44
UI  - 90006951
AU  - Zucconi M
AU  - Coccagna G
AU  - Petronelli R
AU  - Gerardi R
AU  - Mondini S
AU  - Cirignotta F
TI  - Nocturnal myoclonus in restless legs syndrome effect of
      carbamazepine treatment.
SO  - Functional Neurology 1989 Jul-Sep;4(3):263-71
AB  - We studied Restless Legs Syndrome (RLS) and nocturnal myoclonus 
(NM)
      in 9 patients before and after carbamazepine treatment, to verify
      the correlation between improvement of RLS and modification of NM
      pattern during sleep. Although CBZ proved effective in the 
treatment
      of RLS, it did not modify the pattern of nocturnal myoclonus and 
its
      relationship to arousal during sleep. The efficacy of CBZ on RLS 
may
      be due to other properties of the drug rather than to the effect 
on
      nocturnal sleep: reduction of sleep latency and wakefulness after
      sleep onset.

45
UI  - 89289208
AU  - Fry JM
AU  - DiPhillipo MA
AU  - Pressman MR
TI  - Periodic leg movements in sleep following treatment of obstructive
      sleep apnea with nasal continuous positive airway pressure.
SO  - Chest 1989 Jul;96(1):89-91
AB  - Periodic leg movements in sleep are shown to be a common finding 
in
      patients with OSA and may become evident or increase in severity
      after treatment of the OSA with NCPAP. Periodic leg movements in
      sleep were measured during baseline polysomnography, a NCPAP
      treatment trial, and a repeat NCPAP recording in 33 patients 
treated
      with NCPAP for OSA. During baseline PSG, nine patients had five or
      more PLMS per hour of sleep (index), while 14 patients had a PLMSI
      of 5 or more during the NCPAP trial and the repeat NCPAP 
recording.
      Among those patients with a PLMSI of 5 or more during repeat NCPAP
      studies, the PLMSI showed a significant increase from baseline to
      initial NCPAP (16.9 +/- 25.3 vs 39.3 +/- 29.4; p less than 0.001)
      and from baseline to repeat NCPAP (16.9 +/- 25.3 vs 42.9 +/- 39.8; 
p
      less than 0.05). The number of PLMS associated with
      electroencephalographic arousal also increased significantly from
      baseline to initial NCPAP (4.3 +/- 7.4 vs 9.7 +/- 8.9; p less than
      0.05) and from baseline to repeat NCPAP (4.3 +/- 7.4 vs 16.5 +/-
      18.6; p less than 0.05). The 14 patients with a PLMSI of 5 or more
      on the repeat NCPAP had significantly more stage 1 sleep and less
      REM sleep than 19 patients with a PLMSI of less than 5. Bilateral
      anterior tibialis EMG must be measured during NCPAP recordings in
      order to recognize sleep disruption caused by PLMS.

46
UI  - 90123678
AU  - Paik IH
AU  - Lee C
AU  - Choi BM
AU  - Chae YL
AU  - Kim CE
TI  - Mianserin-induced restless legs syndrome [see comments].
CM  - Comment in: Br J Psychiatry 1990 Feb;156:285
SO  - British Journal of Psychiatry 1989 Sep;155:415-7
AB  - Restless legs syndrome was observed in three patients receiving
      mianserin. The symptoms resolved when the treatment was 
discontinued
      or reduced.

47
UI  - 89218660
AU  - Missak SS
TI  - Understanding the pathogenesis of the restless legs syndrome at 
the
      level of the dopamine receptor. Are we about to identify the
      neurochemical deficiency causing schizophrenia?.
SO  - Medical Hypotheses 1989 Mar;28(3):177-9
AB  - According to a recent hypothesis, the restless legs syndrome is
      thought to be due to a caffeine-like substance produced by the 
human
      body (1). Some researchers have reported a case of familial 
restless
      legs that had high concentration of free dopamine in the
      cerebrospinal fluid (2). Other researchers have noticed the
      beneficial effect of opioids in the treatment of the restless legs
      syndrome (3). In this article, I am compiling information
      reconciling the findings of those researchers with the hypothesis
      that proposes that the restless legs syndrome is due to a
      caffeine-like substance produced by the human body. Also, I am
      addressing the pathogenesis of the restless legs syndrome at the
      level of the dopamine receptors in the central nervous system.
      Understanding this pathogenesis probably will help in identifying
      the neurochemical deficiency causing schizophrenia.

48
UI  - 89188081
AU  - Jorgensen S
AU  - Ronborg S
TI  - [The restless leg syndrome]. [Danish]
OT  - Restless legs syndrom.
SO  - Ugeskrift for Laeger 1989 Mar 13;151(11):670-1
AB  - The restless legs syndrome (RLS) is characterized by unusual
      sensations in the lower legs which are difficult to describe. 
These
      sensations are experienced in the muscles and bones. They always
      occur at rest, most frequently at night, and disappear normally on
      movement. The etiology and pathogenesis are still unknown. The
      incidence is stated to be 5%. RLS is the fourth most frequent 
cause
      of insomnia. Treatment has been empirical. In recent single
      controlled investigations clonazepam (Rivotril), carbamazepine
      (Tegretol) and levodopa plus benserazide (Madopar) have all proved
      to be superior to a placebo and these drugs are, therefore,
      recommended. Local treatment should, however, be tried initially 
in
      all patients.

49
UI  - 89186755
AU  - Ausserwinkler M
AU  - Schmidt P
TI  - [Successful clonidine treatment of restless leg syndrome in 
chronic
      kidney insufficiency]. [German]
OT  - Erfolgreiche Behandlung des "restless legs"-Syndroms bei 
chronischer
      Niereninsuffizienz mit Clonidin.
SO  - Schweizerische Medizinische Wochenschrift. Journal Suisse de 
Medecine
      1989 Feb 11;119(6):184-6
AB  - Restless legs syndrome is a common and sometimes incapacitating
      disorder in chronic uraemic patients. While therapeutic concepts
      have so far been disappointing, there have been recent reports on
      the favourable effect of clonidine in non-uraemic patients with
      symptoms of restless legs syndrome. Therefore, a double-blind 
study
      was conducted in 20 patients with chronic renal failure (11
      conservatively treated, 9 on RDT) and symptoms of restless legs. 
10
      patients were treated with 0.075 mg clonidine twice daily and 10
      received placebo. The patients were investigated 3 days after
      starting therapy. - In the clonidine-treated group complete relief
      of symptoms was noted in 8 out of 10 patients, a striking
      alleviation in one, while in one further patient the symptoms
      remained unchanged. In contrast, only one of 10 patients in the
      placebo group had a mild alleviation of symptoms. Blood pressure 
did
      not differ significantly in the two groups. The data show that
      low-dose clonidine administration is a very effective approach in
      the treatment of the restless legs syndrome in chronic uraemic
      patients.

50
UI  - 89175502
AU  - Mosko S
AU  - Zetin M
AU  - Glen S
AU  - Garber D
AU  - DeAntonio M
AU  - Sassin J
AU  - McAnich J
AU  - Warren S
TI  - Self-reported depressive symptomatology, mood ratings, and 
treatment
      outcome in sleep disorders patients.
SO  - Journal of Clinical Psychology 1989 Jan;45(1):51-60
AB  - Based on self-rating questionnaire evaluation of symptoms of major
      affective disorder, 67% of patients who presented to a major sleep
      disorders center reported an episode of depression within the


                                                                                                              

      previous 5 years, and 26% described themselves as depressed at
      presentation. Furthermore, patients with sleep apnea, narcolepsy, 
or
      sleep-related periodic leg movements all averaged high rates of
      self-reported depressive symptomatology, which suggests that sleep
      disorders should be considered in the differential diagnosis of
      affective disorders, and vice versa. Change scores on the Profile 
of
      Mood States were obtained for four subgroups of patients who were
      undergoing conventional treatment. Significant improvement in 
scores
      was observed in obstructive sleep apneics treated surgically and 
in
      patients with sleep-related periodic leg movements placed on
      clonazepam, but not in narcoleptics placed on a stimulant or in
      insomniacs with chronic use of sedative-hypnotic drugs who were
      withdrawn from sleep medications. Differential improvement in POMS
      scores after treatment for different sleep disorders could mean 
that
      the relationship to mood disturbance differs for different sleep
      disorders.

51
UI  - 89090332
AU  - Drake ME
TI  - Restless legs with antiepileptic drug therapy.
SO  - Clinical Neurology & Neurosurgery 1988;90(2):151-4
AB  - The restless legs syndrome is generally benign but is occasionally
      associated with anemia, metabolic disorder, or polyneuropathy. Leg
      restlessness with disruptive nocturnal myoclonus has been 
described
      as a sleep disorder. We report two patients with complex partial 
and
      secondarily generalized seizures, who developed restless legs 
while
      taking methsuximide and phenytoin. They had no evidence of 
metabolic
      disturbance or neuromuscular disease, although one patient had
      fragmented sleep and disruptive myoclonus on polysomnography, and
      leg restlessness subsided with change of antiepileptic drugs. 
These
      symptoms could reflect transient alteration in peripheral nerve
      function not evident by examination or electrophysiologic studies,
      sleep disturbance by antiepileptic drugs or the effects of 
temporal
      lobe seizure foci on perception of the physiologic state of nerves
      and muscles.

52
UI  - 89149022
AU  - Walters AS
AU  - Hening WA
AU  - Kavey N
AU  - Chokroverty S
AU  - Gidro-Frank S
TI  - A double-blind randomized crossover trial of bromocriptine and
      placebo in restless legs syndrome.
SO  - Annals of Neurology 1988 Sep;24(3):455-8
AB  - A double-blind randomized crossover study of 7.5 mg bromocriptine 
at
      bedtime versus placebo was conducted in 30-day phases (with a 2-
week
      washout period between phases) in 6 patients with idiopathic
      restless legs syndrome. Five patients experienced partial 
subjective
      improvement in restlessness and paresthesias on bromocriptine as
      opposed to placebo and expressed a desire to continue on the
      medication. On bromocriptine, the patients showed
      polysomnographically a mean decrease of 43% from control and a 
mean
      decrease of 57% from placebo in the number of periodic movements 
of
      sleep per hour of sleep (p less than 0.025). Two of 3 patients 
with
      abnormally decreased total sleep time and sleep efficiency showed 
an
      improvement in these measures on therapy. The dopamine agonist
      bromocriptine may be a useful therapy in some patients with 
restless
      legs syndrome.

53
UI  - 89057241
AU  - Brodeur C
AU  - Montplaisir J
AU  - Godbout R
AU  - Marinier R
TI  - Treatment of restless legs syndrome and periodic movements during
      sleep with L-dopa: a double-blind, controlled study.
SO  - Neurology 1988 Dec;38(12):1845-8
AB  - Six patients with restless legs syndrome (RLS) and periodic
      movements during sleep (PMS) received placebo or L-dopa in a
      double-blind study. We recorded patients for 36 consecutive hours 
in
      the sleep laboratory during a baseline investigation and at the 
end
      of each treatment period. Daily evening questionnaires and a
      suggested immobilization test (SIT) performed at bedtime on each
      recording night documented the effect of L-dopa in RLS. A 
nocturnal
      EMG recording of the anterior tibialis muscles revealed the effect
      of L-dopa on PMS. L-Dopa proved effective in treating both RLS and
      PMS. Although not present in every patient, leg movements recorded
      during the SIT exhibited a clear periodicity. These observations
      support the hypothesis that RLS and PMS are two manifestations of
      the same central sensorimotor disorder.

54
UI  - 88176697
AU  - Golden RN
AU  - James SP
TI  - Insomnia. Clinical assessment and management of the patient who
      can't sleep.
SO  - Postgraduate Medicine 1988 Mar;83(4):251-8

55
UI  - 88145584
AU  - Kuny S
AU  - Blattler W
TI  - [Psychological findings in alleged phlebologic disorders of the
      leg]. [German]
OT  - Psychische Befunde bei vermeintlich phlebologischen 
Beinbeschwerden.
SO  - Schweizerische Medizinische Wochenschrift. Journal Suisse de 
Medecine
      1988 Jan 9;118(1):18-22
AB  - Twenty-six female patients with restless legs underwent 
psychiatric
      investigation as part of a pilot study. Most exhibited a
      depressive-anxious-hypochondric syndrome. The development of
      physical symptoms in connection with psychic disturbances and the
      treatment of patients with restless legs are discussed.

56
UI  - 87152994
AU  - Pagel JF Jr
TI  - Diagnosis and treatment of insomnia.
SO  - American Family Physician 1987 Mar;35(3):191-7
AB  - Insomnia is a disorder of initiation and maintenance of sleep that
      results in daytime somnolence. The differential diagnosis of the
      various forms of insomnia is based primarily on the history,
      including information from the sleeping partner. The possibility 
of
      underlying depression or sleep apnea must be given consideration 
in
      every patient with insomnia, because inappropriate therapy may be
      dangerous in these instances. In general, the benzodiazepines have
      supplanted the traditional hypnotics in the treatment of insomnia.

57
UI  - 87130804
AU  - Akpinar S
TI  - Restless legs syndrome treatment with dopaminergic drugs.
SO  - Clinical Neuropharmacology 1987;10(1):69-79
AB  - Sixteen patients with symptoms of restless legs syndrome and
      resulting insomnia are included in this study. They were nine 
women
      and seven men with a mean age of 50.8 years and with a mean 
duration
      of symptoms of 6.3 years. The purpose of the study is to determine
      the drugs that are useful for the treatment of restless legs
      syndrome. In 13 patients L-Dopa plus benserazide, in two patients
      bromocriptine, and in the remaining one patient piribedil were 
used
      orally at night approximately 1 h before bedtime. Compared with
      placebo these dopaminergic drugs decreased the times of waking up
      and staying awake periods at a statistically significant level (p
      changed between 0.025 and 0.01, t test). In this susceptibility of
      CNS there is dysfunction of the dopamine system triggered by 
sleep,
      and resting and dopaminergic potentiation by drugs affect the
      symptoms.

58
UI  - 88140812
AU  - Peled R
AU  - Lavie P
TI  - Double-blind evaluation of clonazepam on periodic leg movements in
      sleep.
SO  - Journal of Neurology, Neurosurgery & Psychiatry 1987 
Dec;50(12):1679-81
AB  - Treatment with clonazepam was studied in a group of 20 patients
      suffering from periodic movements in sleep, in a double-blind
      parallel group design. Eleven complained of excessive daytime
      sleepiness, and nine complained of insomnia. Ten patients received
      clonazepam, and 10 received placebo, over a period of 1 month.
      Clonazepam (0.5-2 mg per night) proved to be an effective 
treatment
      of periodic movements in sleep. Polysomnographic recordings
      demonstrated a significant decrease in the number of leg movements
      and a significant improvement in sleep parameters in the 
clonazepam
      group as compared with placebo. Subjective responses to treatment
      corroborated the sleep laboratory findings.

59
UI  - 88061290
AU  - Askenasy JJ
AU  - Weitzman ED
AU  - Yahr MD
TI  - Are periodic movements in sleep a basal ganglia dysfunction?.
SO  - Journal of Neural Transmission 1987;70(3-4):337-47
AB  - Muscle activity during sleep is a new area of interest in sleep
      research. No precise brain structures are known to be involved in
      sleep movement. The etiology of periodic movements during sleep is
      unknown. The present study was dedicated to evaluate involvement 
of
      basal ganglia in periodic movements of the legs during sleep (PMS)
      in Parkinson's diseased patients. Sleep was monitored in 3 
patients
      suffering from Parkinson's disease and PMS (PMS/PD) and in 3
      patients suffering from restless legs syndrome and PMS (PMS/non 
PD).
      Following treatment, the six patients were monitored again during
      sleep. It was found that only the PMS/PD group of patients had
      improved significantly with appropriate treatment. Improved motor
      function in PD patients is associated with decreased PMS, 
regardless
      of wether the patients are treated with dopaminergic or
      anticholinergic agents. This is consistent with our previous data.
      It may be suggested that the striopallidal system is involved in
      periodic sleep movements of Parkinson's diseased patients.

60
UI  - 88006580
AU  - Sandyk R
AU  - Bernick C
AU  - Lee SM
AU  - Stern LZ
AU  - Iacono RP
AU  - Bamford CR
TI  - L-dopa in uremic patients with the restless legs syndrome.
SO  - International Journal of Neuroscience 1987 Aug;35(3-4):233-5
AB  - Restless legs syndrome (RLS) is a poorly understood, often
      distressing condition that is particularly prevalent among 
patients
      with chronic renal failure. A wide variety of medications have 
been
      used to treat RLS with variable results. In order to evaluate the
      efficacy of carbidopa/levodopa therapy, eight consecutive uremic
      patients with RLS on maintenance hemodialysis were treated with
      doses ranging from 25/100 to 25/250 twice daily. Six of eight
      patients obtained satisfactory relief which has continued for 3
      months follow-up. Carbidopa-levodopa appears to be an effective
      opinion in management of RLS in patients with chronic rental
      failure.

61
UI  - 87248890
AU  - Delfino M
AU  - Muscettola G
AU  - Misasi D
AU  - Prisco A
AU  - Santoianni P
TI  - [Use of pimozide in the treatment of dermatoses of psychogenic
      origin]. [Italian]
OT  - L'uso di pimozide nel trattamento di dermatosi di origine 
psicogena.
SO  - Giornale Italiano di Dermatologia e Venereologia 1987 
Mar;122(3):139-41

62
UI  - 87018486
AU  - Mitler MM
AU  - Browman CP
AU  - Menn SJ
AU  - Gujavarty K
AU  - Timms RM
TI  - Nocturnal myoclonus: treatment efficacy of clonazepam and 
temazepam.
SO  - Sleep 1986;9(3):385-92
AB  - Clonazepam (1 mg h.s.) and temazepam (30 mg h.s.) were studied in 
10
      patients diagnosed as having insomnia with nocturnal myoclonus. 
Each
      subject underwent two nocturnal polysomnographic recordings while
      drug-free, two during treatment with clonazepam, and two during
      treatment with temazepam. Treatment sessions were 7 days long, and
      recordings were done on nights 6 and 7 of the treatment sessions. 
A
      14-day washout period separated the treatment sessions. The order 
of
      drugs used in the first and second treatment sessions was
      randomized. Objective and subjective sleep laboratory data showed
      that both drugs improved the sleep of patients with insomnia in
      association with nocturnal myoclonus. Neither drug significantly
      reduced the number of nocturnal myoclonic events. Sleep changes 
were
      consistent with those produced by sedative benzodiazepines in
      general. Thus, the data support clinical reports that clonazepam, 
a
      benzodiazepine marketed for the indication of seizure, is useful 
in
      improving sleep disturbances associated with nocturnal myoclonus.
      Temazepam, a benzodiazepine marketed for the indication of 
insomnia,
      was found to be a suitable alternative to clonazepam in the
      treatment of insomnia associated with nocturnal myoclonus. The
      present data and other studies suggest the need for a model that
      explains why leg movements and sleep disturbances may wax and wane
      independently.

63
UI  - 86283891
AU  - von Scheele C
TI  - Levodopa in restless legs.
SO  - Lancet 1986 Aug 23;2(8504):426-7
AB  - The effectiveness of levodopa in the treatment of restless legs 
was
      assessed in a double-blind trial. 20 patients were given levodopa
      and lactose on alternate days. Treatment was continued until
      patients stated a preference for one of the treatments or were
      unable to discriminate between the two. 17 patients preferred
      levodopa, none lactose, and 3 were unable to discriminate. The 17
      patients who responded to levodopa reported complete relief.

64
UI  - 86177079
AU  - Jeste DV
AU  - Wisniewski AA
AU  - Wyatt RJ
TI  - Neuroleptic-associated tardive syndromes. [Review]
SO  - Psychiatric Clinics of North America 1986 Mar;9(1):183-92
AB  - We have briefly reviewed the literature on late-onset akathisia,
      dystonia, and Tourette-like syndrome in patients on long-term
      neuroleptic treatment. To date, there is no satisfactory
      epidemiologic or other evidence directly implicating neuroleptics 
in
      the etiology of these so-called tardive syndromes. Similarities
      between these disorders and tardive dyskinesia, however, make them
      worthy of some consideration. [References: 34]

65
UI  - 87028023
AU  - Montplaisir J
AU  - Godbout R
AU  - Poirier G
AU  - Bedard MA
TI  - Restless legs syndrome and periodic movements in sleep:
      physiopathology and treatment with L-dopa.
SO  - Clinical Neuropharmacology 1986;9(5):456-63
AB  - Seven patients suffering from restless legs syndrome (RLS) and
      periodic movements in sleep (PMS) were investigated before and 
after
      treatment with L-Dopa. The effect of treatment was evaluated by
      polysomnography, structured interviews, and daily questionnaires.
      Sleep organization and subjective complaints improved during
      treatment with 100 to 200 mg of L-Dopa. Polysomnographic 
recordings
      also revealed a significant decrease of periodic leg movements
      during the first third of the night and a rebound during the last
      third. These results and previous biochemical findings raise the
      hypothesis that RLS and PMS may both result from reduced
      dopaminergic activity in the CNS, perhaps resulting from decreased
      sensibility of postsynaptic receptors.

66
UI  - 86297876
AU  - Boghen D
AU  - Lamothe L
AU  - Elie R
AU  - Godbout R
AU  - Montplaisir J
TI  - The treatment of the restless legs syndrome with clonazepam: a
      prospective controlled study.
SO  - Canadian Journal of Neurological Sciences 1986 Aug;13(3):245-7
AB  - The effect of clonazepam on the restless legs syndrome was studied
      in a group of 6 patients. Following a drug-free period, 3 patients
      received clonazepam for 4 weeks followed by placebo for 4 weeks
      thereafter and 3 patients received the same medication and for the
      same length of time but in reverse order. The effectiveness of the
      medication was evaluated by means of a self-rating system in which
      patients assigned a score daily to the degree of discomfort
      experienced in the previous 24 hours. Three patients improved on
      clonazepam but 2 of these also improved on placebo. Clonazepam was
      not shown to be significantly more effective than placebo in the
      treatment of RLS.

67
UI  - 87016703
AU  - Pearce JW
AU  - Akamine HS
AU  - Kapuniai LE
AU  - Crowell DH
TI  - Insomnia. Rational diagnosis and treatment.
SO  - Postgraduate Medicine 1986 Sep 15;80(4):151-6

68
UI  - 87015275
AU  - Hening WA
AU  - Walters A
AU  - Kavey N
AU  - Gidro-Frank S
AU  - Cote L
AU  - Fahn S
TI  - Dyskinesias while awake and periodic movements in sleep in 
restless
      legs syndrome: treatment with opioids.
SO  - Neurology 1986 Oct;36(10):1363-6
AB  - In five unrelated patients with the restless legs syndrome, opioid
      drugs relieved restlessness, dysesthesias, dyskinesias while 
awake,
      periodic movements of sleep, and sleep disturbances. When naloxone
      was given parenterally to two treated patients, the signs and
      symptoms of the restless legs syndrome reappeared. Naloxone 
placebo
      had no effect. Opioid medications may offer a useful therapy for 
the
      restless legs syndrome. The endogenous opiate system may be 
involved
      in the pathogenesis of the syndrome.

69
UI  - 86239801
AU  - Ginsberg HN
TI  - Propranolol in the treatment of restless legs syndrome induced by
      imipramine withdrawal [letter].
SO  - American Journal of Psychiatry 1986 Jul;143(7):938

70
UI  - 86183575
AU  - Walsh JK
AU  - Sugerman JL
AU  - Chambers GW
TI  - Evaluation of insomnia.
SO  - American Family Physician 1986 Apr;33(4):185-94
AB  - The effective treatment of patients with a complaint of insomnia
      requires an appreciation of the range of etiologic factors
      underlying the symptom of insomnia, as well as sound clinical
      judgment and appropriate application of available therapeutics.
      Systematic inquiry regarding nocturnal and daytime aspects of a
      patient's life is helpful in narrowing the range of diagnostic
      possibilities. Specialized evaluation at a sleep disorders center
      may be useful in cases of chronic insomnia that remain refractory 
to
      initial interventions.

71
UI  - 86156388
AU  - Sandyk R
TI  - L-Tryptophan in the treatment of restless legs syndrome [letter].
SO  - American Journal of Psychiatry 1986 Apr;143(4):554-5

72
UI  - 86126425
AU  - Walters A
AU  - Hening W
AU  - Cote L
AU  - Fahn S
TI  - Dominantly inherited restless legs with myoclonus and periodic
      movements of sleep: a syndrome related to the endogenous opiates?.
SO  - Advances in Neurology 1986;43:309-19
AB  - The restless legs syndrome is a sensory and motor disorder of
      evening, repose, and sleep. The cardinal features include (a)
      restlessness, which is frequently associated with (b) 
dysesthesias,
      (c) myoclonic jerks and other dyskinesias while awake, (d) 
periodic
      movements of sleep, and (e) sleep disturbances. We have recently 
had
      the opportunity to study two patients severely affected by this
      syndrome whose family histories are consistent with dominant
      inheritance. Both patients serendipitously discovered that their
      symptoms responded uniquely well to opiate medication. Both 
patients
      were studied extensively with electrophysiological and videotape


                                                                                                            

      monitoring, and their movements were characterized. In both
      patients, all elements of the syndrome responded to opiates, with
      marked relief of symptoms and without any significant side 
effects.
      The specific opiate antagonist naloxone blocked the therapeutic
      benefit of the opiates. Our findings support the involvement of 
the
      endogenous opiate system in the pathogenesis of restless legs and
      related dyskinesias and suggest that opiate therapy may be a
      potentially valuable treatment for this sometimes disabling
      syndrome.

73
UI  - 86039581
AU  - Sandyk R
TI  - The endogenous opioid system in neurological disorders of the 
basal
      ganglia. [Review]
SO  - Life Sciences 1985 Nov 4;37(18):1655-63
AB  - The endogenous opioid peptides have for some time been implicated 
in
      the regulation of motor behavior in animals. Recently, however,
      there is increased evidence to suggest a role for these peptides 
in
      the control of human motor functions as well as in the
      pathophysiology of abnormal movement disorders. Degeneration of
      opioid peptide-containing neurons in the basal ganglia has been
      demonstrated in Parkinson's disease and Huntington's chorea, but 
the
      clinical significance of these findings is largely unknown. On the
      other hand, there is evidence that excessive opioid activity may 
be
      important in the pathophysiology of some movement disorders such 
as
      tardive dyskinesia, progressive supra-nuclear palsy, and a 
subgroup
      of Tourette's patients. These findings indicate that diseases of 
the
      basal ganglia are possibly associated with alterations in opioid
      peptide activity, and that these alterations may be useful in
      designing experimental therapeutic strategies in these conditions.
      [References: 116]

74
UI  - 86046269
AU  - Auff E
AU  - Holzner F
AU  - Wessely P
TI  - [Further therapeutic possibilities with valproic acid (Convulex)].
      [German]
OT  - Weitere Therapiemoglichkeiten mit Valproinsaure (Convulex).
SO  - Wiener Medizinische Wochenschrift 1985 Sep 15;135(17):421-3
AB  - Valproic acid is used in first case as an antiepileptic; own
      clinical observance and references from the literature show other
      indication-fields outside of the group of cerebral fits; so 
Convulex
      was employed successfully also in the therapy of perioral 
dyskinesia
      of variable etiology and in the medical treatment of
      therapy-resistant pains within the bounds of
      Polyneuropathy-Polyneuritis Syndrome. Our own experience is
      presented by the description of the 10 case histories.

75
UI  - 86047200
AU  - Larsen S
AU  - Telstad W
AU  - Sorensen O
AU  - Thom E
AU  - Stensrud P
AU  - Nyberg-Hansen R
TI  - Carbamazepine therapy in restless legs. Discrimination between
      responders and non-responders.
SO  - Acta Medica Scandinavica 1985;218(2):223-7
AB  - One hundred and seventy-four patients suffering from restless legs
      were included in a double-blind trial. Eighty-four patients were
      treated with carbamazepine (CBZ) and 90 with placebo. 
Discrimination
      analysis was carried out in order to characterize the patients who
      did not benefit from the treatment. Patients treated with CBZ were
      divided into responders and non-responders. A discriminant 
function
      classified 15 out of 19 actual non-responders as non-responders 
and
      60 out of 65 actual responders as responders. By using the
      "leaving-one-out" technique, 14 of the non-responders and 57 of 
the
      responders were still correctly classified. The probability of
      erroneously classifying a patient increased from about 10 to 15% 
by
      this correction. The discriminant function classified 
approximately
      80% of the patients in the placebo group as responders to CBZ.

76
UI  - 86104825
AU  - Cybulska E
AU  - Rucinski J
TI  - Restless legs syndrome.
SO  - British Journal of Hospital Medicine 1985 Dec;34(6):370-1
AB  - Restless legs syndrome is a trivial complaint, but it may become a
      nightmare for some patients. Clinicians may either misdiagnose or
      dismiss it whilst proper scrutiny and treatment could be helpful.

77
UI  - 86040225
AU  - Handwerker JV Jr
AU  - Palmer RF
TI  - Clonidine in the treatment of "restless leg" syndrome [letter].
SO  - New England Journal of Medicine 1985 Nov 7;313(19):1228-9

78
UI  - 84278112
AU  - Trzepacz PT
AU  - Violette EJ
AU  - Sateia MJ
TI  - Response to opioids in three patients with restless legs syndrome.
SO  - American Journal of Psychiatry 1984 Aug;141(8):993-5
AB  - Three patients with restless legs syndrome, two of whom also had
      nocturnal myoclonus, responded well to treatment with low doses of
      opioids. The pathophysiology of the syndrome and the mechanism of
      opioids' therapeutic action are discussed.

79
UI  - 84105674
AU  - Telstad W
AU  - Sorensen O
AU  - Larsen S
AU  - Lillevold PE
AU  - Stensrud P
AU  - Nyberg-Hansen R
TI  - Treatment of the restless legs syndrome with carbamazepine: a 
double
      blind study.
SO  - British Medical Journal Clinical Research Ed. 1984 Feb
11;288(6415):444-6
AB  - One hundred and seventy four patients suffering from the restless
      legs syndrome were examined in a double blind, between patient,
      placebo controlled study in general practice for five weeks to
      investigate the effects of carbamazepine and placebo on the
      syndrome. The syndrome was more common among middle aged women 
with
      relatively low systolic blood pressure. The median haemoglobin
      concentration was about average for the population, but the 
severity
      of the symptoms seemed to increase with decreasing concentrations 
of
      haemoglobin. Both placebo and carbamazepine showed a significant
      therapeutic effect (p less than 0.01). Carbamazepine was
      significantly more effective than placebo (p less than or equal to
      0.03). The significant therapeutic effect of placebo in restless
      legs showed that only double blind controlled trials can confirm 
the
      efficacy of suggested treatments.

80
UI  - 84286225
AU  - Ungvari G
AU  - Vladar K
TI  - [Pimozide therapy in dermatozoon delusion]. [German]
OT  - Pimozid-Therapie des Dermatozoenwahns.
SO  - Dermatologische Monatsschrift 1984;170(7):443-7

81
UI  - 84276799
AU  - Montagna P
AU  - Sassoli de Bianchi L
AU  - Zucconi M
AU  - Cirignotta F
AU  - Lugaresi E
TI  - Clonazepam and vibration in restless legs syndrome.
SO  - Acta Neurologica Scandinavica 1984 Jun;69(6):428-30
AB  - There have been no controlled therapeutic trials in Restless Legs
      Syndrome (RLS). In 6 patients with RLS, a randomized double-blind
      cross-over trial vs placebo showed a significant efficacy of
      clonazepam in improving subjective quality of sleep and leg
      dysaesthesia. Vibratory stimulation of the leg showed a less
      pronounced and non-significant effect. Clonazepam is a safe and
      effective drug for treatment of RLS; however its long-term 
efficacy
      needs confirmation.

82
UI  - 85112913
AU  - Byerley B
AU  - Gillin JC
TI  - Diagnosis and management of insomnia.
SO  - Psychiatric Clinics of North America 1984 Dec;7(4):773-89
AB  - The symptom of insomnia concerns not only psychiatrists, but other
      physicians as well. Most cases of insomnia resolve with the 
passage
      of time or when the underlying medical or psychiatric condition is
      treated. For situational insomnias or psychophysiologic insomnias,
      consider nonpharmacologic interventions before prescribing a
      sedative-hypnotic. When a sedative-hypnotic is indicated, the BZs
      are the drugs of choice because of their better margin of safety 
and
      lower potential for abuse. In most cases, limit the use of a
      sedative-hypnotic to several days to a few weeks.

83
UI  - 83296460
AU  - Lipinski JF
AU  - Zubenko GS
AU  - Barreira P
AU  - Cohen BM
TI  - Propranolol in the treatment of neuroleptic-induced akathisia
      [letter].
SO  - Lancet 1983 Sep 17;2(8351):685-6

84
UI  - 84028841
AU  - Lundvall O
AU  - Abom PE
AU  - Holm R
TI  - Carbamazepine in restless legs. A controlled pilot study.
SO  - European Journal of Clinical Pharmacology 1983;25(3):323-4
AB  - Carbamazepine or placebo were given in random order, during two
      four-week periods, in a double-blind, cross-over trial in six
      patients presenting with symptoms of restless legs. On global
      evaluation after completing the trial three patients and the
      physician preferred to continue treatment with carbamazepine. In 
the
      remaining three cases both the physician and the patients 
preferred
      not to continue with either of the treatments. However, the 
patients
      who did not give any preference also had less pronounced symptoms
      during treatment with carbamazepine. No patient felt better during
      treatment with placebo as compared to carbamazepine. The results
      indicate that certain patients have fewer attacks of restless legs
      during treatment with carbamazepine.

85
UI  - 83255933
AU  - Menon MK
AU  - Kling AS
TI  - Treatment of restless leg syndrome [letter].
SO  - Archives of Neurology 1983 Aug;40(8):526

86
UI  - 83247721
AU  - Boquet J
AU  - Guillerot E
AU  - Monnier JC
TI  - [Limping and muscle hypertonia concentrated in the calves. 
Relation
      to spasmophilia. Clinical and electromyographic study and 
treatment
      plan]. [French]
OT  - Boiterie et hypertonie musculaire focalisee aux mollets. Relation
      avec la spasmophilie. Etude clinique, electromyographique et 
schema
      therapeutique.
SO  - Phlebologie 1983 Apr-Jun;36(2):121-36
AB  - The authors report several cases of patients who presented with 
pain
      in one or both calves and a limping gait. Clinical examination and
      the EMG confirmed that these disorders were of musculo-tendinous
      origin, maximal at the level of the gemellus tendon, frequently
      forming a tendinitis. The syndrome consists of a hypertonia of the
      calves which is maximal on waking and which improves on stretching
      the muscles. Most of the subjects examined suffered from a 
syndrome
      of restless legs and presented alterations of the autonomic 
nervous
      system and spasmophilia (simultaneous EMG recording of the left 
and
      right soleus muscles). Examination of the pathogenesis reveals the
      possibility of a phenomenon of tonic muscular training synchronous
      with variations in an elevated and unstable autonomic tone. The
      authors discuss a possible relationship with spasmophilia and
      algodystrophy. Finally, they propose a plan of treatment.

87
UI  - 83233466
AU  - Bernardi A
AU  - Dainese R
AU  - Brazzo F
AU  - Caniato G
AU  - Uliari U
AU  - De Stefani D
AU  - Poluzzi P
AU  - Bernardi G
TI  - [Gangliosides: a new prospective therapy of uremic neuropathy].
      [Italian]
OT  - I gangliosidi: nuova prospettiva terapeutica della neuropatia
      uremica.
SO  - Clinica Terapeutica 1983 Feb 15;104(3):211-8

88
UI  - 83197850
AU  - Sandyk R
TI  - The restless legs syndrome (Ekbom's syndrome).
SO  - South African Medical Journal 1983 Apr 30;63(18):701-2
AB  - The restless legs syndrome is a condition of unknown aetiology
      characterized by nocturnal paraesthesiae in the lower limbs, an
      irreversible tendency to move the limbs, pain in the distribution 
of
      the paraesthesiae, and psychiatric disturbances. The syndrome may
      occur at any age and in either sex and usually runs a course over
      many years with spontaneous improvements and exacerbations. An
      association with iron deficiency has been suggested but in most
      cases no apparent cause has been found, and treatment at present 
is
      symptomatic with analgesics and sedatives. The differential
      diagnosis includes phenothiazine-induced akathisia and meralgia
      paraesthetica.

89
UI  - 82136143
AU  - Braude W
AU  - Barnes T
TI  - Clonazepam: effective treatment for restless legs syndrome in
      uraemia [letter].
SO  - British Medical Journal Clinical Research Ed. 1982 Feb 
13;284(6314):510

90
UI  - 82024788
AU  - Read DJ
AU  - Feest TG
AU  - Nassim MA
TI  - Clonazepam: effective treatment for restless legs syndrome in
      uraemia.
SO  - British Medical Journal Clinical Research Ed. 1981 Oct 
3;283(6296):885-6

91
UI  - 85066410
AU  - Hoffmann H
TI  - Use of Frenolon in the treatment of delusion of parasitosis 
"Ekbom's
      syndrome").
SO  - Therapia Hungarica 1982;30(1):23-4

92
UI  - 83021939
AU  - Akpinar S
TI  - Treatment of restless legs syndrome with levodopa plus benserazide
      [letter].
SO  - Archives of Neurology 1982 Nov;39(11):739

93
UI  - 82155552
AU  - Biland L
AU  - Blattler P
AU  - Scheibler P
AU  - Studer S
AU  - Widmer LK
TI  - [On the therapy of so-called leg pains. Controlled double-blind
      study of the therapeutic efficacy of Daflon]. [German]
OT  - Zur Therapie sogenannt venoser Beinbeschwerden. (Kontrollierte
      Doppelblind-Studie zur Untersuchung der therapeutischen 
Wirksamkeit
      von Daflon).
SO  - Vasa 1982;11(1):53-8

94
UI  - 82152674
AU  - Blattler W
AU  - Muhlemann M
TI  - [Restless legs and nocturnal leg spasms--forgotten facts in
      diagnosis--new facts for therapy]. [German]
OT  - Restless legs und nachtliche Beinkrampfe - Vergessenes zur 
Diagnose
      - Neues zur Therapie.
SO  - Schweizerische Medizinische Wochenschrift. Journal Suisse de 
Medecine
      1982 Jan 23;112(4):115-7
AB  - An angiologist's experience with the symptom of restless legs is
      reported. The condition was diagnosed in 103 patients presenting
      with pain in their legs occurring predominantly at rest and
      vanishing with walking. Organic lesions could not be identified 
(in
      76%) or were not responsible for the discomfort (in 24%). A
      depressive state, most often masked, was recognized in 67%. In 42%
      anxiety was present alone, and in 49% frank depression was
      diagnosed. In 9% psychiatric treatment was mandatory. Patients 
with
      no depression were either not treated (33%) or were given type
      I-antiarrhythmic drugs (mostly disopyramide) with good results.
      These drugs were only transiently effective in depressed patients
      since anxiety was often intensified when the symptom of restless
      legs disappeared. Antidepressant agents, though ineffective when
      given alone, were most helpful when administered together with
      disopyramide.

95
UI  - 81060936
AU  - Boghen D
TI  - Successful treatment of restless legs with clonazepam [letter].
SO  - Annals of Neurology 1980 Sep;8(3):341

96
UI  - 80167214
AU  - Pulvertaft TB
TI  - Paroven in the treatment of chronic venous insufficiency.
SO  - Practitioner 1979 Dec;223(1338):838-41

97
UI  - 78097807
AU  - Montplaisir J
TI  - [Insomnia and its treatment]. [Review] [French]
OT  - L'insomnie et son traitement.
SO  - Union Medicale du Canada 1977 Dec;106(12):1611-6

98
UI  - 77188453
AU  - Freeman JT
TI  - The restless legs of a Nantucket farmer.
SO  - Journal of the American Geriatrics Society 1977 Jun;25(6):?279-80
AB  - Ekbom's syndrome of restless legs is common but not restricted
      primarily to the elderly. Records of familial occurrence and
      association with several pathologic disorders preclude exclusive
      age-association. Most cases of the syndrome in the general
      population are seen in persons of middle or old age. Lack of
      awareness of the frequency of the syndrome and lack of an adequate
      dependable form of treatment attest the need for additional study.
      Historical documentation is one way of alerting the profession to
      the nature, frequency and lineage of a clinical disorder that
      requires an accepted form of amelioration. Notes from the 1870-73
      diary of a Nantucket farmer are presented.

99
UI  - 79230280
AU  - Botez MI
AU  - Peyronnard JM
AU  - Berube L
AU  - Labrecque R
TI  - Relapsing neuropathy, cerebral atrophy and folate deficiency. A
      close association.
SO  - Applied Neurophysiology 1979;42(3):171-83
AB  - The case of a 48-year-old woman with a relapsing radial palsy 
which
      followed diarrheic episodes is reported. She had low folate
      concentrations in serum and cerebrospinal fluid, as well as low 
and
      borderline values of cerebrospinal fluid and erythrocyte folates.
      She had chronic gastrointestinal disease with edema of jejunal
      mucosa. The patient had some degree of cerebral atrophy. The 
effect
      of folate therapy on the neuropathy was spectacular. A beneficial
      effect of the therapy has been observed on both EEG tracings and
      neuropsychological performances after 6 months of treatment.

100
UI  - 79167020
AU  - Matthews WB
TI  - Treatment of the restless legs syndrome with clonazepam [letter].


               

SO  - British Medical Journal 1979 Mar 17;1(6165):751

101
UI  - 78238745
AU  - Botez MI
AU  - Fontaine F
AU  - Botez T
AU  - Bachevalier J
TI  - Folate-responsive neurological and mental disorders: report of 16
      cases. Neuropsychological correlates of computerized transaxial
      tomography and radionuclide cisternography in folic acid
      deficiencies.
SO  - European Neurology 1977;16(1-6):230-46
AB  - Two groups of patients with folic acid responsive neurological and
      psychiatric disorders are reported. The first group (7 patients) 
had
      well-established acquired folate deficiency due either to 
defective
      absorption (4 cases with atrophy of jejunal mucosa) or to a
      deficient diet (3 cases). One patient had a subacute combined
      degeneration of the spinal cord while others were depressed and 
had
      weight loss, permanent muscular and intellectual fatigue, restless
      legs syndrome, depressed ankle jerks, diminution of the sense of
      vibration in the knees and a stocking-type tactile hypoesthesia. 
The
      second group (9 patients) comprised idiopathic cases of folic acid
      deficiency. Their main subjective complaints were chronic
      fatigability and familial restless legs syndrome. The neurological
      findings were similar to those of the patients with acquired
      disorders. Neuropsychological testing procedures revealed an
      abnormal intellectual functioning in all 16 patients. Abnormal
      patterns of radionuclide cisternograms and computerized transaxial
      tomography (CTT) were found in 11 patients. After 6-12 months of
      folic acid therapy a striking improvement regarding their
      intellectual functioning was noticed: the IQ, Kohs Block Design 
and
      Category tests were significantly improved. The correlation of
      neuropsychological findings with CTT and radionuclide 
cisternograms
      led to the conclusion that chronic folate deficiency could induce
      cerebral atrophy.

102
UI  - 76255325
AU  - Botez MI
AU  - Cadotte M
AU  - Beaulieu R
AU  - Pichette LP
AU  - Pison C
TI  - Neurologic disorders responsive to folic acid therapy.
SO  - Canadian Medical Association Journal 1976 Aug 7;115(3):217-23
AB  - Six women aged 31 to 70 years had folate deficiency and
      neuropsychiatric disorders. The three with acquired folate
      deficiency were depressed and had permanent muscular and
      intellectual fatigue, mild symptoms of restless legs, depressed
      ankle jerks, diminution of vibration sensation in the legs,
      stocking-type hypoesthesia and long-lasting constipation; D-xylos
      absorption was abnormal. The bone marrow was megaloblastic in only
      one patient, and she and one other had atrophy of the jejunal
      mucosa. The third was a vegan. All three recovered after folic 
acid
      therapy. The other three were members of a family with the 
restless
      legs syndrome, fatigability and diffuse muscular pain. One also 
had
      subacute combined degeneration of the spinal cord and kidney 
disease
      but no megaloblastosis; she improved spectacularly after receiving
      large daily doses of folic acid. The other two also had minor
      neurologic signs, controlled with 5 to 10 mg of folic acid daily.
      Unrecognized and treatable folate deficiency (with low serum folic
      acid values but normal erythrocyte folate values) may be the basis
      of a well defined syndrome of neurologic, psychiatric and
      gastroenterologic disorders, and the restless legs syndrome may
      represent the main clinical expression of acquired and familial 
(or
      inborn) folate deficiency in adults.

103
UI  - 76174738
AU  - Snider SR
AU  - Fahn S
AU  - Isgreen WP
AU  - Cote LJ
TI  - Primary sensory symptoms in parkinsonism.
SO  - Neurology 1976 May;26(5):423-9
AB  - Forty-three of 101 outpatients with parkinsonism reported that 
they
      regularly experienced primary sensory symptoms, i.e., spontaneous
      abnormal sensations not caused by somatic disease. This is in
      contrast to similar symptoms reported by only 8 percent of a 
control
      population. The most striking and severe symptom was burning of 
the
      trunk and proximal extremities, occurring in 11 patients.
      Twenty-nine patients reported spontaneous pain; a variety of other
      paresthesialike sensations, e.g., tingling, numbness, and
      formication, occurred in 32 patients. These subjective sensory
      phenomena were not associated with sensory loss or autonomic or
      motor signs. In 20 percent of affected individuals (9 percent of 
the
      total), sensory symptoms preceded the onset of the movement
      disorder, causing difficulty in diagnosis. It is concluded that at
      least some sensory symptoms originate within the nervous system as 
a
      manifestation of the disease process and are not secondary effects
      of the motor disorder.

104
UI  - 75186116
AU  - Procacci P
AU  - Zoppi M
AU  - Maresca M
TI  - [Guanethidine therapy of reflex sympathetic syndromes]. [Italian]
OT  - Terapia con guanetidina di sindromi simpatiche riflesse
SO  - Clinica Terapeutica 1975 Jun 30;73(6):572-80

105
UI  - 73152233
AU  - Roberts HJ
TI  - Spontaneous leg cramps and "restless legs" due to diabetogenic
      (functional) hyperinsulinism. A basis for rational therapy.
SO  - JFMA - Journal of the Florida Medical Association 1973 
May;60(5):29-31




                        
