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Neurotherapeutics : the Journal of the... Jan 2021Restless legs syndrome (RLS) is characterized by an uncomfortable urge to move the legs while at rest, relief upon movement or getting up to walk, and worsened symptom... (Review)
Review
Restless legs syndrome (RLS) is characterized by an uncomfortable urge to move the legs while at rest, relief upon movement or getting up to walk, and worsened symptom severity at night. RLS may be primary (idiopathic) or secondary to pregnancy or a variety of systemic disorders, especially iron deficiency, and chronic renal insufficiency. Genetic predisposition with a family history is common. The pathogenesis of RLS remains unclear but is likely to involve central nervous system dopaminergic dysfunction, as well as other, undefined contributing mechanisms. Evaluation begins with a thorough history and examination, and iron measures, including ferritin and transferrin saturation, should be checked at presentation and with worsened symptoms, especially when augmentation develops. Augmentation is characterized by more intense symptom severity, earlier symptom occurrence, and often, symptom spread from the legs to the arms or other body regions. Some people with RLS have adequate symptom control with non-pharmacological measures such as massage or temperate baths. First-line management options include iron-replacement therapy in those with evidence for reduced body-iron stores or, alternatively, with prescribed gabapentin or pregabalin, and dopamine agonists such as pramipexole, ropinirole, and rotigotine. Second-line therapies include intravenous iron infusion in those who are intolerant of oral iron and/or those having augmentation with intense, severe RLS symptoms, and opioids including tramadol, oxycodone, and methadone. RLS significantly impacts patients' quality of life and remains a therapeutic area sorely in need of innovation and a further pipeline of new, biologically informed therapies.
Topics: Dopamine Agonists; Humans; Quality of Life; Restless Legs Syndrome
PubMed: 33880737
DOI: 10.1007/s13311-021-01019-4 -
Praxis Sep 2020Bruxism: Classification, Diagnostics and Treatment Bruxism, the grinding or clenching of teeth, is common in the population. Stress, anxiety syndromes and genetic...
Bruxism: Classification, Diagnostics and Treatment Bruxism, the grinding or clenching of teeth, is common in the population. Stress, anxiety syndromes and genetic disposition seem to be dominant factors that lead to increased muscle tension. A distinction is made between two circadian manifestations, sleep and wake bruxism. Bruxism is a major risk factor for tooth structure and dentures. The diagnosis is based on a targeted medical history and examination. Sleep bruxism can be demonstrated by electromyography and video recording in the sleep laboratory. The treatment aims to protect the hard tooth substance and preserve the denture using occlusal splints. Relaxation exercises can improve bruxism. Specialized physiotherapy can improve tension, pain and restricted movement. Botulinum toxin treatment reduces the subjective complaints during the period of action.
Topics: Anxiety; Electromyography; Humans; Risk Factors; Sleep; Sleep Bruxism
PubMed: 32933386
DOI: 10.1024/1661-8157/a003517 -
International Journal of Environmental... Sep 2021(1) Background: Bruxism, a condition characterized by grinding and involuntary clenching of the teeth, is a risk factor for the development of masticatory dysfunction.... (Review)
Review
(1) Background: Bruxism, a condition characterized by grinding and involuntary clenching of the teeth, is a risk factor for the development of masticatory dysfunction. It can occur together with sleep disturbances and may be associated with abnormal body movements, breathing difficulties, increased muscle activity, and heart rate disturbances. This disorder is becoming an important dental concern in children. (2) Methods: A literature review was carried out based on a search in PubMed and Google Scholar databases for articles on bruxism in children, published between 2014 and 2021. The etiology, diagnosis, and treatment of bruxism in children were of particular interest in the study. (3) Results: A total of 40 articles were included in the review. The analyzed studies indicated that the prevalence rates of bruxism in children vary widely from 13% to 49%. The etiology of bruxism is complex and incomprehensible, and the main diagnostic criteria for this condition in children are subjective observation, clinical history, and clinical examination. The recommended therapy for sleep bruxism in children is physiotherapy and psychotherapy. (4) Conclusions: Dentists and primary care physicians should correctly diagnose bruxism in children, educate parents, prevent potential consequences for oral health, and identify possible comorbidities. Appropriate clinical guidelines for the treatment and prophylaxis of bruxism in children should also be developed.
Topics: Child; Comorbidity; Humans; Prevalence; Risk Factors; Sleep Bruxism; Sleep Wake Disorders
PubMed: 34574467
DOI: 10.3390/ijerph18189544 -
Neurotherapeutics : the Journal of the... Jan 2021Nightmare disorder and recurrent isolated sleep paralysis are rapid eye movement (REM) parasomnias that cause significant distress to those who suffer from them.... (Review)
Review
Nightmare disorder and recurrent isolated sleep paralysis are rapid eye movement (REM) parasomnias that cause significant distress to those who suffer from them. Nightmare disorder can cause insomnia due to fear of falling asleep through dread of nightmare occurrence. Hyperarousal and impaired fear extinction are involved in nightmare generation, as well as brain areas involved in emotion regulation. Nightmare disorder is particularly frequent in psychiatric disorders and posttraumatic stress disorder. Nonmedication treatment, in particular imagery rehearsal therapy, is especially effective. Isolated sleep paralysis is experienced at least once by up to 40% of the general population, whereas recurrence is less frequent. Isolated sleep paralysis can be accompanied by very intense and vivid hallucinations. Sleep paralysis represents a dissociated state, with persistence of REM atonia into wakefulness. Variations in circadian rhythm genes might be involved in their pathogenesis. Predisposing factors include sleep deprivation, irregular sleep-wake schedules, and jetlag. The most effective therapy consists of avoiding those factors.
Topics: Dreams; Humans; Sleep Paralysis; Sleep, REM
PubMed: 33230689
DOI: 10.1007/s13311-020-00966-8 -
Mayo Clinic Proceedings Jul 2021Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2... (Review)
Review
Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2 or more times a week and causing at least moderate distress. It is important for primary care physicians to be familiar with the disorder and its management. Much has changed in the management of RLS since our previous revised algorithm was published in 2013. This updated algorithm was written by members of the Scientific and Medical Advisory Board of the RLS Foundation based on scientific evidence and expert opinion. A literature search was performed using PubMed identifying all articles on RLS from 2012 to 2020. The management of RLS is considered under the following headings: General Considerations; Intermittent RLS; Chronic Persistent RLS; Refractory RLS; Special Circumstances; and Alternative, Investigative, and Potential Future Therapies. Nonpharmacologic approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation, are outlined. The choice of an alpha-delta ligand as first-line therapy for chronic persistent RLS with dopamine agonists as a second-line option is explained. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS and describe management approaches, including combination therapy and the use of high-potency opioids. Treatment of RLS in pregnancy and childhood is discussed.
Topics: Algorithms; Humans; Patient Care Management; Restless Legs Syndrome
PubMed: 34218864
DOI: 10.1016/j.mayocp.2020.12.026 -
Current Pediatric Reviews 2020Sleep terrors are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made. (Review)
Review
BACKGROUND
Sleep terrors are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made.
OBJECTIVE
To familiarize physicians with the clinical manifestations, diagnosis, and management of children with sleep terrors.
METHODS
A PubMed search was completed in Clinical Queries using the key terms "sleep terrors" OR "night terrors". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
RESULTS
It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age. Sleep terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7 years of age. The exact etiology is not known. Developmental, environmental, organic, psychological, and genetic factors have been identified as a potential cause of sleep terrors. Sleep terrors tend to occur within the first three hours of the major sleep episode, during arousal from stage three or four non-rapid eye movement (NREM) sleep. In a typical attack, the child awakens abruptly from sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky, and has a frightened expression. The child is confused and incoherent: verbalization is generally present but disorganized. Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. The child is difficult to arouse and console and may express feelings of anxiety or doom. In the majority of cases, the patient does not awaken fully and settles back to quiet and deep sleep. There is retrograde amnesia for the attack the following morning. Attempts to interrupt a sleep terror episode should be avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good sleep hygiene and an appropriate sleeping environment. Medical intervention is usually not necessary, but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment, such as fatigue, daytime sleepiness, and distress. Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors.
CONCLUSION
Most children outgrow the disorder by late adolescence. In the majority of cases, there is no specific treatment other than reassurance and parental education. Underlying conditions, however, should be treated if possible and precipitating factors should be avoided.
Topics: Child; Child, Preschool; Diagnosis, Differential; Humans; Infant; Night Terrors; Prognosis; Sleep
PubMed: 31612833
DOI: 10.2174/1573396315666191014152136 -
Nature Reviews. Disease Primers Nov 2021Restless legs syndrome (RLS) is a common sensorimotor disorder characterized by an urge to move that appears during rest or is exacerbated by rest, that occurs in the... (Review)
Review
Restless legs syndrome (RLS) is a common sensorimotor disorder characterized by an urge to move that appears during rest or is exacerbated by rest, that occurs in the evening or night and that disappears during movement or is improved by movement. Symptoms vary considerably in age at onset, frequency and severity, with severe forms affecting sleep, quality of life and mood. Patients with RLS often display periodic leg movements during sleep or resting wakefulness. RLS is considered to be a complex condition in which predisposing genetic factors, environmental factors and comorbidities contribute to the expression of the disorder. RLS occurs alone or with comorbidities, for example, iron deficiency and kidney disease, but also with cardiovascular diseases, diabetes mellitus and neurological, rheumatological and respiratory disorders. The pathophysiology is still unclear, with the involvement of brain iron deficiency, dysfunction in the dopaminergic and nociceptive systems and altered adenosine and glutamatergic pathways as hypotheses being investigated. RLS is poorly recognized by physicians and it is accordingly often incorrectly diagnosed and managed. Treatment guidelines recommend initiation of therapy with low doses of dopamine agonists or αδ ligands in severe forms. Although dopaminergic treatment is initially highly effective, its long-term use can result in a serious worsening of symptoms known as augmentation. Other treatments include opioids and iron preparations.
Topics: Brain; Dopamine; Dopamine Agonists; Humans; Quality of Life; Restless Legs Syndrome
PubMed: 34732752
DOI: 10.1038/s41572-021-00311-z -
International Journal of Molecular... Dec 2022Parkinson's disease (PD) is an age-related neurodegenerative disorder, diagnosed on the basis of typical motor disturbances, but also characterized by the presence of... (Review)
Review
Parkinson's disease (PD) is an age-related neurodegenerative disorder, diagnosed on the basis of typical motor disturbances, but also characterized by the presence of non-motor symptoms, such as rapid eye movement (REM)-sleep behavior disorders, olfactory impairment, and constipation, which are often prodromal to the onset of the disease. PD is often associated with the presence of oxidative brain injury and chronic neuroinflammation, with infiltration and accumulation of peripheral immune cells that have been found in affected brain regions of PD patients. Recently, the role of the gut-brain axis in the pathogenesis of PD is getting more and more attention, and several pieces of evidence indicate alterations in the gut microbiota of PD-affected patients. Diet exerts a central role in defining the microbiota composition and different dietetic patterns can result in a higher or lower abundance of specific bacteria that, in turn, can affect gut permeability and express anti- or pro-inflammatory metabolites. In the present review, the effects of the Mediterranean diet in modulating both PD onset and its progression will be considered with a special focus on the antioxidant and anti-inflammatory properties of this dietetic regimen as well as on its effects on the microbiota composition.
Topics: Humans; Parkinson Disease; Diet, Mediterranean; REM Sleep Behavior Disorder; Brain; Constipation
PubMed: 36613486
DOI: 10.3390/ijms24010042 -
Missouri Medicine 2020Aging is associated with several changes in sleep patterns. Older adults have increased prevalence of primary sleep disorders including insomnia, sleep disordered... (Review)
Review
Aging is associated with several changes in sleep patterns. Older adults have increased prevalence of primary sleep disorders including insomnia, sleep disordered breathing, restless legs syndrome, REM sleep behavior disorder, and circadian rhythm disturbances. These can be further compromised by sleep disturbances secondary to medical or psychiatric disorders, and medication side effects. This review discusses age-related changes in sleep architecture, etiology, clinical presentation, and treatment options of various sleep disorders in the elderly.
Topics: Aged; Aging; Humans; REM Sleep Behavior Disorder; Restless Legs Syndrome; Sleep; Sleep Wake Disorders
PubMed: 33311760
DOI: No ID Found -
Journal of Prosthodontics : Official... Apr 2021The purpose of this Best Evidence Consensus Statement is to report on the prevalence, potential causes or association, treatment and cure of bruxism. (Review)
Review
PURPOSE
The purpose of this Best Evidence Consensus Statement is to report on the prevalence, potential causes or association, treatment and cure of bruxism.
MATERIALS AND METHODS
A literature search limited to Clinical Trials, Randomized Controlled Trials, Systematic Reviews and Meta Analyses, with the key words bruxism, and prevalence identified 22 references, bruxism and causation 21, bruxism, and treatment 117, and bruxism and cure none.
RESULTS
Prevalence received 5 references which were relevant to the question researched. Causation received 11 relevant references, treatment 34 relevant references and cure none. Eighteen additional references were culled from the reference lists in the aforementioned articles.
CONCLUSIONS
Due to variations in demographics and the dependence on anamnestic data, the true prevalence of bruxism in any specific population is unknown. There is moderate evidence that psychosocial factors such as stress, mood, distress, nervousness, and feeling blue are associated with sleep bruxism (SB) as well as caffeine, alcohol, and smoking. There is no consensus on what symptoms of SB or awake bruxism (AB) should be treated. There is some evidence that occlusal devices and bio feedback therapies can be utilized in SB treatment. There is conflicting evidence in the use of Botulinum toxin A and no compelling evidence for the use of drug therapy to treat SB. There is not an established cure for bruxism. The clinician is best served in using caution in the dental rehabilitation of patients with severe occlusal wear.
Topics: Consensus; Humans; Prevalence; Sleep Bruxism
PubMed: 33331675
DOI: 10.1111/jopr.13308