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African Health Sciences Sep 2023Restless legs syndrome (RLS) occurs in patients with chronic renal failure (CRF).
BACKGROUND
Restless legs syndrome (RLS) occurs in patients with chronic renal failure (CRF).
OBJECTIVES
To determine the prevalence and morbidity of RLS in CRF patients on dialysis.
METHODS
This cross-sectional questionnaire-based study included 100 dialysis patients (50 on haemodialysis [HD]; 50 on peritoneal dialysis [PD]). A focused lower limb examination was done. Patients were classified with RLS when reporting uncomfortable feelings in their legs that improved with movement and worsened when resting and at night.
RESULTS
Gender distribution was equal. The median age was 43 (19-67) years. Six patients (HD and PD n=3 each) had international criteria-confirmed RLS. Twenty-four patients reported symptoms suggestive of RLS. Fourteen and 16 patients with RLS symptoms were on HD and PD, respectively. Sleep disturbances occurred in 43.3% (n=13) of patients with RLS symptoms, compared to 20.0% (n=20) of the large cohort. Sleep disturbances, peripheral sensory loss, chronic disease-related anaemia, increased urea and decreased albumin levels were more common among patients with RLS symptoms.
CONCLUSION
RLS symptoms occurred in 30.0% of the entire cohort, although only 6.0% met the international criteria. The type of dialysis had no impact on the incidence of symptoms. Identifying RLS in patients with CRF on dialysis will allow for early intervention.
Topics: Humans; Adult; Renal Dialysis; Restless Legs Syndrome; Cross-Sectional Studies; Kidney Failure, Chronic; Renal Insufficiency, Chronic
PubMed: 38357105
DOI: 10.4314/ahs.v23i3.88 -
A new perspective on positive symptoms: expression of damage or self-defence mechanism of the brain?Neurological Sciences : Official... May 2024Usually, positive neurological symptoms are considered as the consequence of a mere, afinalistic and abnormal increase in function of specific brain areas. However,...
Usually, positive neurological symptoms are considered as the consequence of a mere, afinalistic and abnormal increase in function of specific brain areas. However, according to the Theory of Active Inference, which argues that action and perception constitute a loop that updates expectations according to a Bayesian model, the brain is rather an explorer that formulates hypotheses and tests them to assess the correspondence between internal models and reality. Moreover, the cerebral cortex is characterised by a continuous "conflict" between different brain areas, which constantly attempt to expand in order to acquire more of the limited available computational resources, by means of their dopamine-induced neuroplasticity. Thus, it has recently been suggested that dreams, during rapid eye movement sleep (REMS), protect visual brain areas (deprived of their stimuli during rest) from being conquered by other normally stimulated ones. It is therefore conceivable that positive symptoms also have a functional importance for the brain. We evaluate supporting literature data of a 'defensive' role of positive symptoms and the relevance of dopamine-induced neuroplasticity in the context of neurodegenerative and psychiatric diseases. Furthermore, the possible functional significance of idiopathic REMS-related behavioural disorder as well as phantom limb syndrome is examined. We suggest that positive neurological symptoms are not merely a passive expression of a damage, but active efforts, related to dopamine-induced plasticity, to maintain a correct relationship between the external world and its brain representation, thus preventing healthy cortical areas from ousting injured ones.
Topics: Humans; Dopamine; Bayes Theorem; Brain; Sleep, REM; REM Sleep Behavior Disorder
PubMed: 38353846
DOI: 10.1007/s10072-024-07395-x -
Alzheimer's & Dementia : the Journal of... Apr 2024Patients with dementia with Lewy bodies (DLB) may have Alzheimers disease (AD) pathology that can be detected by plasma biomarkers. Our objective was to evaluate plasma...
INTRODUCTION
Patients with dementia with Lewy bodies (DLB) may have Alzheimers disease (AD) pathology that can be detected by plasma biomarkers. Our objective was to evaluate plasma biomarkers of AD and their association with positron emission tomography (PET) biomarkers of amyloid and tau deposition in the continuum of DLB, starting from prodromal stages of the disease.
METHODS
The cohort included patients with isolated rapid eye movement (REM) sleep behavior disorder (iRBD), mild cognitive impairment with Lewy bodies (MCI-LB), or DLB, with a concurrent blood draw and PET scans.
RESULTS
Abnormal levels of plasma glial fibrillary acidic protein (GFAP) were found at the prodromal stage of MCI-LB in association with increased amyloid PET. Abnormal levels of plasma phosphorylated tau (p-tau)-181 and neurofilament light (NfL) were found at the DLB stage. Plasma p-tau-181 showed the highest accuracy in detecting abnormal amyloid and tau PET in patients with DLB.
DISCUSSION
The range of AD co-pathology can be detected with plasma biomarkers in the DLB continuum, particularly with plasma p-tau-181 and GFAP.
Topics: Humans; Alzheimer Disease; Lewy Body Disease; Amyloid beta-Peptides; tau Proteins; Biomarkers; Cognitive Dysfunction; REM Sleep Behavior Disorder
PubMed: 38329197
DOI: 10.1002/alz.13653 -
Clinical Neurophysiology Practice 2024
PubMed: 38328387
DOI: 10.1016/j.cnp.2024.01.002 -
Clinical Neurophysiology Practice 2024Parasomnias are due to a transient unstable state dissociation during entry into sleep, within sleep, or during arousal from sleep, and manifest with abnormal sleep... (Review)
Review
Parasomnias are due to a transient unstable state dissociation during entry into sleep, within sleep, or during arousal from sleep, and manifest with abnormal sleep related behaviors, perceptions, emotions, dreams, and autonomic nervous system activity. Rapid eye movement (REM) parasomnias include REM sleep behavior disorder (RBD), isolated recurrent sleep paralysis and nightmare disorder. Neurophysiology is key for diagnosing these disorders and provides insights into their pathophysiology. RBD is very well characterized from a neurophysiological point of view, also thank to the fact that polysomnography is needed for the diagnosis. Diagnostic criteria are provided by the American Academy of Sleep Medicine and video-polysomnography guidelines for the diagnosis by the International REM Sleep Behavior Disorder Study Group. Differences between the two sets of criteria are presented and discussed. Availability of polysomnography in RBD provides data on sleep electroencephalography (EEG), electrooculography (EOG) and electromyography (EMG). Sleep EEG in RBD shows e.g. changes in delta and theta power, in sleep spindles and K complexes. EMG during REM sleep is essential for RBD diagnosis and is an important neurodegeneration biomarker. RBD patients present alterations also in wake EEG, autonomic function, evoked potentials, and transcranial magnetic stimulation. Clinical neurophysiological data on recurrent isolated sleep paralysis and nightmare disorder are scant. The few available data provide insights into the pathophysiology of these disorders, demonstrating a state dissociation in recurrent isolated sleep paralysis and suggesting alterations in sleep macro- and microstructure as well as autonomic changes in nightmare disorder.
PubMed: 38328386
DOI: 10.1016/j.cnp.2023.10.003 -
Clinical Medicine & Research Dec 2023Restless legs syndrome (RLS) is a sensorimotor disorder leading to disturbance of resting, discomfort, stress, and impaired daytime activity in the sufferers. The... (Meta-Analysis)
Meta-Analysis Review
Restless legs syndrome (RLS) is a sensorimotor disorder leading to disturbance of resting, discomfort, stress, and impaired daytime activity in the sufferers. The present systematic review and meta-analysis was conducted to determine the effect of temperature therapy on the severity of RLS. The electronic databases of Google Scholar, ProQuest, Scopus, PubMed, Web of Science, and State Inpatient Databases (SID) were searched from inception to August 2022. The Cochrane Collaboration's Risk of Bias Tool was used to check the quality of included studies. Meta-analysis was performed by calculating standardized mean differences (SMDs), using random effects model, and running Comprehensive Meta-Analysis (CMA) software version 2. The included studies (n=6) comprised 177 participants, whose mean age was 49.85 years old. The results of the meta-analysis showed temperature therapy could reduce the severity of RLS (SMD=-1.520, 95% CI: -2.122 to -0.918). Regarding the source of heterogeneity, meta-regression results indicated the efficacy of the intervention in reducing the severity of RLS enhanced significantly by increasing the duration of the intervention in each session (β=-0.039, 95% CI -0.076 to -0.002, <0.001). The results also showed increasing the duration (β=-0.039, 95% CI -0.076 to -0.002, P<0.001) and the temperature of the intervention in each session (β=-0.016, 95% CI -0.028 to -0.003, <0.05) significantly enhanced the efficacy of the intervention in reducing the severity of RLS. The results also indicated that, among patients with underlying clinical conditions, the effectiveness of temperature therapy was higher in hemodialysis patients (β=-2.006, 95% CI -2.736 to -1.276, <0.05). The present study findings suggested temperature therapy could mildly reduce the severity of RLS symptoms. It was also found that the highest efficacy of this intervention could be achieved when the higher temperature was used in fewer treatment sessions in hemodialysis patients. Based on our findings, this intervention can be included in the care plan of patients with RLS considering the settings described to achieve the highest efficacy.
Topics: Humans; Middle Aged; Restless Legs Syndrome; Temperature; Renal Dialysis
PubMed: 38296642
DOI: 10.3121/cmr.2023.1824 -
Sleep Medicine Mar 2024Isolated rapid eye movement sleep behavior disorder (iRBD) is a clinically important parasomnia syndrome preceding α-synucleinopathies, thereby prompting us to develop...
BACKGROUND
Isolated rapid eye movement sleep behavior disorder (iRBD) is a clinically important parasomnia syndrome preceding α-synucleinopathies, thereby prompting us to develop methods for evaluating latent brain states in iRBD. Resting-state functional magnetic resonance imaging combined with a machine learning-based classification technology may help us achieve this purpose.
METHODS
We developed a machine learning-based classifier using functional connectivity to classify 55 patients with iRBD and 97 healthy elderly controls (HC). Selecting 55 HCs randomly from the HC dataset 100 times, we conducted a classification of iRBD and HC for each sampling, using functional connectivity. Random forest ranked the importance of functional connectivity, which was subsequently used for classification with logistic regression and a support vector machine. We also conducted correlation analysis of the selected functional connectivity with subclinical variations in motor and non-motor functions in the iRBDs.
RESULTS
Mean classification performance using logistic regression was 0.649 for accuracy, 0.659 for precision, 0.662 for recall, 0.645 for f1 score, and 0.707 for the area under the receiver operating characteristic curve (p < 0.001 for all). The result was similar in the support vector machine. The classifier used functional connectivity information from nine connectivities across the motor and somatosensory areas, parietal cortex, temporal cortex, thalamus, and cerebellum. Inter-individual variations in functional connectivity were correlated with the subclinical motor and non-motor symptoms of iRBD patients.
CONCLUSIONS
Machine learning-based classifiers using functional connectivity may be useful to evaluate latent brain states in iRBD.
Topics: Humans; Aged; REM Sleep Behavior Disorder; Magnetic Resonance Imaging; Brain; Cerebellum; Temporal Lobe
PubMed: 38295625
DOI: 10.1016/j.sleep.2024.01.019 -
Sleep Medicine Reviews Apr 2024This systematic review and meta-analysis (MA) aimed to evaluate the diagnostic validity of portable electromyography (EMG) diagnostic devices compared to the reference... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis (MA) aimed to evaluate the diagnostic validity of portable electromyography (EMG) diagnostic devices compared to the reference standard method polysomnography (PSG) in assessing sleep bruxism. This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and was registered with PROSPERO prior to the accomplishment of the main search. Ten clinical studies on humans, assessing the diagnostic accuracy of portable instrumental approaches with respect to PSG, were included in the review. Methodological shortcomings were identified by QUADAS-2 quality assessment. The certainty of the evidence analysis was established by different levels of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. A meta-analysis of diagnostic test accuracy was performed with multiple thresholds per study applying a two-stage random effects model, using the thresholds offered by the studies and based on the number of EMG bruxism events per hour presented by the participants. Five studies were included. The MA indicated that portable EMG diagnostic devices showed a very good diagnostic capacity, although a high variability is evident in the studies with some outliers. Very low quality of evidence due to high risk of bias and high heterogeneity among included studies suggests that portable devices have shown high sensitivity and specificity when diagnosing sleep bruxism (SB) compared to polysomnography. The tests performed in the MA found an estimated optimal cut-off point of 7 events/hour of SB with acceptably high sensitivity and specificity for the EMG portable devices.
Topics: Humans; Sleep Bruxism; Polysomnography; Electromyography
PubMed: 38295573
DOI: 10.1016/j.smrv.2024.101906 -
Revista de Neurologia Feb 2024Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is one of the strongest prodromal markers of alpha-synucleinopathies. We aimed to investigate...
INTRODUCTION
Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is one of the strongest prodromal markers of alpha-synucleinopathies. We aimed to investigate non-invasive clinical and quantitative predictors of phenoconversion from iRBD to parkinsonism.
PATIENTS AND METHODS
We prospectively followed-up a total of 45 patients (57.8% men) for eight years. Clinical assessments, Sniffin' Sticks Odor Identification Test, Farnsworth-Munsell 100 Hue Color Vision test, Beck Depression Inventory and Rome III Criteria for constipation were performed. Polysomnographic parameters, sleep spindles, electroencephalographic (EEG) spectral analysis, heart rate variability (HRV) were analyzed.
RESULTS
Eight patients (17.8%) showed phenoconversion to parkinsonism after a mean duration of 3.2 ± 1 years. Odds ratio for predicting phenoconversion was highest for patients =60 years of age with anosmia and constipation -44.8 (4.5-445.7); kappa = 4.291-. Duration, frequency or density of sleep spindles failed to demonstrate significant correlations. In EEG spectral analysis, lower alpha power in occipital region during wakefulness and REM sleep was significantly correlated with phenoconversion. Slowing in EEG spectrum power, together with age =60 years, anosmia and constipation, resulted in the highest odds ratio -122.5 (9.7-1543.8); kappa = 3.051-.
CONCLUSIONS
It is of great importance to have a world-wide perspective of phenoconversion rates from iRBD to overt neurodegeneration, since racial and geographical factors may play important modifying roles. Relatively younger age and shorter disease duration may also be confounding factors for lower rate in our study. Neurophysiological biomarkers seem to be important predictors of phenoconversion, though more research is needed to establish subtypes of iRBD with different probabilities of evolution to overt synucleinopathy.
Topics: Male; Humans; Middle Aged; Female; REM Sleep Behavior Disorder; Follow-Up Studies; Turkey; Anosmia; Constipation; Parkinsonian Disorders; Risk Assessment
PubMed: 38289245
DOI: 10.33588/rn.7803.2023181