RESUMEN
INTRODUCTION: Restless legs syndrome (RLS) is a highly prevalent sleep movement disorder usually accompanied by periodic limb movements of sleep (PLMS). The incidence of RLS and PLMS in patients with end-stage renal disease (ESRD) on dialysis is much higher. Clinically, RLS and PLMS can co-occur. We hypothesized that patients with ESRD on dialysis would have a distinct presentation of RLS, with a higher prevalence of PLMS. METHODS: We examined clinical, demographic, biochemical, and polysomnographic characteristics of RLS in patients on dialysis matched to control subjects with normal renal function based on age, sex, body mass index, and frequency of apneas and hypopneas per hour of sleep, defined by the apnea and hypopnea index (AHI), in a proportion of 3:1. Patients with ESRD were on hemodialysis three times per week. Polysomnography was performed overnight in the sleep laboratory. FINDINGS: Patients on dialysis compared to control subjects had a lower amount of N3 sleep (77.6 ± 39.9 minutes vs. 94.8 ± 33.7 minutes, p = 0.037) and REM sleep (55.6 ± 27.5 minutes vs. 74.1 ± 28.4 minutes, p = 0.006), regardless of the presence of RLS. Among the patients on dialysis, those with RLS had higher PLMS. In the control group, patients with RLS had a lower ferritin level, which was not observed in the dialysis group. There was a significant interaction between PLMS and ESRD (p = 0.001), with a higher prevalence of PLMS in patients with ESRD on dialysis in a model adjusted for AHI, sex, arousals, and age. Factors that were associated with PLMS were RLS (p = 0.003), ESRD (p = 0.0001), and AHI (p = 0.041), with an adjusted R2 of 0.321. CONCLUSION: RLS in patients with ESRD on dialysis is independently associated with PLMS, regardless of the severity of sleep apnea, arousals, and age.
Asunto(s)
Polisomnografía/métodos , Diálisis Renal/efectos adversos , Síndrome de las Piernas Inquietas/etiología , Trastornos del Sueño-Vigilia/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal/métodos , Síndrome de las Piernas Inquietas/patología , Trastornos del Sueño-Vigilia/patologíaRESUMEN
OBJECTIVE: To evaluate a group of spinocerebellar ataxia type 3 (SCA3) or Machado-Joseph disease (MJD) (SCA3/MJD) patients and assess whether there is an association between neuropathy and serum ferritin levels and restless legs syndrome (RLS). METHODS: Twenty-six SCA3/MJD patients underwent electromyography studies to check for neuropathy. Their serum ferritin levels were measured as well. These findings were evaluated based on the presence or not of RLS and its severity. RESULTS: The proportion of neuropathy in the RLS group was not significantly higher compared to the non-RLS group (23 vs. 15%, Fisher's exact test, p = 1.000). Furthermore, no association was found between RLS and ferritin levels. CONCLUSION: We found no correlation between neuropathy or ferritin levels and RLS in SCA3/MJD patients.
Asunto(s)
Enfermedad de Machado-Joseph/complicaciones , Enfermedad de Machado-Joseph/patología , Nervios Periféricos/fisiopatología , Síndrome de las Piernas Inquietas/etiología , Síndrome de las Piernas Inquietas/patología , Adulto , Intervalos de Confianza , Evaluación de la Discapacidad , Estimulación Eléctrica/métodos , Electromiografía , Femenino , Ferritinas/sangre , Humanos , Enfermedad de Machado-Joseph/sangre , Masculino , Persona de Mediana Edad , Conducción Nerviosa , Síndrome de las Piernas Inquietas/sangre , Índice de Severidad de la EnfermedadRESUMEN
It is believed that periodic limb movement (PLM) and more specifically, restless leg syndrome (RLS), are a common cause of insomnia. And one study in the literature examined PLM when associated to the use of estrogens. Polo-Kantola et al. [Polo-Kantola P, Rauhala E, Erkkola R, Irjala K, Polo O. Estrogen replacement therapy and nocturnal periodic limb movements: a randomized controlled trial. Obstet Gynecol 2001;97(4):548-54] observed that estrogen therapy improved subjective sleep quality regardless of periodic limb movements or related arousals. Herein is a case of a symptomatic postmenopausal patient with high PLM index who complained of insomnia and leg pain. Given that the patient had hot flashes and a high Kupperman Menopausal Index (which evaluates climacteric symptoms), we decided to administer transdermal ESTRADOT 25 microg (Novartis, Brazil) twice-a-week. Our patient experienced a significant decrease in PLM as well as a great increase in REM and a slight increase in slow wave sleep (stages 3 and 4), as shown in the polysomnography. The patient reported an overall improvement in her condition.
Asunto(s)
Terapia de Reemplazo de Estrógeno , Síndrome de las Piernas Inquietas/diagnóstico , Síndrome de las Piernas Inquietas/tratamiento farmacológico , Diagnóstico Diferencial , Esquema de Medicación , Femenino , Humanos , Persona de Mediana Edad , Síndrome de las Piernas Inquietas/patologíaRESUMEN
O delírio parasitário (ou síndrome de Ekbom) é uma condição rara, onde o paciente apresenta uma forte convicção de que está infestado por pequenos parasitas ou organismos. Muitas vezes, os delírios são tão intensos que levam esses pacientes à automutilação. Relatamos aqui um caso de um senhor de 67 anos, isolado socialmente, solteiro, apresentando delírio parasitário em região perineal, culminando em lesões por automutilação.
Delusional parasitosis (or Ekbom's syndrome) is a rare condition, in which the patient has a strong conviction that he or she is infested by small parasites or organisms. These delusions are often so intense that they lead the patient to self-mutilation. We report a case of a 67-year-old man, socially isolated, single, with delusional parasitosis in the perineal area, culminating in self-mutilation lesions.