Restless Legs Syndrome is Frequent in Narcolepsy with Cataplexy Patients

Department of Neurological Sciences University of Bologna, Bologna, Italy.
Sleep (Impact Factor: 4.59). 05/2010; 33(5):689-94.
Source: PubMed


To investigate the occurrence of restless legs syndrome (RLS) in narcolepsy with cataplexy (NC).
A case-control study assessing the frequency of comorbidity of RLS and NC in three European sleep disorder centers.
Three sleep research centers recruited 184 NC patients and 235 age-matched controls.
NC patients and controls underwent a face-to-face interview investigating demographics, medical and drug history, sleep habits, and sleep disorders, in particular RLS based on the 4 international criteria and on a frequency > or =2 times/week, with a detailed description of RLS symptoms when present. RLS was significantly more prevalent among NC patients (14.7%) than in controls (3.0%). The age at onset of RLS in NC patients fits with the age at onset in idiopathic RLS, and RLS appeared more than 10 years after NC onset. Unlike idiopathic RLS, RLS in NC subjects was not more prevalent in women and was less familial (15.4% of cases). Lastly, NC patients with RLS showed a moderate disease severity and an almost daily occurrence of symptoms, which were also diurnal in 35% of cases. Older age, higher blood ferritin levels, and sleep paralysis seem to have a predictive value for RLS in NC. The higher ferritin levels indicate that different pathophysiological mechanisms underlie secondary RLS associated with NC.
This study highlights the association between RLS and NC. The nature of this association is still investigational, but it does indicate that RLS must be addressed in the evaluation and management of nocturnal sleep impairment in NC patients.

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    • "However, PLM is also an optional symptom of RLS (American Academy of Sleep Medicine 2005), which was diagnosed in our patient. RLS in NC is increasingly described (Plazzi et al. 2010), concurrent PD and RLS has been described, and some work suggests that severe RLS may be considered an early stage of PD (Wong et al. 2014). Another common manifestation of NC and PD is RBD. "
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    ABSTRACT: We present the case of an 86 year old female, in whom narcolepsy with cataplexy (NC) manifested at 52 years of age. She was treated by an amphetamine-like drug phenmetrazine and tricyclic antidepressants for more than 10 years. Hypokinetic-rigid syndrome manifested at 83 years of age and Parkinson´s disease (PD) was diagnosed. Detailed examination at the age of 86 confirmed the previous diagnosis of NC and the diagnosis of PD. Severe periodic limb movements in sleep, severe sleep apnea, REM sleep behavior disorder and restless legs syndrome, which are frequently comorbid in NC and PD, were revealed. The patient's somnolence worsened, apparently accentuated by pramipexole treatment, as changing therapy to levodopa led to a reduction of sleepiness.
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    • "Subjective complaints of poor sleep quality in patients with NC [3] include vivid frightening dreams [4], inability to sleep without awakening, getting up to eat at night [5], early awakenings or unrefreshed feeling upon awakening in the morning [6], sleep paralysis , and hallucinations [7]. Moreover, patients with NC may present restless legs syndrome [8], and several comorbid conditions can be often found with polysomnographic sleep recording (PSG), such as periodic leg movements during sleep (PLMS), increased isolated leg movements (LMs), obstructive sleep apnea, rapid eye movement (REM) sleep behavior disorder (RBD), and other parasomnia [2,9–11]. Although disrupted nocturnal sleep may have a central role in patients' complaints, traditional pharmacological treatment of NC is only symptomatic, principally focusing on daytime symptoms and based on polytherapy with stimulants and antidepressants. "
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    ABSTRACT: Objective To analyze the acute effects of sodium oxybate (SO) on polysomnographic night-time (PSG) and multiple sleep latency test (MSLT) of patients with narcolepsy with cataplexy (NC). Methods Sixteen NC adult patients were recruited, together with 16 normal controls. Two consecutive PSG followed by two MSLT sessions were carried out, before and during the first night of SO assumption, respectively. Results The administration of SO was followed by a significant decrease in number of stage shifts and awakenings, wakefulness after sleep onset, percentage of sleep stage 1. Sleep efficiency and slow wave sleep percentage increased. REM latency decreased significantly from 73 to 12 min. Cyclic alternating pattern (CAP) rate remained unchanged but the percentage of CAP A3 subtypes decreased. The number of CAP A3 subtypes per hour of NREM sleep decreased significantly, whereas that of A1 remained unchanged. The duration of A1 and A3 subtypes was slightly increased. Chin muscle tone was not modified by SO as well as periodic leg movements during sleep, but their periodicity index decreased, becoming similar to that of controls. MSLT sleep latency also significantly improved after SO intake. Conclusions The administration of SO in NC patients is followed by immediate important and complex effects on PSG parameters and MSLT, including an evident (over)increase in slow wave sleep, which does not display a physiological microstructure, a moderate decrease in periodic and isolated LMs, possibly mediated by a disinhibited dopaminergic neuronal activity, and an improvement on daytime mean sleep latency at the MSLT.
    Full-text · Article · Sep 2014 · Sleep Medicine
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    • "Although it is not clear how far LM and PLMS contribute to the typical sleep disruption and daytime sleepiness of patients with NC, a reduced night-time REM sleep efficiency and a small but significant decrease in sleep latency on the multiple sleep latency test (MSLT) have been reported in patients with NC with a high PLMS index (Dauvilliers et al., 2007) . Restless legs syndrome is significantly more frequent in individuals with NC (approximately 15%) than in control subjects, older age being a predictive factor of RLS in NC (Plazzi et al., 2010). This might suggest a common pathophysiological mechanism shared by these disorders, but the consequences of RLS in NC and the characteristics of PLMS in NC with or without RLS remain unknown. "
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    ABSTRACT: We compared periodic and non-periodic leg movements during sleep and polysomnography in patients with narcolepsy with cataplexy (NC) with or without restless legs syndrome (RLS) with matched idiopathic RLS (iRLS) and control subjects. We enrolled 100 patients with NC: 17 having RLS were compared with 34 sex- and age-matched patients without RLS and with 17 normal controls and 17 iRLS subjects. Periodic leg movements were highest in iRLS and lowest in controls, with those in NC with RLS very close to iRLS, but higher than those in NC without RLS. The periodicity indexes showed the highest value in iRLS followed by NC with or without RLS and, finally, by controls. The inter-leg movement intervals peaked between 10 and 50 s in NC with RLS and in iRLS, the former did not display the nocturnal gradual decrease of periodic leg movements typical of iRLS. Periodic leg movements during sleep and polysomnography displayed specific features in RLS and NC, respectively, with NC with RLS showing an intermediate pattern. Even if RLS is only detected by targeted interview in NC, its frequency and impact on night-time sleep architecture and continuity suggest that this condition should be routinely searched for in NC.
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