Signs of sympathetic and endothelial cell activation in the skin of patients with restless legs syndrome

Bergmann, Melanie; Heidbreder, Anna; Stefani, Ambra; Raccagni, Cecilia; Brandauer, Elisabeth; Rudzki, Dagmar; Fischer, Michael B.; Roßmanith, Eva; Pasztorek, Markus; Löscher, Wolfgang N.; Högl, Birgit; Wanschitz, Julia

doi:10.1016/j.sleep.2021.05.044

Cited by 5 publications

(4 citation statements)

References 49 publications

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“…Furthermore, the FMI increased with a growing PLMS index. An association between EFM and PLMS was previously reported (Bergmann, Wanschitz, et al, 2023; Broughton et al, 1985) but studies describing the relationship between the FMI and PLMS index are missing. One plausible explanation could be age and gender again, as population‐based studies found age and male gender to be associated with PLMS indices of >15 events/h (Haba‐Rubio et al, 2016; Szentkiralyi et al, 2019).…”

Section: Discussionmentioning

confidence: 94%

A 24% prevalence of excessive fragmentary myoclonus in 500 consecutive sleep laboratory patients

Bergmann,

Stefani,

Ibrahim

et al. 2023

Journal of Sleep Research

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SummaryExcessive fragmentary myoclonus (EFM) is a frequent finding during routine video‐polysomnography (VPSG). We aimed to automatically measure the prevalence of EFM according to current American Academy of Sleep Medicine (AASM) criteria, and the fragmentary myoclonus index (FMI) in sleep stage N1, N2, N3, rapid eye movement (REM) sleep and wake in a large patient population. A total of 500 VPSG recordings of patients admitted to the Sleep Laboratory, Department of Neurology, Medical University of Innsbruck, Austria, between May 1, 2022 and February 28, 2023, were included. EFM according to AASM criteria and FMI were computed by applying a previously validated algorithm. EFM was automatically detected in 121 of the 500 Sleep Laboratory patients (24.2%, 95% confidence interval 20.1%–28.9%). FMI increased with age, male gender, apnea–hypopnea‐index (AHI), oxygen desaturation index (ODI), and periodic leg movements of sleep (PLMS) index. FMI was highest in REM sleep behaviour disorder (RBD), followed by neurodegenerative and internal medicine diseases, but the increase in the FMI was not explained by the disease itself but rather by the age and sex of the patients. Almost a quarter of our patient population had EFM. However, the prevalence of EFM does not allow the drawing of any conclusions about the pathophysiology of EFM or even the determination of a pathological FMI cut‐off value. Associations of the FMI with age, sex, AHI, ODI and PLMS are in line with previous studies, but the FMI needs to be evaluated in different disease entities to learn more about its pathophysiology.

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Section: Discussionmentioning

confidence: 94%

A 24% prevalence of excessive fragmentary myoclonus in 500 consecutive sleep laboratory patients

Bergmann,

Stefani,

Ibrahim

et al. 2023

Journal of Sleep Research

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“…In patients with RLS associated with small fiber neuropathy thermal hypoesthesia to cold and warm, as well as hyperalgesia to pinprick have been reported ( Bachmann et al, 2010 ). A recent study underlines that skin biopsy should be performed to assess the presence of small fiber neuropathy, according to current diagnostic criteria ( Bergmann et al, 2021 ). Using this methodology, the coexistence of RLS and small fiber neuropathy seems to be rare.…”

Section: Restless Legs Syndrome and Periodic Leg Movements During Sleepmentioning

confidence: 99%

“…Using this methodology, the coexistence of RLS and small fiber neuropathy seems to be rare. Of note, skin biopsy showed increased expression of tyrosine hydroxylase in dermal nerve bundles in patients with RLS, suggesting enhanced peripheral adrenergic activity ( Bergmann et al, 2021 ). These findings are in line with the proposed concepts of postganglionic sympathetic disinhibition in RLS ( Walters and Rye, 2009 ).…”

Section: Restless Legs Syndrome and Periodic Leg Movements During Sleepmentioning

confidence: 99%

Myoclonus and other jerky movement disorders

Veen

Caviness

Dreissen

et al. 2022

Clinical Neurophysiology Practice

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“…The pathogenesis of RLS is complex and involves various factors, such as brain iron deficiency, altered dopaminergic neuron transmission, peripheral neuropathy, chronic inflammation, and immune deficiency (Weinstock et al, 2012;Allen, 2015;Didato et al, 2020). In recent years, studies have shown that the development of RLS is associated with excessive activation of sympathetic nerves (Stevens, 2015;Bergmann et al, 2021), and inflammation and immune changes are common in RLS patients (Weinstock et al, 2012). Stellate ganglion block (SGB) is a safe and effective minimally invasive treatment.…”

Section: Introductionmentioning

confidence: 99%

Case report: A new treatment for restless leg syndrome: three cases

Li,

Zhang,

Wang

et al. 2024

Front. Neurosci.

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Restless legs syndrome is a movement disorder that seriously affects the quality of life of patients. It is characterized by marked discomfort mainly occurring in the deep tissues of the lower extremities, including deep muscle or bone chafing, as well as crawling sensations or pulling sensations. These sensations often cause patients to awaken after falling asleep and to feel the urge to walk around, which seriously affects their sleep quality. Patients with restless leg syndrome exhibit significantly enhanced sympathetic nerve activity and immune disorders, while stellate ganglion blockage can block sympathetic nerves and regulate immune cells and cytokines to maintain immune system homeostasis. We report three patients with restless legs syndrome complicated with severe nephrotic syndrome. After treatment with stellate ganglion block, the symptoms in the restless legs were relieved within 1 month, and the quality of sleep was significantly improved. Our findings suggest that stellate ganglion block has broad promise in the management of restless legs syndrome patients with severe comorbidities.

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Signs of sympathetic and endothelial cell activation in the skin of patients with restless legs syndrome

Cited by 5 publications

References 49 publications

A 24% prevalence of excessive fragmentary myoclonus in 500 consecutive sleep laboratory patients

A 24% prevalence of excessive fragmentary myoclonus in 500 consecutive sleep laboratory patients

Myoclonus and other jerky movement disorders

Case report: A new treatment for restless leg syndrome: three cases

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