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Background and purpose: The aim of this study was to evaluate the presence of abnormalities in the brain of patients with restless legs syndrome (RLS) using voxel-based morphometry and diffusion tensor imaging (DTI). Methods: Twenty patients and twenty controls were studied. Voxel-based morphometry analysis was performed using statistical parametric mapping (SPM8) and FSL-VBM software tools. For voxel-wise analysis of DTI, tract-based spatial statistics (TBSS) and SPM8 were used. Results: Applying an appropriate threshold of probability, no significant results were found either in comparison or in correlation analyses. Conclusions: Our data argue against clear structural or microstructural abnormalities in the brain of patients with idiopathic RLS, suggesting a prevalent role of functional or metabolic impairment. [ABSTRACT FROM AUTHOR]

Restless Legs Syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an irresistible urge to move them to relieve discomfort. Evidence-based guidelines consider dopaminergic therapy to be the mainstay of treatment for RLS. Ropinirole is a modern, non-ergoline dopamine agonist which has been widely studied for the treatment of moderatetosevere primary RLS. Data from placebo-controlled studies show that ropinirole significantly improves the symptoms of RLS. These improvements are supported by data from individual studies and pooled analyses. In addition, ropinirole significantly enhances the objective measures of RLS motor symptoms, such as periodic leg movements, and subjective measures of sleep. Ropinirole is generally well-tolerated, but a newly developed extended-release formulation may benefit patients who warrant an extended duration of therapy. [ABSTRACT FROM AUTHOR]

Catathrenia (nocturnal groaning) is a rare condition characterized by monotonous irregular groans occurring during sleep. Ten patients (five women; mean age: 27 ± 7.4 years, range: 15–41) with sleep-related groaning persisting for years or decades and normal daytime fibreoptic laryngoscopy and respiratory function tests underwent videopolysomnographic recording (VPSG) analysing their respiratory patterns during sleep. After the VPSG, all patients were clinically followed up for a mean period of 4.9 ± 3.5 years. On VPSG, all patients showed nocturnal groaning during NREM sleep and particularly during REM sleep stages. Groaning was associated with disproportionate prolonged expiration causing reduced breathing rate without oxygen desaturation. The breathing pattern with prolonged expiration and sound production alternated with a normal respiratory pattern without groaning. Endoesophageal pressure during groaning showed mildly positive swings at the initial phase of expiration suggesting a partial mild expiratory upper airway obstruction. At the end of the follow-up period, all patients reported persistent nocturnal groaning but no other clinical manifestations. Groaning confined to sleep alternating with normal breathing and the absence of long-term clinical consequences suggest that catathrenia is because of an abnormality of the internal respiratory drive system, possibly related to persistence of a neonatal (vestigial) type of breathing pattern. [ABSTRACT FROM AUTHOR]

Previously referred to as “nocturnal myoclonus”, periodic limb movements in sleep (PLMS) is regarded as a distinct nosologic entity, although it overlaps a great deal with restless legs syndrome and other sleep disorders. While there is a lack of complete consensus on this matter, PLMS are regarded as pathological if more than five events occur per hour of sleep, and as a disorder (PLMD) if there is comorbid insomnia or daytime sleepiness in the absence of other symptoms. PLMS are common in healthy elderly individuals and have been reported to increase with age. The pathogenesis of PLMS is not clear. Lesion, imaging and laboratory studies indicate neuronal hyperexcitability with involvement of brain stem and spinal cord structures, in particular the central pattern generator for gait, and decreased dopaminergic transmission. Dopaminergic drugs, dopamine agonists, opiates, benzodiazepines and anticonvulsants are all used, with dopaminergic drugs or dopamine agonist regarded as first-line treatment. [ABSTRACT FROM AUTHOR]

Different pathological conditions may lead to somnambulic automatisms arising from nocturnal sleep. Video polysomnography represents the diagnostic tool but, due to the difficulty of capturing complex episodes in the sleep laboratory, audio-video recordings at home of the episodes may help in the differential diagnosis also. Sleepwalking is a disorder of arousal in which the subject arises from deep sleep, even displaying long complex behaviour, including leaving the bed and walking, with memory impairment of the event. Disordered arousal mechanisms with an inability of the brain to fully awaken from slow-wave sleep are thought to lead to these motor automatisms. REM sleep behaviour disorders begin during REM sleep and are accompanied by features of REM sleep. The motor behaviour may be violent and injurious to the patient and/or bed partner. In some patients, how- ever, the behaviour may be similar to that observed in sleepwalking and some patients have an overlap syndrome. In nocturnal frontal lobe epilepsy in particular, and in complex partial seizures in general, stereotypic and repetitive motor attacks may recur, at any time, on the same night and on different nights, with a continuum between minimal or minor attacks and major or prolonged episodes up to agitated epileptic nocturnal wanderings. [ABSTRACT FROM AUTHOR]

We describe the clinical, neurophysiological and polysomnographic characteristics of some involuntary motor nocturnal events occurring during sleep or at the transition from wakefulness to sleep. [ABSTRACT FROM AUTHOR]

Sleep-related eating disorder (SRED) is characterized by recurrent arousals from sleep associated with compulsive ingestion of food. No controlled therapeutic trials are available for SRED. We assessed the safety, tolerability and efficacy of pramipexole, a dopamine D3-receptor agonist, in the treatment of SRED. Eleven consecutive patients with SRED in the absence of concurrent daytime eating disorders underwent actigraphic recording and subjective sleep diary evaluation for a week before and every week for 2 weeks of treatment with pramipexole 0.18–0.36 mg or placebo, administered in a double-blind crossover randomized sequence. The primary outcomes of the trial were actigraphic measures of night sleep parameters (sleep efficiency, motor activity mean and median, number and duration of wake episodes), secondary outcomes were the number of good sleep nights/weekly, number and duration of nocturnal awakenings/night, and visual analogue preference score. Pramipexole was well tolerated without any patient withdrawing from the study. Pramipexole reduced night-time activity median (P = 0.02) and increased the number of nights of good sleep/week (P = 0.02). All other measurements remained unaffected. Pramipexole at low doses was well tolerated, improving some measures of sleep quality and reducing median night activity in SRED. Further studies with higher dosages and for longer time-periods are warranted. [ABSTRACT FROM AUTHOR]

The previously unrecognised association of myoclonus in two patients with LHON with the 11778/ND4 pathogenic mutation is described. EEG failed to disclose epileptic figures, and a back averaging study suggested that myoclonus was cortical in origin in both patients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented that describes the case of a 58-year-old man with rapid-eye-movement (REM) sleep disorder who had amputated arm usage and disappearance of limb during dreaming.

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Obtructive sleep apnoea syndrome (OSAS) is a common disorder in the general population with an estimated prevalence in an adult population of 2% in women and 4% in men. Although several studies have suggested that headaches, particularly morning headaches, are more common in patients with OSAS than in normal subjects, others have yielded contradictory findings. When the sleep-related breathing disorder was treated with success, the headache generally disappeared, supporting a causal role of the sleep disorder for headache. Several hypotheses have been proposed to explain the relationship between OSAS and the occurrence of headache, particularly on awakening. Night-time fluctuations of oxygen saturation during the night with hypercapnia, vasodilatation, increased intracranial pressure and impaired sleep quality are all considered contributing factors. However the exact mechanisms of headache pathogenesis and the relationship between OSAS, headache and morning headaches in particular remain controversial. [ABSTRACT FROM AUTHOR]

Investigates the development of myoglobinuria after ingestion of extracts of guarana, Ginkgo biloba and kava. Description of myoglobinuria; Diagnosis of the disease; Association of neuroleptic malignant syndrome with myoglobinuria; Causes of myoglobinuria.