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INTRODUCCIÓN: El síndrome de piernas inquietas (SPI) es una enfermedad neurológica nocturna altamente incidente en los últimos años con afectación sensitiva y motora, que disminuye drásticamente la calidad de vida de los pacientes que la sufren. A su vez, las enfermedades cardiovasculares (ECV) y marcadores de aterosclerosis son las enfermedades que presentan mayor comorbilidad en la población occidental, resultando de gran interés evaluar la posible asociación entre ambas patologías. OBJETIVO: El objetivo de esta revisión bibliográfica es analizar la evidencia científica disponible entre el SPI con los marcadores de ateroesclerosis y ECV. METODOLOGÍA DE BÚSQUEDA: La base de datos utilizada para esta revisión bibliográfica ha sido PubMed. Los criterios de búsqueda prefijados fueron: fecha de publicación en los últimos cinco años, estudios realizados en humanos y en lengua inglesa. A través de la estrategia de búsqueda utilizada se localizaron 38 artículos, que tras analizar su título y abstract se seleccionaron 3. Se incorporó como segunda estrategia de búsqueda, la búsqueda en copo de nieve, la cual añadió otro artículo más, constando finalmente de 4 artículos esta revisión. RESULTADOS: No se ha encontrado evidencia de que los sujetos que sufren SPI padezcan más riesgo de eventos adversos cardiovasculares, hipertensión o desarrollar una enfermedad arterial periférica. En uno de los estudios si observamos una asociación entre la comorbilidad vascular y la incidencia de SPI, pero el estado del SPI no supuso un factor predictor de una futura ECV. Se consideró el aumento del IMC como un factor de riesgo para la instauración de SPI, y también se relacionó la incidencia de esta enfermedad neurológica con la edad avanzada. DISCUSIÓN: Los estudios que conforman esta revisión bibliográfica son heterogéneos, con muestras no totalmente representativas y un tiempo de seguimiento variable que pueden sesgar los resultados. Sería necesaria más investigación de esta materia con muestras más representativas y extensas. CONCLUSIÓN: No se ha demostrado una asociación significativa entre el SPI y las ECV o marcadores de aterosclerosis. La relación entre estas enfermedades prevalentes debe seguir siendo motivo de estudio.

Objectives: Insomnia is the most prevalent sleep disorder in the general population, and one of the most frequent reasons for consultation in the Sleep Units. Perampanel is an antiepileptic also effective on the structure of sleep, and in restless legs syndrome. We describe the first study that evaluates perampanel in patients with chronic insomnia. Patients and methods: Observational retrospective cohorts study of 66 patients with chronic resistant insomnia, 33 exposed to perampanel, other 33 as non-exposed group. All patients attended in Neurology or Psychiatry Consultation, from November 2017 to November 2018. Patients included had been treated with more than 4 different drugs in the previous 4 years. We reviewed age, sex, insomnia etiology, years of evolution, number of previously used drugs, and the results of perampanel for insomnia after 3 months of treatment in the exposed cohort, measured by the improvement of 3 or more points in the ISI and Pittsburgh scales, as well as the average of hours of sleep gained. Non-exposed patients were matched with this variables, but never treated with perampanel. Results: We have included 66 patients. In the exposed cohort: we describe 33 patients with chronic resistant insomnia, 20 women (60 %), 13 men (40 %). Average age 53.48 years, average time of evolution: 11.25 years. Main etiology: depression 13 cases (40 %). After the combination of perampanel 2–4 mg (100 %) with antidepressants (17 cases, 51.5 %) or anxiolytics (12 cases, 36.36 %) along 3 months: the total number of hours of sleep improves in 2.5 h, the scale ISI improves by 6 points (± 2.1 SD, p = 0.02), and Pittsburgh scale improves in 4 points (± 1.7, p = 0.04). In non-exposed cohort, the improvement of the ISI scale was 2.2 points (±0.8, p = 0.06), on the Pittsburgh scale was 1.6 points (± 0.5, p = 0.01). The main adverse effect was irritability in 3 patients, without withdrawal perampanel. The treatment was abandoned by 4 patients (12.12%): 1 due to persistent irritability (3%), 2 due to lack of efficacy (6 %), 1 due to pregnancy wish (3 %). Conclusion: The combination of Perampanel with an antidepressant, or an anxiolytic, improves the quality of sleep measured by ISI and Pittsburgh scales (statistically significant), probably due to its antagonistic action on glutamate. A clinical trial compared with placebo would be necessary to corroborate these results. Sin financiación 1.876 JCR (2020) Q3, 142/211 Surgery 0.587 SJR (2020) Q2, 1153/2447 Medicine (miscellaneous) No data IDR 2020 UEM

Objective In idiopathic Parkinson disease (IPD) sleep disorders are common and may antedate the onset of parkinsonism. Based on the clinical similarities between IPD and Parkinson disease associated with LRRK2 gene mutations (LRRK2-PD), we aimed to characterize sleep in parkinsonian and nonmanifesting LRRK2 mutation carriers (NMC). Methods A comprehensive interview conducted by sleep specialists, validated sleep scales and questionnaires, and video-polysomnography followed by multiple sleep latency test (MSLT) assessed sleep in 18 LRRK2-PD (17 carrying G2019S and one R1441G mutations), 17 NMC (11 G2019S, three R1441G, three R1441C), 14 non-manifesting non-carriers (NMNC) and 19 unrelated IPD. Results Sleep complaints were frequent in LRRK2-PD patients; 78% reported poor sleep quality, 33% sleep onset insomnia, 56% sleep fragmentation and 39% early awakening. Sleep onset insomnia correlated with depressive symptoms and poor sleep quality. In LRRK2-PD, excessive daytime sleepiness (EDS) was a complaint in 33% patients and short sleep latencies on the MSLT, which are indicative of objective EDS, were found in 71%. Sleep attacks occurred in three LRRK2-PD patients and a narcoleptic phenotype was not observed. REM sleep behavior disorder (RBD) was diagnosed in three LRRK2-PD. EDS and RBD were always reported to start after the onset of parkinsonism in LRRK2-PD. In NMC, EDS was rarely reported and RBD was absent. When compared to IPD, sleep onset insomnia was more significantly frequent, EDS was similar, and RBD was less significantly frequent and less severe in LRRK2-PD. In NMC, RBD was not detected and sleep complaints were much less frequent than in LRRK2-PD. No differences were observed in sleep between NMC and NMNC. Conclusions Sleep complaints are frequent in LRRK2-PDand show a pattern that when compared to IPD is characterized by more frequent sleep onset insomnia, similar EDS and less prominent RBD. Unlike in IPD, RBD and EDS seem to be not markers of the prodromal stage of LRRK2-PD., This manuscript received support through the grant number 061130/31 from La Fundacio la Marato de TV3 to Eduard Tolosa. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.