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Background: Sleep disorders can cause tiredness. The relationship between sleep disorders and fatigue in patients with multiple sclerosis (MS) has not yet been investigated systematically., Objective: To investigate the relationship between fatigue and sleep disorders in patients with MS., Methods: Some 66 MS patients 20 to 66 years old were studied by overnight polysomnography. Using a cut-off point of 45 in the Modified Fatigue Impact Scale (MFIS), the entire cohort was stratified into a fatigued MS subgroup (n=26) and a non-fatigued MS subgroup (n=40)., Results: Of the fatigued MS patients, 96% (n=25) were suffering from a relevant sleep disorder, along with 60% of the non-fatigued MS patients (n=24) (p=0.001). Sleep-related breathing disorders were more frequent in the fatigued MS patients (27%) than in the non-fatigued MS patients (2.5%). Significantly higher MFIS values were detected in all (fatigued and non-fatigued) patients with relevant sleep disorders (mean MFIS 42.8; SD 18.3) than in patients without relevant sleep disorders (mean MFIS 20.5; SD 17.0) (p<0.001). Suffering from a sleep disorder was associated with an increased risk of fatigue in MS (odds ratio: 18.5; 95% CI 1.6-208; p=0.018)., Conclusion: Our results demonstrate a clear and significant relationship between fatigue and sleep disorders.

Introduction: For more than 50 years the acetylcholinesterase inhibitor pyridostigmine bromide has been the drug of choice in the symptomatic therapy for myasthenia gravis. The sustained-release dosage form of pyridostigmine (SR-Pyr) is only available in a limited number of countries (e.g. in the United States and Germany). Astonishingly, the therapeutic usefulness of SR-Pyr has not yet been evaluated., Methods: In this non-interventional prospective open-label trial, 72 patients with stable myasthenia gravis were switched from instant-release dosage forms of pyridostigmine bromide to SR-Pyr. The results from the 37 patients younger than 60 years were separately analyzed., Results: The initial daily dose of SR-Pyr was 288.1 ± 171.0mg. The drug switch was unproblematic in all patients. The number of daily doses was significantly reduced from 4.3 to 3.6 (p=0.011). The switch to SR-Pyr ameliorated the total quantified myasthenia gravis (QMG) score from 0.9 ± 0.5 to 0.6 ± 0.4 (p<0.001) in all patients and in the younger subgroup. This was accompanied by a significant improvement in the quality of life parameters. The health status valued by EuroQoL questionnaire improved from 0.626 ± 0.286 to 0.782 ± 0.186 (p<0.001). After switching to SR-Pyr, 28 adverse reactions disappeared and 24 adverse reactions occurred less frequent or weaker, however, 17 new adverse reactions were documented., Conclusions: Our results support the usefulness of SR-Pyr in an individualized therapeutic regimen to improve quality of life regardless of the patient's age in myasthenia gravis., (Copyright © 2010 Elsevier B.V. All rights reserved.)

In Germany approximately one percent of the population suffers from clinically relevant restless legs syndrome (RLS). Three non-ergoline dopamine agonists and levodopa/benserazide are now specifically licensed for RLS in Germany. Augmentation is the main complication of long-term dopaminergic treatment of RLS. Augmentation is defined as a paradoxical worsening of the symptoms during long-term dopaminergic treatment with increasing dose. According to a recent study this occurs in up to 60% of RLS patients during the first 6 months of treatment. Augmentation emerges less frequently during dopamine agonist treatment. The dopamine agonist doses required for the treatment of RLS patients is far below the dose range in Parkinson therapy. However, severe complications of dopamine agonist treatment can occur even in this dose range, like compulsive behaviours. A considerable number of RLS patients needs non-dopaminergic treatment for RLS. Most of them receive opioids as one of the second-line options in RLS therapy.