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Periodic limb movements of sleep & the restless legs syndrome

  [ 38 votes ]   [ Discuss This Article ] • September 5, 1996

Periodic limb movements of sleep and the restless legs syndrome are
not diagnoses but rather an indication that there is some CNS
disturbance and are associated with an ever-growing number of
conditions. They are very common, exist in many forms and are
often overlooked by physicians. It is the author's opinion
thatthey are parts of what has been called an akathisia
syndrome in the most severe situations and may include the
same mechanisms that underlie attention disorders, chronic
fatigue syndrome and"sun-downing." They are likely parts of
a syndrome caused by dysfunction in a complex brainstem
center. This center's normal function is to maintain a smooth
electrical template on which discrete neuronal impulses
sculpture the rich repertoire we recognize as sensory and
motor function awake and to effect asmooth "switching"
mechanism allowing sleep to occur withoutmotor and sensory
input invading consciousness (awakening). While the DA-ergic
CNS pathways have been thought to be the primary
neurotransmitter involved, the opioids secondary, there is
mounting evidence that the situation is far more complicated,
that many neurotransmitter, including stimulating and
inhibitingamino acids, play a part. These patients agonize
with their indisposition but can be helped by various
treatments. Treatment alleviates not only the distress caused
by the symptoms but also the devastating insomnia and
excessive daytime sleepinessassociated with it.

Williams DC

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