Murat GÜLTEKİN, Sevda İSMAİLOĞULLARI, Murat AKSU

Comparison of motor pattern of periodic limb movements in patients with restless legs syndrome and obstructive sleep apnea syndrome

Periodic limb movements (PLMs) are repetitive and stereotypical movements of the lower extremities that occur during sleep. The purpose of this study was to analyze the leg muscle activity patterns in PLMs seen in restless legs syndrome (RLS) and obstructive sleep apnea syndrome (OSAS). Materials and methods: In this study, 1260 PLMs from 4 patients with RLS and 4 patients with OSAS were analyzed. The spreading and frequency characteristics of the gastrocnemius, medial hamstring, and vastus muscles were examined separately for each muscle in addition to the tibialis anterior muscle already included in the standard polysomnography recording. Results: A greater number of PLMs (57.34%) were observed in patients with RLS. A greater number of apnea-related PLMs (59.83%) were observed in patients with OSAS. The number of PLMs with spreading characteristics was higher in both patient groups. In both groups, the first muscle to contract was most frequently the tibialis anterior. Analysis of the subsequent contraction patterns showed no regular course in RLS and OSAS patients. Conclusion: PLMs may occur with a nonstereotypical muscle spreading pattern generated by different, independent, and, most frequently, unsynchronized spinal generators.

Anahtar Kelimeler:

Periodic limb movement, spreading pattern, restless legs syndrome, obstructive sleep apnea syndrome

Comparison of motor pattern of periodic limb movements in patients with restless legs syndrome and obstructive sleep apnea syndrome

Keywords:

Periodic limb movement, spreading pattern, restless legs syndrome, obstructive sleep apnea syndrome,

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Lugaresi E, Coccagna G, Mantovani M, Lebrun R. Some periodic phenomena arising during drowsiness and sleep in man. Electroencephalogr Clin Neurophysiol 1972; 32: 701– 705.
Symonds CP. Nocturnal myoclonus. J Neurochem 1953; 16: 166–171.
Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. 1st ed. Westchester, IL, USA: American Academy of Sleep Medicine, 2007.
Espinar-Sierra J, Vela-Bueno A, Luque-Otero M. Periodic leg movements in sleep in essential hypertension. Psychiatry Clin Neurosci 1997; 51: 103–107.
Garvey MJ, Tollefson GD. Occurrence of myoclonus in patients treated with cyclic antidepressants. Arch Gen Psychiatry 1987; 44: 269–272.
Genç H, Saracoglu, Duyur B, Erdem HR. Primer ve sekonder fibromiyalji hastalarında huzursuz bacak sendromu ve hipermobilite birlikteliği. Romatoloji ve Tıbbi Rehabilitasyon Dergisi 2002; 13: 94–97 (article in Turkish).
Myers BA, Klerman GL, Hartmann E. Nocturnal cataclysm with myoclonus: a new side effect of clomipramine. Am J Psych 1986; 143: 1490–1491.
Picchietti DL, England SJ, Walters AS, Willis K, Verrico T. Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder. J Child Neurol 1999; 13: 588–594.
Montplaisir J, Boucher S, Poirier G, Lavigne G, Lapierre O, Lespérance P. Clinical, polysomnographic and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria. Mov Disord 1997; 12: 61–65.
Baran AS, Richert AC, Douglass AB, May W, Ansarin K. Change in periodic limb movement index during treatment of obstructive sleep apnea with continuous positive airway pressure. Sleep 2003; 26: 717–720.
Baker TL, Guillminault C, Nino-Murcia G, Dement WC. Comparative polysomnographic study of narcolepsy and central nervous system hypersomnia. Sleep 1986; 9: 232–242.
Boivin DB, Montplaisir J, Poirier G. The effects of L-dopa on periodic leg movements and sleep organization in narcolepsy. Clin Neuropharmacol 1989; 12: 339–345.
Fantini ML, Michaud M, Gosselin N, Lavigne G, Montplaisir J. Periodic leg movements in REM sleep behavior disorder and related autonomic and EEG activation. Neurology 2002; 59: 1889–1894.
Walters AS, LeBrocq C, Dhar A, Hening W, Rosen R, Allen RP, Trenkwalder C. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med 2003; 4: 121–132.
Weerd de AW, Rijsman RM, Brinkley A. Activity patterns of leg muscles in movement periodic limb disorder. J Neurol Neurosurg Psychiatry 2004; 75: 317–319.
Plazzi G, Vetrugno R, Meletti S, Provini F. Motor pattern of periodic limb movements in sleep in idiopathic RLS patients. Sleep Med 2002; 3: 31–34.
Bara-Jimenez W, Aksu M, Graham B, Sato S, Hallett M. Periodic limb movements in sleep: state dependent excitability of the spinal flexor reflex. Neurology 2000; 54: 1609–1616.
Rijsman RM, Stam CJ, Weerd de AW. Abnormal H reflexes periodic limb movement disorder; impact on understanding the pathophysiology of disorder. Clin Neurophysiol 2005: 116; 204–210.