Showing papers by "Michael H. Silber published in 2003"

Pramipexole in the management of restless legs syndrome: an extended study.

Abstract: Study objectives To determine whether pramipexole used over an extended time for restless legs syndrome (RLS) remains effective; whether the dose of the drug needs to be increased; whether augmentation develops; and whether side effects, especially sleepiness, are prominent. Design Retrospective review of the records of consecutive patients treated with pramipexole for RLS. Setting Sleep disorders center in an academic hospital. Patients 60 consecutive patients treated with pramipexole for RLS. Interventions N/A. Measurements and results Pramipexole was completely effective in controlling RLS in 67%, partially effective in 27%, and ineffective in 7% of patients. Eleven patients (18%) discontinued pramipexole after less than 4 months; the remainder were followed for a mean of 27.2 months, during which only 4 others stopped the drug. The median daily dose increased from 0.38 mg after stabilization to 0.63 mg at the end of the study. Forty percent experienced mild side effects, most commonly insomnia, nausea or dyspepsia, and dizziness. Only 5% experienced sleepiness, and none experienced sleep attacks while driving. Augmentation developed in 33%, most in the first year and all by 30 months. Augmentation was not predictable by prior augmentation with other dopaminergic agents. Only 1 patient discontinued pramipexole because of augmentation. Conclusions Pramipexole was effective for RLS with continued response with time. Modest escalations in dose occurred, partly due to additional doses prescribed for augmentation. Side effects were common, but generally mild and tolerated. Sleepiness while driving was not a problem. Augmentation occurred in 33% of patients but was treatable with increased doses earlier in the day.

Multiple blood donations associated with iron deficiency in patients with restless legs syndrome.

Abstract: Objective To describe a series of patients with restless legs syndrome (RLS) and iron deficiency with and without anemia related to repeated blood donations. Patients and Methods Study patients were identified by asking consecutive patients with RLS seen at the Mayo Clinic in Rochester, Minn, from February 1 to December 31, 2001, whether they donated blood. All patients who fulfilled the International Restless Legs Syndrome Study Group criteria for RLS, had donated blood a minimum of 3 times a year the preceding 3 years, and had iron deficiency (serum ferritin concentration Results Eight patients met the study criteria. The mean ± SD serum ferritin concentration was 8.1±3.5 μg/L, and 4 patients had anemia. In 6 of the 8 patients, RLS began at about the same time of or after blood donation. Patients had donated blood for 4.2±1.3 times a year (range, 3-6 times a year) for 15.2±8.3 years (range, 5-25 years). Hemoglobin concentrations were 12.8±1.8 g/dL (range, 10.6-15.5 g/dL). In 2 patients, RLS essentially resolved with correction of iron stores alone, and medications for RLS were successfully discontinued in 2 other patients. Conclusions Repeated blood donation is associated with induction or perpetuation of RLS due to iron deficiency with or without coexisting anemia. Potential blood donors should be questioned about RLS, and donation should not be allowed until the serum ferritin concentration has been measured and iron stores replenished if necessary.

REM Sleep Behavior Disorder in Parkinson’s Disease, Dementia with Lewy Bodies, and Multiple System Atrophy

Abstract: Rapid eye movement sleep behavior disorder (RBD) is characterized by loss of normal skeletal muscle atonia during rapid eye movement (REM) sleep with prominent motor activity and dreaming. The evolving literature and our clinical experience suggests RBD may not simply represent an interesting parasomnia, but rather reflect dysfunction in REM sleep control that has relevance for understanding certain neurodegenerative disorders. In this chapter, we first review the clinical and polysomnographic features of RBD, criteria for diagnosis of RBD, management of RBD, pathophysiologic underpinnings of RBD, and neuroimaging findings. We then view RBD in the context of certain neurodegenerative disorders. The window that RBD provides in understanding key features of REM sleep control as well as the clinical and pathophysiologic significance of REM sleep dyscontrol in neurodegenerative disorders become clear.