Han Jin-Kyu, Oh Kyungmi, Kim Byung-Jo, Koh Seong-Beom, Kim Ju-Yeon, Park Kun-Woo, Lee Dae-Hie
Department of Neurology, Korea University Medical Center, Korea University College of Medicine, #126-1, Anam-Dong 5Ga, Seongbuk-Gu, Seoul 136-705, Republic of Korea.
Clin Neurophysiol. 2007 Aug;118(8):1705-10. doi: 10.1016/j.clinph.2007.04.024. Epub 2007 Jun 22.
To investigate the pathophysiological relationship between RLS and small fiber neuropathy using the cutaneous silent period (CSP), which is a spinal reflex mediated by Adelta cutaneous afferents and is useful for the evaluation of small-diameter nerve function.
The CSP was measured from the extensor digitorum brevis in 157 patients with RLS and 60 healthy controls. The CSP measurement was repeated in the RLS patients after dopamine agonist treatment for one month. The RLS rating scale for clinical severity was used to evaluate each patient before and after treatment. The measured CSP variables were compared between the patient group and the control group. In addition, the possible correlation between the CSP variables and the RLS rating scale score related to treatment was analyzed.
The mean CSP latencies did not differ between the RLS patients and the healthy controls; however, the mean CSP duration was significantly longer in the RLS patients than in the controls, and this prolonged CSP duration improved to the level of the control subjects after dopamine agonist treatment (p=0.003). The mean RLS rating scale score also significantly decreased after medication (p=0.000). However, the changes in the CSP variables did not correlate with the decrement in the RLS rating scale score.
Although our results do not support the role of Adelta fiber dysfunction in RLS, the observed change in CSP duration may be useful as a clinical measure of the improvement with dopamine agonist treatment in patients with RLS.
Further study is needed to elucidate the exact mechanism involved in the prolonged CSP duration in response to treatment.
使用皮肤静息期（CSP）来研究不宁腿综合征（RLS）与小纤维神经病变之间的病理生理关系，皮肤静息期是一种由Aδ皮肤传入神经介导的脊髓反射，对评估小直径神经功能有用。
对157例不宁腿综合征患者和60名健康对照者的趾短伸肌进行皮肤静息期测量。不宁腿综合征患者在接受多巴胺激动剂治疗1个月后重复进行皮肤静息期测量。使用不宁腿综合征临床严重程度评分量表对每位患者治疗前后进行评估。比较患者组和对照组之间测量的皮肤静息期变量。此外，分析皮肤静息期变量与不宁腿综合征治疗相关评分量表得分之间可能的相关性。
不宁腿综合征患者与健康对照者的平均皮肤静息期潜伏期无差异；然而，不宁腿综合征患者的平均皮肤静息期持续时间显著长于对照组，多巴胺激动剂治疗后这种延长的皮肤静息期持续时间改善至对照受试者水平（p = 0.003）。用药后不宁腿综合征评分量表平均得分也显著降低（p = 0.000）。然而，皮肤静息期变量的变化与不宁腿综合征评分量表得分的降低无关。
虽然我们的结果不支持Aδ纤维功能障碍在不宁腿综合征中的作用，但观察到的皮肤静息期持续时间的变化可能作为不宁腿综合征患者多巴胺激动剂治疗改善情况的临床指标。
需要进一步研究以阐明治疗后皮肤静息期持续时间延长所涉及的确切机制。
