Akpinar Sevket
Erdemkent Gurgen Sokak, No. 31, 06820 Cayyolu-Ankara, Turkey.
Med Hypotheses. 2009 Aug;73(2):169-76. doi: 10.1016/j.mehy.2009.02.028. Epub 2009 Apr 24.
Restless legs syndrome (RLS) exhibits sensorimotor symptoms. In familial cases, a gene at chromosomal location 9p-24-22 is linked to RLS and the expressed mutation is Dopamine Receptor Specific Individual Sensitivity (DRSIS). The symptoms are triggered during changes in alertness, generally at sleep hours, resulting from insufficient dopamine transmission. The conscious experience of sensory abnormalities are described as 'an urge to move the limbs with or without paresthesias' leading to motor signs such as periodic limb movements and motor restlessness which exhibit temporary loss of extensor motor system dominance over the flexor motor system of the upright posture. The relationship of the expressed mutation to EEG alpha activity makes RLS a sleep disorder as well as a cognitive dysfunction. The recurrent character of sensorimotor symptoms impede the patient's ability to sleep, wake and force to move leading to insomnia. In Uner Tan Syndrome, the nonsense mutation in the same gene leads to underdevelopment of the neural substrates of upright posture. The defects include dopamine receptor deficiency (DRD) leading to severe cognitive dysfunctions and motor disorders-complete loss of extensor motor system dominance over the flexor motor system-quadrupedality, primitive speech, cerebellar symptoms, and strabismus. Comparisons between the neural substrates of sensorimotor symptoms seen in RLS and MRI findings for cases of Uner Tan Syndrome show cortico-cerebellar hypoplasias in the neural networks involved in upright posture. Both RLS and Uner Tan Syndrome seem to be due to different mutations in the dopamine receptor gene at 9p-24 locus, affecting the diencephalon dopaminergic system and the neural networks involved in upright posture.
不宁腿综合征(RLS)表现出感觉运动症状。在家族性病例中,位于染色体9p-24-22位置的一个基因与RLS相关联,所表达的突变是多巴胺受体特异性个体敏感性(DRSIS)。这些症状在警觉性变化期间触发,通常在睡眠时间,是由多巴胺传递不足引起的。感觉异常的有意识体验被描述为“一种伴有或不伴有感觉异常的肢体移动冲动”,导致诸如周期性肢体运动和运动不安等运动体征,这些体征表现出在直立姿势中伸肌运动系统对屈肌运动系统的暂时优势丧失。所表达的突变与脑电图α活动的关系使RLS成为一种睡眠障碍以及一种认知功能障碍。感觉运动症状的反复出现阻碍了患者的睡眠、觉醒和移动能力,导致失眠。在乌纳·坦综合征中,同一基因中的无义突变导致直立姿势神经基质发育不全。这些缺陷包括多巴胺受体缺乏(DRD),导致严重的认知功能障碍和运动障碍——伸肌运动系统对屈肌运动系统的完全优势丧失——四足行走、原始语言、小脑症状和斜视。对RLS中所见感觉运动症状的神经基质与乌纳·坦综合征病例的MRI结果进行比较,发现在参与直立姿势的神经网络中存在皮质小脑发育不全。RLS和乌纳·坦综合征似乎都是由于9p-24位点多巴胺受体基因的不同突变,影响了间脑多巴胺能系统和参与直立姿势的神经网络。