Kumru Hatice, Albu Sergiu, Vidal Joan, Barrio Manuela, Santamaria Joan
Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Universidad Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.
Department of Psychology, Texas A&M University , College Station, TX, USA.
Spinal Cord Ser Cases. 2016 Aug 18;2:16022. doi: 10.1038/scsandc.2016.22. eCollection 2016.
Recent studies report high incidence of restless legs syndrome (RLS) in patients with spinal cord injury (SCI), who may also present pain and sensory disturbances. In the present manuscript, we examine and discuss diagnostic and treatment challenges of comorbid RLS and neuropathic pain (NP) in SCI. We evaluated seven men with a mean age of 55.6 (s.d.=14.0) years, with chronic complete or incomplete SCI at the thoracic or lumbar level, for complaints of sensory disturbances in the legs, which initially were attributed to drug-resistant NP. Because overlapped RLS was suspected, clinical evaluation of NP and RLS, serum ferritin and iron level assessment, and video polysomnographic (VPSG) studies were conducted. Pramipexole (0.18 mg q.d.) was added to treat RLS, and a follow-up was performed at 2 months. We found that in six subjects the RLS was comorbid with NP and in one subject the symptoms of RLS were misdiagnosed as NP. VPSG revealed periodic limb movements (PLMs) in all patients, including PLMs of the legs, arms or both. Serum ferritin was <50 ng ml in two patients. RLS improved significantly after 2 months with pramipexole. On the basis of current findings, we recommend physicians to be aware of the comorbidity between RLS and NP secondary to SCI to include suitable diagnostic procedures and effective treatments.
近期研究报告称，脊髓损伤（SCI）患者中不安腿综合征（RLS）的发病率很高，这些患者还可能伴有疼痛和感觉障碍。在本论文中，我们研究并讨论了SCI合并RLS和神经性疼痛（NP）的诊断及治疗挑战。我们评估了7名男性患者，平均年龄55.6（标准差=14.0）岁，患有胸段或腰段慢性完全性或不完全性SCI，他们主诉腿部感觉障碍，最初这些症状被归因于耐药性NP。由于怀疑存在重叠的RLS，因此对NP和RLS进行了临床评估、检测了血清铁蛋白和铁水平，并进行了视频多导睡眠图（VPSG）研究。添加普拉克索（0.18毫克/每日）来治疗RLS，并在2个月后进行随访。我们发现，6名受试者的RLS与NP合并存在，1名受试者的RLS症状被误诊为NP。VPSG显示所有患者均有周期性肢体运动（PLM），包括腿部、手臂或两者的PLM。2名患者的血清铁蛋白<50纳克/毫升。使用普拉克索治疗2个月后，RLS有显著改善。基于目前的研究结果，我们建议医生了解SCI继发的RLS和NP之间的合并症情况，以便采用合适的诊断程序和有效的治疗方法。
