不安腿综合征在功能性运动障碍中的患病率：来自捷克共和国的一项病例对照研究。
Prevalence of restless legs syndrome in functional movement disorders: a case-control study from the Czech Republic.
机构信息
Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic.
Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
出版信息
BMJ Open. 2019 Jan 21;9(1):e024236. doi: 10.1136/bmjopen-2018-024236.
OBJECTIVES
The prevalence of restless legs syndrome (RLS) in functional movement disorders (FMD) is not known. Patients with FMD often present with multiple motor and sensory symptoms. Some of these symptoms might be due to comorbid RLS. Therefore, our objective was to evaluate possible association between FMD and RLS.
DESIGN
Case-control study.
SETTING
Movement Disorders Center, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic.
PARTICIPANTS
96 consecutive patients with clinically established FMD (80 females, mean age (SD) 45.0 (13) years), and 76 matched controls.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome measure was prevalence of RLS based on updated International RLS Study Group criteria. Secondary outcome measures included prevalence of periodic limb movements (PLM) using actigraphy; pain, motor and sensory symptoms in lower limbs; organic comorbidities and medication affecting RLS.
RESULTS
RLS criteria were fulfilled in 43.8% of patients (95% CI 34 to 54) and in 7.9% of controls (95% CI 3 to 17, p<0.00001). Both RLS and PLM indices (PLMi) ≥22.5/hour were found in 21.2% of patients with FMD and 2.6% of controls. Patients with FMD with RLS had a higher mean PLMi (p<0.001) and a higher proportion of PLMi ≥22.5/hour (p<0.01) than RLS-negative patients. Patients with RLS had higher prevalence of pain and sensory symptoms in lower limbs, no difference was found in medication and prevalence of organic comorbidities in patients with FMD with and without RLS.
CONCLUSIONS
We found an increased prevalence of RLS in patients with FMD. Clinical diagnosis of RLS was supported by actigraphic measurement of clinically relevant PLM in a significant proportion of patients with FMD. Although functional motor and sensory symptoms may mimic RLS, RLS may be unrecognised in patients with FMD. This finding may have clinical implications in management of FMD, and it raises the possibility of common pathophysiological mechanisms of FMD and RLS/PLM.
目的
尚不清楚不安腿综合征（RLS）在功能性运动障碍（FMD）中的患病率。FMD 患者常出现多种运动和感觉症状。其中一些症状可能是由于合并 RLS 引起的。因此，我们的目的是评估 FMD 和 RLS 之间可能存在的关联。
设计
病例对照研究。
地点
捷克布拉格第一医学院和综合大学医院运动障碍中心。
参与者
96 例临床确诊的 FMD 连续患者（80 名女性，平均年龄（SD）45.0（13）岁）和 76 名匹配的对照。
主要和次要结果测量
主要结果测量是根据更新的国际 RLS 研究组标准确定的 RLS 患病率。次要结果测量包括使用活动记录仪测量周期性肢体运动（PLM）的患病率；下肢疼痛、运动和感觉症状；影响 RLS 的器质性合并症和药物治疗。
结果
43.8%（95%置信区间 34 至 54）的患者符合 RLS 标准，7.9%（95%置信区间 3 至 17）的对照组符合标准（p<0.00001）。在 FMD 患者中，21.2%和对照组中 2.6%发现同时存在 RLS 和 PLM 指数（PLMi）≥22.5/小时。患有 FMD 的 RLS 患者的平均 PLMi 更高（p<0.001），PLMi≥22.5/小时的比例更高（p<0.01）。患有 RLS 的患者下肢疼痛和感觉症状的患病率较高，但 FMD 患者中无论是否存在 RLS，药物治疗和器质性合并症的患病率均无差异。
结论
我们发现 FMD 患者的 RLS 患病率增加。在 FMD 患者中，PLM 的临床相关测量在很大一部分患者中支持 RLS 的临床诊断。尽管功能性运动和感觉症状可能与 RLS 相混淆，但 RLS 在 FMD 患者中可能未被识别。这一发现可能对 FMD 的治疗具有临床意义，并提出了 FMD 和 RLS/PLM 之间可能存在共同病理生理机制的可能性。
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