不宁腿综合征〔复旦大学华山医院王坚〕.ppt

复旦大学华山医院 王坚 根据对治疗的反应，推测RLS机制： 铁代谢异常 多巴胺功能异常 RLS的自然进程 变数很大 目前的研究均来源于严重病例，不能反映真实的情况 总体上，缓慢进展，但部分患者可有自发缓解。 但有报道，个别分娩后RLS持续存在。 继发性RLS：当病因去除后，多数RLS持续缓解。 特殊时期可发生RLS 有报道，20％孕妇出现RLS 20％－62％透析者出现RLS 与周围神经病关系密切 PD中的RLS 一项303例的PD患者研究发现19．5％患者同时存在不安腿综合征 应用左旋多巴治疗也同样存在剂量逐渐增加，并出现类似于PD患者的症状波动、运动障碍等表现。 周期性腿部运动(PLM) 除了RLS外，还可以出现在： 睡眠呼吸暂停 神经变性疾病 脊髓损坏 中风 发作性睡病 抗抑郁剂、精神类药物 积极治疗原发病 如果能找到病因，原发病的治疗和加重因 素的去除对于减轻病人的症状往往奏效。 仅是抛砖引玉。感兴趣，与大家探讨。 Objective tests can be helpful in doubtful cases, but have not become accepted as diagnostic criteria 难以名状。即便好不容易表达出了，也是一种怪异的感觉。 The most recent standards emphasize the presence of one main symptom—the urge to move—and three key modulators: rest, activity, and time of day. Movement immediately relieves the symptoms, and continued movement (such as walking) provides ongoing relief. However, if patients stop moving their legs, the symptoms may return. Ignoring the urge to move the legs may lead to progressive intensification of the akathisia, until patients either move their legs or the legs jerk involuntarily. Although initially the symptoms occur at bedtime or during the night, as the syndrome progresses, symptoms start to occur earlier in the day and become more intense at night. Even when they occur throughout the day, the symptoms are always worst in the evening or at night. 尤其是小纤维性周围神经病与晚发性RLS关系密切。 如肾功能障碍，帕金森病等。 Series of periodic limb movements in a sleeping patient. These occur almost exclusively in the left leg. Burst at arrow shows several initial high amplitude brief components. Middle burst in record is prolonged, consistent with an arousal leading to voluntary prolongation of movement. After this burst, there is an altered EEG rhythm and EMG activity spreading to chin and right leg, as well as altered respiratory rhythm. (Chin EMG has respiratory artifacts through tracing). The bursts recur in a nearly periodic fashion. Top four traces—EEG from vertex (top two traces) and occiput (third and fourth traces) referenced to the oppo