We read with great interest the paper by Boentert et al. [1]
regarding the prevalence of sleep disorders in Charcot-Marie-Tooth (CMT)
1A patients. The Authors found the presence of Restless Leg Syndrome (RLS)
in about 50% of patients with different forms of CMT, including CMT1A,
CMT1B and CMTX. Considering these results the Authors conclude that RLS is
highly prevalent not only in axonal subtypes of CMT but also in primari...
We read with great interest the paper by Boentert et al. [1]
regarding the prevalence of sleep disorders in Charcot-Marie-Tooth (CMT)
1A patients. The Authors found the presence of Restless Leg Syndrome (RLS)
in about 50% of patients with different forms of CMT, including CMT1A,
CMT1B and CMTX. Considering these results the Authors conclude that RLS is
highly prevalent not only in axonal subtypes of CMT but also in primarily
demyelinating subforms of CMT [2].
Our experience confirms a significant association of RLS with
demyelinating neuropathies including inflammatory neuropathies, as chronic
inflammatory demyelinating neuropathy (CIDP), or inherited neuropathy, as
CMT1A. We found the presence of RLS in 6/26 (23%) patients with CIDP and
4/14 (28%) patients with CMT1A (Luigetti et al., in press
http://www.aasmnet.org/jcsm/AcceptedPapers.aspx [3]). Interestingly, we
have not noted any significant association between RLS and hereditary
neuropathy with liability to pressure palsy (HNPP) that is another form of
demyelinating inherited neuropathy that shares a common genetic origin
with CMT1A, being caused by the deletion of the same region of chromosome
17 that is duplicated in CMT1A.
Probably in HNPP, where peripheral nerves are only more susceptible to
external noxious stimuli, the somato-sensory pathway is generally
preserved, thus explaining the absence of an increased prevalence of RLS
in this condition.
One major issue in evaluating the prevalence of RLS in neuropathies is the
tool used for the diagnosis. In their paper, Boentert et al. [1] applied
the criteria proposed by Allen et al. [4], even though the Authors do not
specify how many of the four requested criteria should be met to confirm
the diagnosis. In a previous paper, addressing the association between RLS
and neuropathies, different criteria were applied: i.e. Hattan et al. [5]
"considered any subject who responded positively to three of the four
questions to be screen-positive for RLS." The decision to assess RLS by
the presence of three rather than all four criteria can lead to over
esteem the prevalence of RLS in a cohort of neuropathic patients. Larger
multicenter studies, based on widely accepted diagnostic criteria, are
needed to evaluate the strength of the association between RLS and
neuropathies.
Marco Luigetti and Giacomo Della Marca.
Institute of Neurology, Catholic University of Sacred Heart, Rome-Italy
References
1) Boentert M, Knop K, Schuhmacher C, et al. Sleep disorders in
charcot-marie-tooth disease type 1. J Neurol Neurosurg Psychiatry 2013
2) Gemignani F, Marbini A, Di Giovanni G, et al. Charcot-marie-tooth
disease type 2 with restless legs syndrome. Neurology 1999;52:1064-6.
3) Luigetti M, Del Grande A, Testani E, et al. Restless leg syndrome
in different types of demyelinating neuropathies: A single-centre pilot
study. Journal of clinical sleep medicine : JCSM : official publication of
the American Academy of Sleep Medicine in press
4) Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome:
Diagnostic criteria, special considerations, and epidemiology. A report
from the restless legs syndrome diagnosis and epidemiology workshop at the
national institutes of health. Sleep Med 2003;4:101-19.
5) Hattan E, Chalk C, Postuma RB. Is there a higher risk of restless
legs syndrome in peripheral neuropathy? Neurology 2009;72:955-60.
We read with interest the article written by de Seze et al(de Seze,
Blanc et al. 2010), published on the April 2010 issue of the Journal of
Neurology, Neurosurgery and Psychiatry. The authors describe a transversal
investigational research comparing magnetic resonance spectroscopy (MRS)
of NAWM and NAGM of 24 patients with NMO, 46% of whom had brain
abnormalities, and 12 healthy subjects. In this st...
We read with interest the article written by de Seze et al(de Seze,
Blanc et al. 2010), published on the April 2010 issue of the Journal of
Neurology, Neurosurgery and Psychiatry. The authors describe a transversal
investigational research comparing magnetic resonance spectroscopy (MRS)
of NAWM and NAGM of 24 patients with NMO, 46% of whom had brain
abnormalities, and 12 healthy subjects. In this study, the authors found
no difference on Naa/Cr of NAWM and NAGM in patients with NMO comparing to
healthy controls, an information that corroborates the idea that there is
no silent and continuous degenerative process in the SNC tissues of
patients with NMO(Wingerchuk, Pittock et al. 2007).
The authors state that they had no previous knowledge of MRS studies
on NMO, so we would like to share our experience evaluating the NAWM of 16
patients with NMO and 16 age matched healthy control subjects. We
described similar results, i.e., there was no difference in NAWM of
patients and healthy volunteers(Bichuetti, Rivero et al. 2008). We also
included patients with brain abnormalities and cautiously positioned the
voxel away from brain lesions to avoid changes in the metabolic pattern of
the spectrum in this region. We further evaluated 41 patients with
relapsing NMO in order to clarify if the brain abnormalities seen on
recent studies(Pittock, Lennon et al. 2006; Bichuetti, Rivero et al. 2008)
correlate with a worse prognosis, and found that there is no different on
annualized relapse rate and progression index between patients with or
without brain abnormalities, in our cohort.(Bichuetti, Oliveira et al.
2009). We were not able to evaluate the impact of NMO-IgG positivity in
our cohort since the test was not available in Brazil during the period we
conducted the study.
We congratulate de Seze et al for their very interesting work and
would like to encourage them and other investigators to look for their
clinical data in order to search for clinical marker of disease severity,
as well as MRI/clinical correlations.
Aboul-Enein, F., M. Krssak, et al. (2010). "Diffuse white matter
damage is absent in neuromyelitis optica." AJNR Am J Neuroradiol 31(1): 76
-79.
Bichuetti, D., E. Oliveira, et al. (2009). "Neuromyelitis optica in
Brazil: a study on clinical and prognostic factors." Mult Scler 15(5): 613
-619.
Bichuetti, D. B., R. L. Rivero, et al. (2008). "White matter
spectroscopy in neuromyelitis optica: a case control study." J Neurol
255(12): 1895-1899.
Bichuetti, D. B., R. L. Rivero, et al. (2008). "Neuromyelitis optica:
brain abnormalities in a Brazilian cohort." Arq Neuropsiquiatr 66(1): 1-4.
de Seze, J., F. Blanc, et al. (2010). "Magnetic resonance
spectroscopy evaluation in patients with neuromyelitis optica." J Neurol
Neurosurg Psychiatry 81(4): 409-411.
Pittock, S. J., V. A. Lennon, et al. (2006). "Brain abnormalities in
neuromyelitis optica." Arch Neurol 63(3): 390-396.
Wingerchuk, D. M., S. J. Pittock, et al. (2007). "A secondary
progressive clinical course is uncommon in neuromyelitis optica."
Neurology 68(8): 603-605.
We read the viewpoint on leg stereotypy1 by Joseph Jankovic with great interest. He has described leg stereotypy as repetitive, 1-4 Hz flexion extension, abduction-adduction movement at hips when the patient is seated and the feet rest on the floor.1 This movement has also been described to manifest as flexion extension at the knee joint or as tapping movement of foot.1 Patients as per this description have also been found to have...
We read the viewpoint on leg stereotypy1 by Joseph Jankovic with great interest. He has described leg stereotypy as repetitive, 1-4 Hz flexion extension, abduction-adduction movement at hips when the patient is seated and the feet rest on the floor.1 This movement has also been described to manifest as flexion extension at the knee joint or as tapping movement of foot.1 Patients as per this description have also been found to have some anxiety when asked to control these movements and also have an inner need to move their legs due to mounting tension. Additionally this movement has been described to reappear on distracting the patient.
Stereotypy has been defined as a non-goal-directed movement pattern that is repeated continuously for a period of time in the same form and on multiple occasions, and which is typically distractible.2,3 The key word discernable from this definition is its distractibility. These movements usually disappear when the patient is distracted with various stimuli especially when observed upon by others. This is in contrast with the above mentioned article where the patient's movements reappeared on distracting the patient. Second, stereotypic movements are not associated with an inner urge to perform the movement or to reduce an inner tension by performing the movement. This feature again contradicts with findings described in the above mentioned article in which patients experience an inner need to make the movement in response to an inner need. Such premonitory urges have however been described in the phenomenology of tics.4 Hence the reappearance of movement on distraction and presence of an inner urge to perform the movement create an uncertainity whether the described leg movement should be termed as stereotypy.
References
1. Leg stereotypy disorder. Jankovic J. J Neurol Neurosurg Psychiatry 2015;0:1-2.
2. Stereotypies: A Critical Appraisal and Suggestion of a Clinically Useful Definition. Mark J. Edwards, Anthony E. Lang,Kailash P. Bhatia. Movement Disorders, Vol. 27, No. 2, 2012.
3. Pandey S, Sarma N. Stereotypy After Acute Thalamic Infarct. JAMA Neurol. 2015;72(9):1068.
4. Christos Ganos, Davide Martino. Tics and Tourette Syndrome. Neurol Clin 33 (2015) 115-136.
Vestibular paroxysmia has been defined classically by series of
rotational to-and-fro vertigo, precipitated or modulated by head
position.Then , descriptional basis of the clinical picture may be
disclosed if vertigo may be associated to hipoacusis and tinitus or not.
In the case of pure tinnitus description , the loud / low pitch
sound of the tinnitus may be defined as paroxysmal tinnitus.
Ethilogical purposes...
Vestibular paroxysmia has been defined classically by series of
rotational to-and-fro vertigo, precipitated or modulated by head
position.Then , descriptional basis of the clinical picture may be
disclosed if vertigo may be associated to hipoacusis and tinitus or not.
In the case of pure tinnitus description , the loud / low pitch
sound of the tinnitus may be defined as paroxysmal tinnitus.
Ethilogical purposes have been described considering neurovascular
compression : a vascular compression of the eight cranial nerve , defined
in up to 65 % of samples ( vascualr loops in the internal auditory canal )
. Mechanisms have been proposed , such as ectopic discharges / conduction
block ( vestibular hypofunction / excitation ).
Recent findings enhance the role of amygdalohippocampal , cochlear and
temporal cortex in tinnitus pathogenesis .What should be discerned is the
concurrent importance of ephaptic transmission in a solely description /
plus or not central mechanisms derived of such condition.
References:
-Strupp M et al. Acute vestibulopathy. Curr Opin neurol 2001 ; 14: 11-20.
We are grateful for the notificiation that restless legs syndrome
(RLS) has been found to be associated also with demyelinating neuropathies
other than CMT type 1. It would be interesting to further investigate the
putative association between RLS and sensory symptoms in the conditions Dr
Luigetti and Dr Della Marca mention in the response to our article. With
regard to the prevalence of RLS in patients with CMT1 we would...
We are grateful for the notificiation that restless legs syndrome
(RLS) has been found to be associated also with demyelinating neuropathies
other than CMT type 1. It would be interesting to further investigate the
putative association between RLS and sensory symptoms in the conditions Dr
Luigetti and Dr Della Marca mention in the response to our article. With
regard to the prevalence of RLS in patients with CMT1 we would like to
state that we found a prevalence of 40.9% in the study population (not
50%). In our study, diagnosis of RLS was only confirmed when all four
diagnostic criteria for RLS (proposed by Allen et al.)were met. Thus, over
-estimation of RLS frequency cannot be ascribed to diagnostic inaccuracy.
However, we already mentioned in our article that RLS prevalence was
unexpectedly high in our study which may be due to a selection of patients
with RLS during patient recruitment.
We read with a great interest the article of Mart?nez-Lapiscina et
al.[1] which elegantly demonstrate how an intervention with Mediterranean
Diets enhanced with either extra-virgin olive oil or nuts supplements
appears to improve cognition compared with a generic low-fat diet.
Concurrently, elsewhere, the article in "Epidemiology" by Samieri et
al.[2] casts doubt on the available evidence that Adherence to a
Mediterran...
We read with a great interest the article of Mart?nez-Lapiscina et
al.[1] which elegantly demonstrate how an intervention with Mediterranean
Diets enhanced with either extra-virgin olive oil or nuts supplements
appears to improve cognition compared with a generic low-fat diet.
Concurrently, elsewhere, the article in "Epidemiology" by Samieri et
al.[2] casts doubt on the available evidence that Adherence to a
Mediterranean diet may help prevent cognitive decline in older age. We
agree with the limitations discussed(2) since many questions are still
open, warranting randomized trials, as the study published by your Journal
is[1].We should like to add some comment for a more comprehensive
discussion on this important subject. It is our opinion that any study on
the effects of healthier nutritional profiles, such Mediterranean Diet is
currently considered, should need more broad information within
epidemiological studies and more focused tools in interventions; among
them the assessment and the modification of sedentary habits have a very
critical relevance, throughout the life, including its cornerstones, such
as pregnancy. All behaviors are linked each other and interferences are
very likely. We reported that effectiveness of a dietary intervention is
facilitated by the enhancement of self-efficacy, i.e. by the awareness of
the benefits of the diet itself and its affordability(3). Self-efficacy,
Mediterranean diet adherence and olive oil intake were significant
independent predictors of the increase of physical activity achieved by
counseling(3). Also the epidemiology of cognitive decline has several
interrelated components: it is recognized that physical exercise has a
retarding effect on cognitive decline, and therapeutic effects are also
described(4). Patients and Methods. We performed a reappraisal of our
counseling intervention study (6 months) aimed at increasing Adherence to
Mediterranean Diet Score (AMDS; range 0-55) and at reducing sedentary
habits, assessed by detailed physical activity reports (Baecke tool) in
overweight-moderately obese subjects. The study was performed in 138
subjects,(males 61, females 77, years 49.95?14.88); suggestions and advice
on individual "healthy" food purchase, storage and cooking were given.
Reliable feedback and evidence of patients' adherence were obtained by
scheduled dietician's interviews at the beginning of the study and after
six months. Health psychology tools, i.e. GSE (General Self-Efficacy), PSM
(Psychological Stress Measure) and HAD (Hospital Anxiety Depression Scale)
validated in our population, are currently used in our preliminary and
post-intervention assessment, and not previously reported. Results.
Challenging the predictive effects of changes of Adherence to
Mediterranean Diet (?AMDS) and of changes of physical activity (?Baecke),
of ?GSE and of ?PSE vs. ?HAD, in an age-balanced model, we found that
both Mediterranean Diet Adherence and Physical Activity increase explain
(R2 0.309 ; p<0.0001) the decrease of the level of anxiety: this
provides evidence of the links among mood, cognition and stress with diet
and exercise. By Odds Ratio, the increase of AMDS is associated with
decreased hazard of Anxiety (Odds Ratio 0.653; 95% CI 0.292-1.463) so that
Mediterranean Diet is seemingly a protective factor against anxiety.
Differently, increase of Physical Activity is associated with an increased
hazard of depression (Odds Ratio 1.298; 95% CI 0.561-3.004), while the
increase of AMDS is associated with a decreased hazard of depression (Odds
Ratio 0.793 ; 95% CI 0.343-1.831); so Mediterranean Diet may be
beneficial against depression occurrence. Conclusion. Mediterranean Diet
is associated with lower hazard of depression and may be beneficial
against its occurrence and, as well, against the hazard of anxiety. No
favorable effect on depression is associated with the increase of physical
activity. Even discordant, we think that contributions along these lines
will enhance further accurate and extensive clinical research, which
should include the concurrent but not univocal effects of different
lifestyle interventions.
REFERENCES
[1] Mart?nez-Lapiscina EH, Clavero P,et al. Mediterranean diet improves
cognition: the PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg
Psychiatry. 2013 May 13. [Epub ahead of print]
[2] Samieri C, Grodstein F, Rosner BA,et al. Mediterranean Diet and
Cognitive Function in Older Age. Epidemiology. 2013;24:490-499.
[3] Catalano D, Trovato GM, Pace P, Martines GF, Trovato FM. Mediterranean
diet and physical activity: An intervention study. Does olive oil exercise
the body through the mind? Int J Cardiol. 2013 May 25. [Epub ahead of
print]
[4] Buchman AS, Boyle PA, Yu L, Shah RC, Wilson RS, Bennett DA. Total
daily physical activity and the risk of AD and cognitive decline in older
adults. Neurology. 2012;78:1323-9.
We appreciate the comments by Trovato FM et al in their Letter to the
Editor regarding our recently published trial on Mediterranean Diet
(MedDiet) and cognition (The PREDIMED-NAVARRA trial) [1]. The PREDIMED-
NAVARRA trial found a favorable effect of MedDiet on cognitive function
[1]. This protection was independent of other confounders including mood
disorders and physical activity. In a previous report, Trovato et al
s...
We appreciate the comments by Trovato FM et al in their Letter to the
Editor regarding our recently published trial on Mediterranean Diet
(MedDiet) and cognition (The PREDIMED-NAVARRA trial) [1]. The PREDIMED-
NAVARRA trial found a favorable effect of MedDiet on cognitive function
[1]. This protection was independent of other confounders including mood
disorders and physical activity. In a previous report, Trovato et al
stressed the complex relationships between cognition, mood disorders and
lifestyle factors, such as MedDiet and physical activity [2]. We concur
with them that mood disorders, MedDiet, physical activity and other
lifestyle factors jointly influence cognitive performance. Adjusting for
all these factors is the accepted strategy in observational studies to
deal with confounding. However, the PREDIMED-NAVARRA trial followed a
randomised design and the randomisation allowed us to reduce the
possibilities for residual confounding. Furthermore, when we adjusted for
some factors, including incident depression, our results did not change.
We decided to adjust for depression as a potential confounder because the
available evidence points to a protective effect of MedDiet on depression.
Recently, a meta-analysis has reported a protective effect of MedDiet on
depression (pooled RR=0.68, 95%CI: 0.54-0.86) [3]. This meta-analysis was
almost completely based on cross-sectional findings (regarding
depression), since few longitudinal studies have focused on this topic.
Among longitudinal studies, it is worthwhile to underline that Sanchez-
Villegas A et al showed that a better adherence to the MedDiet pattern was
associated with lower incidence of depression after 4.4-year of median
follow-up in the Seguimiento Universidad de Navarra (SUN) cohort study.
Interestingly, an inverse dose-response trend was found [4].
In any case, we agree with Trovato et al that an extensive clinical
research is needed to further understand the complex mechanisms by which
lifestyle-based preventive strategies can influence the risk of cognitive
impairment, depression and other chronic diseases.
REFERENCES
1. Martinez-Lapiscina EH, Clavero P, Toledo E, et al. Mediterranean
diet improves cognition: the PREDIMED-NAVARRA randomised trial. J Neurol
Neurosurg Psychiatry 2013;84:824-6.
2. Trovato GM, Catalano D, Martines GF, et al. Mediterranean diet:
Relationship with anxiety and depression. Ann Neurol 2013. Aug 8. [Epub
ahead of print]
3. Psaltopoulou T, Sergentanis TN, Panagiotakos DB, et al. Mediterranean
diet and stroke, cognitive impairment, depression: A meta-analysis. Ann
Neurol 2013. May 30 [Epub ahead of print]
4. Sanchez-Villegas A, Delgado-Rodriguez M, Alonso A, et al. Association
of the Mediterranean dietary pattern with the incidence of depression: the
Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN)
cohort. Arch Gen Psychiatry 2009;66:1090-8.
We read with great interest the paper by Boentert et al. [1] regarding the prevalence of sleep disorders in Charcot-Marie-Tooth (CMT) 1A patients. The Authors found the presence of Restless Leg Syndrome (RLS) in about 50% of patients with different forms of CMT, including CMT1A, CMT1B and CMTX. Considering these results the Authors conclude that RLS is highly prevalent not only in axonal subtypes of CMT but also in primari...
Dear Editor,
We read with interest the article written by de Seze et al(de Seze, Blanc et al. 2010), published on the April 2010 issue of the Journal of Neurology, Neurosurgery and Psychiatry. The authors describe a transversal investigational research comparing magnetic resonance spectroscopy (MRS) of NAWM and NAGM of 24 patients with NMO, 46% of whom had brain abnormalities, and 12 healthy subjects. In this st...
Vestibular paroxysmia has been defined classically by series of rotational to-and-fro vertigo, precipitated or modulated by head position.Then , descriptional basis of the clinical picture may be disclosed if vertigo may be associated to hipoacusis and tinitus or not.
In the case of pure tinnitus description , the loud / low pitch sound of the tinnitus may be defined as paroxysmal tinnitus. Ethilogical purposes...
We are grateful for the notificiation that restless legs syndrome (RLS) has been found to be associated also with demyelinating neuropathies other than CMT type 1. It would be interesting to further investigate the putative association between RLS and sensory symptoms in the conditions Dr Luigetti and Dr Della Marca mention in the response to our article. With regard to the prevalence of RLS in patients with CMT1 we would...
We read with a great interest the article of Mart?nez-Lapiscina et al.[1] which elegantly demonstrate how an intervention with Mediterranean Diets enhanced with either extra-virgin olive oil or nuts supplements appears to improve cognition compared with a generic low-fat diet. Concurrently, elsewhere, the article in "Epidemiology" by Samieri et al.[2] casts doubt on the available evidence that Adherence to a Mediterran...
We appreciate the comments by Trovato FM et al in their Letter to the Editor regarding our recently published trial on Mediterranean Diet (MedDiet) and cognition (The PREDIMED-NAVARRA trial) [1]. The PREDIMED- NAVARRA trial found a favorable effect of MedDiet on cognitive function [1]. This protection was independent of other confounders including mood disorders and physical activity. In a previous report, Trovato et al s...
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