L-dopa therapy of uremic and idiopathic restless legs syndrome: a double-blind, crossover trial.

We report the effects of a single bedtime dose of L-dopa 100-200 mg on sleep quality, frequency of periodic leg movements (PLM) and daily living in patients with idiopathic and uremic restless legs syndrome (RLS). Seventeen patients with idiopathic and 11 with uremic (on continuous hemodialysis) RLS were evaluated comparatively by polysomnography, actigraphy and subjective ratings in a randomized, controlled and double-blind crossover trial with L-dopa and placebo for 4 weeks each. Neurophysiologic assessments showed significant reduction of the number of periodic leg movements (p = 0.003) and the PLM-index (p = 0.005) most pronounced during the first 4 hours of bedtime after L-dopa (p = 0.001). Subjective evaluation confirmed improvement of sleep quality (p = 0.002) and showed significantly higher quality of life during daytime (p = 0.030) while the patients received L-dopa therapy. We conclude that L-dopa 100-200 mg proved to be effective in idiopathic RLS and for the first time under controlled conditions in uremic RLS without any severe side effects.

New actigraphic assessment method for periodic leg movements (PLM).

A new actigraphic method by which periodic leg movements (PLM) can be measured is presented. Data acquistion and analysis were brought into line to distinguish short-lasting repetive leg movements from random motor restlessness. The definition of PLM follows the generally accepted criteria for PLM scoring. Thirty restless legs patients, all also suffering from PLM, were investigated three times by polysomnography, including tibialis anterior surface electromyography and actigraphy. A high correlation (reliability) was found for the number of PLM per hour spent in bed between the two methods. Furthermore, the actigraph records PLM specifically. An index of random motor restlessness is not sufficient for a reliable PLM according. In addition, periodic movements in sleep (PMS) and PLM show comparable variability in general. The actigraphic assessment of PLM, however, gives a better measure because PMS recordings may result in a substantial underestimation of PLM when sleep efficiency is reduced. This method is an ambulatory assessment tool that can also be used for screening purposes.

[Treatment of idiopathic and uremic restless legs syndrome with L-dopa--a double-blind cross-over study]. / Behandlung des idiopathischen und urämischen Restless-legs-Syndrom mit L-Dopa--Eine doppelblinde Cross-over-Studie.

In a randomized, controlled and double-blind cross-over trial with L-Dopa and placebo we evaluated the effects of a single bedtime dose of L-Dopa 100 to 200 mg on sleep quality and frequency of periodic leg movements (PLM) in 17 patients with idiopathic and in 11 patients with uremic restless legs syndrome (RLS) by polysomnography, actigraphy, and subjective ratings. Treatment with L-Dopa showed significant reduction of the number of periodic leg movements and the PLM-index most pronounced during the first 4 hours of bedtime. Subjective evaluation confirmed improvement of sleep quality. L-Dopa proved to be effective in idiopathic and uremic RLS without any severe side effects.

[Growing-up of children from HIV-positive mothers in Switzerland. Pediatric AIDS-Group Switzerland]. / Aufwachsen der Kinder HIV-positiver Mütter in der Schweiz. Padiatrische AIDS-Gruppe Schweiz.

OBJECTIVE: The social situation (placements, material conditions, needs) of children of HIV-infected mothers living in Switzerland was studied and their future needs were estimated. METHOD: Data were gathered by anonymous questionnaires mailed to the primary care physicians of the children of HIV-infected mothers registered in the Swiss Neonatal HIV Study. The physicians handed a copy to the parents or guardians. RESULTS: The social situation could be adequately evaluated for 84 children. With respect to the proportion of mothers with a history of intravenous drug use (75%) or of foreign origin (19%), the children did not differ significantly from the whole population represented in the Swiss Neonatal HIV Study. Of a total of 3154 months, the children spent 75% with their natural mother, 14% with other family members, 6% in a foster family, 3% in a foster home and 2% with adoptive parents. At the time of the study 32 children (38%) could not be cared for by their own mother. The cumulative probability (by the Kaplan-Meier method) of continuing care by the mother was estimated at 78%, 70%, 60% and 50% for an age of 12, 24, 36 and 48 months respectively. Maternal reasons for placement in foster care were: enrollment in an institutional drug withdrawal program (11), neglect (8), death (8) or illness (5). The following ways of improving social conditions were identified: social acceptance without discrimination, early planning of the future care of children in anticipation of the imminent disruption of the family, financial support, assistance in baby sitting and support groups for parents and guardians. CONCLUSION: A minimum annual requirement of 25 new foster care places for children of HIV-infected mothers can be estimated--assuming a stable annual incidence of some 50 deliveries of seropositive women in Switzerland. For primary care physicians it is a major challenge to stay sufficiently informed about the ever changing social situation in order to identify the often wide variety of assistance needed by the family. The quality and coordination of medical and psychosocial care for families confronted with HIV infection definitely needs improvement, especially outside metropolitan areas.

Urinary excretion patterns of endogenously produced alcohols in type 1 (IDDM) and type 2 (NIDDM) diabetes mellitus compared with healthy control subjects.

Urinary excretion patterns of various endogenously produced alcohols, such as ethanol, propanol, isobutanol, butanol, and isopentanol, were evaluated in 17 type 1 (IDDM) and 15 type 2 (NIDDM) diabetic patients, and in two different groups of healthy control subjects (n = 12, n = 8, respectively) matched for sex, age and weight. In addition to the urinary alcohol excretion determined by gas-chromatography and mass-spectrometry, four cardiovascular reflex tests were performed, and the motor and sensory conduction velocities of three different peripheral nerves were measured. In the type 1 diabetic patients, urinary excretions of ethanol and propanol were significantly higher than in the control subjects (P less than 0.0001, P less than 0.00001, respectively), whereas the control subjects exhibited significantly higher urinary excretion rates of the other three alcohols (P less than 0.007, P less than 0.02 and P less than 0.002, respectively) compared with the type 1 diabetic patients. In the type 2 diabetic patients, only the urinary excretion of propanol was significantly elevated (P less than 0.002) compared with the control subjects, while the urinary excretion rates of butanol and isopentanol were significantly lower (P less than 0.02, P less than 0.05, respectively) than in the controls. Urinary alcohol excretions were not related to diabetic peripheral neuropathy in both groups studied. The clinical meaning of the urinary excretion patterns of different endogenously produced alcohols in diabetes mellitus has to be further evaluated.

[Patients born in autumn more frequently develop atopic eczema]. / Im Herbst Geborene erkranken häufiger am atopischen Ekzem.

Data of birth from 4040 atopic dermatitis patients born in the Berlin area were analyzed in view of their distribution over the 12 months of the year. For comparison the data of birth of all people being born during two years were treated the same way. There was a marked increase of atopic dermatitis with the persons born during the months August to October. On the other hand, the prevalence of atopic dermatitis was diminished with that persons who were born from February till July (with exception of May). Obviously, during the first months of life seasonally differing external factors influence directly o indirectly the decision, whether atopic dermatitis later on will manifest or not. These results should been taken into consideration for family planning in high-risk families.

Current investigations in headache.

The responses of supraorbital (SA), superficial temporal (TA), and digital (F) arterial beds and heart rate were studied in 5 normal subjects and 10 migraineurs when hand temperature was increased by volition and/or by heat. In normal subjects, volitional digital arterial dilation coincided with vasoconstriction in SA and TA. In migraineurs, the response varied. Bradycardia resulted in most subjects except in unimproved migraineurs. Heat-induced hand vasodilation led to dilation in SA and TA and to tachycardia. In the 8 migraineurs who improved clinically, the finger temperature feedback training apparently did not result in conditioning of a single autonomic response (i.e. digital vasocilation), but in a general decrease of the sympathetic tonic outflow. Improvement in migraine could also be correlated with improvement in psychological tests, with MMPI scores indicative of neurosis, significantly improving in those patients who learned and practiced the BF technique. A pilot study aimed at detection of serum complement alterations in migraine does not suggest a diminished level of the inhibitor of the first component and further inquiry into the possible serum complement abnormalities in migraineurs is in process. The possible relationships between the vasomotor changes in migraine, the reduction in sympathetic tonic outflow evoked by biofeedback, and their psycho-physiological significance have been discussed. An integrated, interpretative fusion of these data is proposed. A new conditioned vasomotor reflex, which we have termed the relaxation reflex, has been described. It should be explored whether BF has more wide applications in the treatment of other "psychosomatic" disorders characterized by vasomotor abnormalities and increased sympathetic tone.

Conditioned adaptation-relaxation reflex in migraine therapy.

A new conditioned reflex, the adaptation-relaxation reflex, characterized by dilation of the peripheral blood vessels of the hand and arm, is associated with reduced blood flow in the area of the supraorbital and superficial temporal arteries. This reflex, learned through biofeedback training, is a central requirement for successful autonomic conditioning for migraine. In migraine patients whose conditions improve clinically, the finger-temperature feedback training is not associated with the conditioning of a single autonomic response, ie, digital vasodilation, but is associated with a general decrease of sympathetic tonic outflow.