Daytime impulsiveness, attention, and learning in the restless legs syndrome.

INTRODUCTION: Restless legs syndrome (RLS) is a sensorimotor condition characterized by disturbing sensations and the desire to move, often localized in the legs. Cognitive changes and impulsivity can be present in RLS, although the potential effect of commonly co-occurring attention-deficit/hyperactivity disorders (ADHD) or dopamine agonist (DA) use on these are unclear. METHOD: Twenty-three RLS patients and 22 healthy controls were included. Rey Auditory Verbal Learning Test (RAVLT), Continuous Performance Test (CPT), Beck Depression Inventory (BDI), Epworth Sleepiness Scale (ESS), State and Trait Anxiety Inventory (STAI), and Adult Attention Deficit Self-Evaluation Scale (ASRS) were administered. Performance was compared between RLS patients and controls accounting for the presence of attention-deficit/hyperactivity disorder (ADHD) and DA use. RESULTS: Age, education, BDI, ESS, STAI, and ASRS scores were similar for control and RLS groups. Control and RLS groups performed similarly on auditory verbal learning and general attention tests. In the CPT, commission error was significantly higher and response time was significantly shorter in the RLS group compared to controls (p = .014 and p = .010, respectively). These significant differences persisted after adjusting for ADHD and DA usage. CONCLUSION: In this study, RLS patients were more impulsive than the healthy individuals independent of ADHD and DA use. However, learning and attention performances of the patients are not affected.

Intravenous immunoglobulin for prophylaxis of acute exacerbation in Myasthenia Gravis.

Intravenous immunoglobulin (IVIg) treatment for acute exacerbations of Myasthenia Gravis (MG) was shown in several open-label studies. There are only two studies demonstrating the efficiency of regular intermittent IVIg therapy on MG patients who are not in their acute attack periods. Thirteen patients who had displayed an inadequate clinical response to immunosuppressive treatments, or who were not appropriate for immunosuppressive treatment due to the age factor and thus were given regular IVIg therapy, were retrospectively investigated. Moreover, the pre- and post-treatment attack frequencies were also evaluated. The mean number of attacks was 0.0960 attacks/year before IVIg therapy, and 0.0056 attacks/year after IVIg therapy (p = 0.002). The number and severity of the attacks were decreased in all patients. Eight patients (62 %) had used steroids; among them, steroid was completely stopped in two patients following the regular IVIg therapy, and the dose was decreased by 50 % in the other six patients. The requirement for pyridostigmine did not decrease in four patients, whereas this need decreased by 20-50 % in nine patients. IVIg can produce repeated beneficial effects in patients with MG and may be useful as an adjunct in the management of MG. IVIg has minimal adverse effects and ability to reduce corticosteroid dose. These results suggest that intravenous immunoglobulin maintenance therapy is a valid modality in patients with resistant treatment MG.