EFNS guidelines on management of restless legs syndrome and periodic limb movement disorder in sleep.

In 2003, the EFNS Task Force was set up for putting forth guidelines for the management of the Restless Legs Syndrome (RLS) and the Periodic Limb Movement Disorder (PLMD). After determining the objectives for management and the search strategy for primary and secondary RLS and for PLMD, a review of the scientific literature up to 2004 was performed for the drug classes and interventions employed in treatment (drugs acting on the adrenoreceptor, antiepileptic drugs, benzodiazepines/hypnotics, dopaminergic agents, opioids, other treatments). Previous guidelines were consulted. All trials were analysed according to class of evidence, and recommendations formed according to the 2004 EFNS criteria for rating. Dopaminergic agents came out as having the best evidence for efficacy in primary RLS. Reported adverse events were usually mild and reversible; augmentation was a feature with dopaminergic agents. No controlled trials were available for RLS in children and for RLS during pregnancy. The following level A recommendations can be offered: for primary RLS, cabergoline, gabapentin, pergolide, ropinirole, levodopa and rotigotine by transdermal delivery (the latter two for short-term use) are effective in relieving the symptoms. Transdermal oestradiol is ineffective for PLMD.

Effects of locus coeruleus lesions on heart rate during sleep in the cat.

Bilateral electrocoagulation of the locus coeruleus (LC) were performed in 8 cats, in order to study the effects on the heart rate modulation during sleep. In 4 cats the lesions were restricted to the posterior part of LC: they induced a permanent tachycardia in all states, and a reduction of the phasic changes during paradoxical sleep (PS), while the state-linked modulations remained similar to those of controls. In another group of 4 cats, lesions extended rostrally to the anterior LC. They induced a bradycardia evidenced mostly during PS. Phasic changes persisted though the tachycardic component was greatly reduced. The state-linked modulations were opposite to those of controls: increase during transition from slow waves sleep (SWS) to PS and decrease during PS. No recovery trend was observed within the 3 weeks post-lesion experimental period. These data are discussed in relation to the well-known parasympathetic and sympathetic regulations of the heart rate, with special attention to the changes observed during transition from slow waves sleep (SWS) to PS and during the first minute of PS. This period corresponds to a shift in the balance of tonic and phasic influences.