[Quality of the Forensic Case Formulation in Mental Health]. / La calidad de la formulación del caso forense en salud mental.

OBJECTIVES: The "Guide to understand and assess the quality of the case formulation in forensic mental health - TECF" is tested in order to contribute to the development of the forensic reports. METHOD: Twelve mental health professionals of different Latin American traditions assessed with the TECF the quality of ten international forensic reports, both psychological and psychiatric. The guide includes the manual that describes the dimensions, criteria and guidelines to assess the quality of the forensic case formulation. RESULTS: Internal consistency indicators were in a rank of 0.34- 0.81 for the dimensions and 0.85 for the total TECF. The absolute agreement intraclass correlation coefficient among evaluators with similar tradition reached values of 0.72; 0.52; 0.76 and 0.77 for the dimensions and 0.84 for the total. The agreement among evaluators with different traditions was less. CONCLUSIONS: The TECF is a promising instrument to guide the assessment of quality and to stimulate improvement of the forensic reports. Caution is recommended in light of the traditional rating scale method due to the effect that can be produced by the different practices.

Port-site metastases is an independent prognostic factor in patients with peritoneal carcinomatosis.

INTRODUCTION: Port-site metastases (PSMs) have been reported after laparoscopy in patients with peritoneal carcinomatosis (PC). We hypothesize that PSM is an independent negative predicting factor of survival in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). METHODS: A retrospective review of a prospective database was conducted to search patients who underwent laparoscopy prior to CRS/HIPEC. Most of the tumors were of appendiceal origin. All previous laparoscopy port sites were excised regardless of macroscopic tumor involvement. Patients were divided into two groups: patients with PSM [PSM (+)] and patients without PSM [PSM (-)]. Overall survival (OS) was estimated by Kaplan-Meier curves and the log-rank test. Cox regression [hazard ratios (HRs) and 95 % confidence intervals (CIs)] was used to test for independent effects of the PSM (+) and the associated clinicopathological variables. RESULTS: Sixty-five patients had laparoscopy before CRS/HIPEC. One hundred and forty-four port-sites were resected; 41 (29 %) ports were positive for malignancy in a total of 22 (34 %) patients. Mean OS at 1, 3, and 5 years was 88, 66, and 63 %, respectively. Survival in patients with PSM was 73, 35, and 23 %, respectively, compared with 95, 82, and 82 %, respectively, in patients without PSM (p ≤ 0.001). Positive lymph nodes (LNs) were detected in 13/22 patients with PSM and 11/43 patients without PSM. Independent effects on survival shows an HR of 3.136, 95 % CI 1.150-8.549 (p = 0.026) for LN metastases, and an HR of 3.462, 95 % CI 1.198-10.006 (p = 0.022) in patients with positive PSM. CONCLUSION: PSMs are common in patients with PC undergoing CRS/HIPEC and are independently associated with a worse prognosis. Resection of previous laparoscopy port sites is advocated in patients with PC to ensure complete cytoreduction.

Morbidity of the abdominal wall resection and reconstruction after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).

BACKGROUND: CRS/HIPEC has evolved as a therapeutic option for selected patients with peritoneal surface malignancies. To achieve complete cytoreduction (CC), some patients require extensive abdominal-wall resection (AWR) and subsequent complex reconstructions, which may be associated with wound complications (WC) and delay of postoperative cancer therapy. METHODS: Review of a prospective database of 350 patients revealed 213 patients with peritoneal carcinomatosis who underwent AWR due to suspected or proven wound/port site metastases during CRS/HIPEC. Tumor origin included: appendix, colon, ovarian, peritoneal mesothelioma, primary peritoneal, and others. WC were related to peritoneal carcinomatosis index (PCI), CC score, length of surgery, type of AWR and closure, blood transfusion, and albumin levels using binary logistic regression (odds ratios (OR) and 95 % CIs) analysis. RESULTS: PCI ≥ 20 was found in 151 (71 %), CC was achieved in 178 (84 %). Mean length of surgery was 613 min. Postoperative WC were detected in 49 of 213 (23 %) patients, 13 (6 %) had Grade III (according to Clavien-Dindo's classification) WC, and led to delay of postoperative chemotherapy. WC occurred in 21 of 64 (32.8 %) patients with excision of port sites (odds ratio [OR] = 2.11, confidence interval [CI] = 1.09-4.10, p = 0.026). Primary fascial closure was performed in 191 of 213 (89.7 %) patients, 40 (21 %) of whom had WC. Mesh-assisted abdominal wall reconstruction was required in 22 of 213 (10.3 %) patients, of whom 9 (40.9 %) had WC (OR = 2.61, CI = 1.04-6.55, p = 0.035). CONCLUSIONS: Port-site excision and mesh-assisted abdominal wall reconstruction were associated with higher incidence of postoperative WC following CRS/HIPEC. The implications of these preliminary findings may need to be considered during surgical planning for these patients.

Melphalan: a promising agent in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become an option for peritoneal carcinomatosis (PC). Frequently, these patients have failed systemic chemotherapies and surgeries, including CRS/HIPEC with traditional regimens (mitomycin-C or platinum based). An alternative agent for failed or repeated CRS/HIPEC is unknown. We hypothesize that melphalan is an alternative agent in patients with PC from aggressive primaries, including recurrences following failed regional therapies. METHODS: A retrospective review of a prospective database of 247 patients revealed 25 patients (9 male and 16 female) who received intraperitoneal melphalan (50 mg/m(2)) in 31 CRS/HIPEC procedures, of which 19 were repeated. Primary malignancies included 17 appendiceal, one colorectal, two ovarian, two uterine sarcomas, two primary peritoneal and one mesentery sarcoma. RESULTS: PC index (PCI) was ≥20 in 76 % of patients (19/25). 88 % of patients (22/25) had complete cytoreduction. Seventeen patients were alive, with mean survival of 63.6 months, and eight patients are deceased. Overall survival (OS) for the entire group since diagnosis was 95.8, 84.5, 50.9, and 38.2 % at 1, 3, 5, and 10 years, respectively; OS since melphalan HIPEC was 89.4, 45, and 30 % at 1, 3, and 5 years, respectively; and OS in patients with appendiceal malignancies was 91.7, 48.1 and 32.1 % at 1, 3 and 5 years, respectively. There was no postoperative mortality. Grade III-IV morbidity was 23 % (7/31). Nine patents had neutropenia, controlled with filgrastim. CONCLUSIONS: Melphalan is an efficacious alternative agent in patients undergoing CRS/HIPEC for aggressive and recurrent peritoneal surface malignancies. Its postoperative significant myelosuppression effect should be addressed.

Predictive and prognostic survival factors in peritoneal carcinomatosis from appendiceal cancer after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has survival benefit in the treatment of selected patients with peritoneal carcinomatosis (PC) from appendiceal cancer (AC). We evaluated factors affecting the survival of patients with PC from AC after CRS/HIPEC. METHODS: A retrospective analysis of 387 CRS/HIPEC procedures performed between February 1998 and February 2013 identified 202 patients with PC from AC. Tumor histopathology, complete cytoreduction (CC 0-1), Peritoneal Cancer Index (PCI), and lymph node (LN) status were related to overall survival (OS) and progression-free survival (PFS) using the Kaplan-Meier method. RESULTS: Overall, 129 women (64 %) and 73 men (36 %), mean age 54 years (range 25-81), with a mean follow-up of 36 months were included in the study. Seventy-seven low-grade tumors (disseminated peritoneal adenomucinosis [DPAM]; 38 %) and 125 high-grade tumors (peritoneal mucinous carcinomatosis [PMCA]; 62 %) were identified. Five- and 10-year OS was 56 % and 47 %, respectively, with PFS of 44 % at 5 and 10 years. Five-year OS in DPAM patients was 83 %, with a 5-year OS significant difference related to CC 0-1 versus CC 2-3 (incomplete cytoreduction) [p = 0.021]. Five-year OS in PMCA patients was 41 %, with a 5-year OS significant difference related to CC 0-1 versus CC 2-3 (p < 0.001), PCI <20 versus PCI ≥20 (p = 0.002), and (-)LN versus (+)LN (p < 0.001). Grade III/IV complications were 16 %. No perioperative mortality was reported. CONCLUSION: Positive LN, PMCA histopathology, and PCI ≥20 are negative prognostic factors, while CC 0-1 is a positive survival predictor in PC from AC treated with CRS/HIPEC. However, in patients with PMCA and PCI ≥20 in whom CC 0-1 was a potential outcome should not be denied CRS/HIPEC.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of recurrent high-grade uterine sarcoma with peritoneal dissemination.

OBJECTIVE: Peritoneal sarcomatosis from primary uterine sarcoma (US) is a rare condition. Conventional therapeutic modalities have failed to improve survival and outcomes among patients with high-grade US with extrapelvic spread. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown improved outcomes for peritoneal carcinomatosis from other epithelial primaries with similar clinical presentation. We report our experience applying this treatment in 3 patients with recurrent high-grade US with peritoneal dissemination. STUDY DESIGN: This retrospective review of a prospective database of 378 patients with peritoneal dissemination of cancer treated with CRS/HIPEC identified 3 patients with recurrent high-grade US. Follow-up for disease progression was carried out by physical examination and computed tomography scan of the chest, abdomen, and pelvis. RESULTS: Two leiomyosarcomas and 1 adenosarcoma with sarcomatous overgrowth were identified. Two of the 3 had failed standard treatment with surgery and systemic chemotherapy before CRS/HIPEC was performed. Follow-up ranged from 34 to 140 months. All 3 patients are alive, 2 with no evidence of disease (NED), and 1 alive with disease. Adramycin/cisplatin was used for HIPEC in 1 case (140 months with NED), whereas melphalan was used in the other 2 cases (53 months alive with disease, 34 months with NED). Two patients underwent 1 CRS/HIPEC, whereas 1 required 3 CRS/HIPEC due to disease recurrence. CONCLUSION: CRS/HIPEC shows promise as a treatment modality for the management of selected patients with recurrent high-grade US with peritoneal dissemination. Further studies are warranted.

The activation of representative emotional verbal contexts interacts with vertical spatial axis.

Several experimental studies have shown that there exists an association between emotion words and the vertical spatial axis. However, the specific conditions under which this conceptual-physical interaction emerges are still unknown, and no study has been devised to test whether longer linguistic units than words can lead to a mapping of emotions on vertical space. In Experiment 1, Spanish and Colombian participants performed a representative verbal emotional contexts production task (RVEC task) requiring participants to produce RVEC for the emotions of joy, sadness, surprise, anger, fear, and disgust. The results showed gender and cultural differences regarding the average number of RVEC produced. The most representative contexts of joy and sadness obtained in Experiment 1 were used in Experiment 2 in a novel spatial-emotional congruency verification task (SECV task). After reading a sentence, the participants had to judge whether a probe word, displayed in either a high or low position on the screen, was congruent or incongruent with the previous sentence. The question was whether the emotion induced by the sentence could modulate the responses to the probes as a function of their position in a vertical axis by means of a metaphorical conceptual-spatial association. Overall, the results indicate that a mapping of emotions on vertical space can occur for linguistic units larger than words, but only when the task demands an explicit affective evaluation of the target.

Fear and Trembling While Working in a Pandemic: an Exploratory Meta-Analysis of Workers' COVID-19 Distress.

The global COVID-19 pandemic has disrupted the lives of workers and taken its toll on health and well-being. In line with recent calls for more inductive and abductive occupational health science research, we exploratorily meta-analyzed workers' COVID-19 distress, defined as psychological and psychosomatic strain contextualized to experiencing the virus and pandemic broadly. We identified many existing COVID-19 distress measures (e.g., Fear of COVID-19 Scale by Ahorsu et al., International Journal of Mental Health and Addiction, 2020; Coronavirus Anxiety Scale by Lee, Death Studies, 44(7), 393-401, 2020a) and correlates, including demographic variables (viz., gender, marital status, whether worker has children), positive well-being (e.g., quality of life, perceived social support, resilience), negative well-being (e.g., anxiety, depression, sleep problems), and work-related variables (e.g., job satisfaction, burnout, task performance). Additionally, we found preliminary evidence of subgroup differences by COVID-19 distress measure and country-level moderation moderators (viz., cultural values, pandemic-related government response) as well as COVID-19 distress's incremental validity over and above anxiety and depression. The findings-based on k = 135 independent samples totaling N = 61,470 workers-were abductively contextualized with existing theories and previous research. We also call for future research to address the grand challenge of working during the COVID-19 pandemic and ultimately develop a cumulative occupational health psychology of pandemics. Supplementary Information: The online version contains supplementary material available at 10.1007/s41542-022-00131-x.

Effect of an ionic antineoplastic agent Cytoreg on blood chemistry in a Wistar rat model.

Cytoreg is an ionic therapeutic agent comprising a mixture of hydrochloric, sulfuric, phosphoric, hydrofluoric, oxalic, and citric acids. In diluted form, it has demonstrated efficacy against human cancers in vitro and in vivo. Although Cytoreg is well tolerated in mice, rats, rabbits, and dogs by oral and intravenous administration, its mechanism of action is not documented. The acidic nature of Cytoreg could potentially disrupt the pH and levels of ions and dissolved gases in the blood. Here, we report the effects of the intravenous administration of Cytoreg on the arterial pH, oxygen and carbon dioxide pressures, and bicarbonate, sodium, potassium, and chloride concentrations. Our results demonstrate that Cytoreg does not disturb the normal blood pH, ion levels, or carbon dioxide content, but increases oxygen levels in rats. These data are consistent with the excellent tolerability of intravenous Cytoreg observed in rabbits, and dogs. The study was approved by the Bioethics Committee of the University of the Andes, Venezuela (CEBIOULA) (approval No. 125) on November 3, 2019.

Evaluation of dermal corrosion and irritation by Cytoreg in rabbits.

Cytoreg is an experimental therapeutic platform consisting of an aqueous solution of six acids (hydrofluoric, hydrochloric, sulfuric, phosphoric, citric, and oxalic) with oncolytic, antiviral, immune modulatory and antibacterial activities. Cytoreg may be formulated for topical, oral, and parenteral administration. In the present study, a skin corrosion/irritation screen was conducted on three albino rabbits for the Cytoreg topical formulation at three dilutions; one animal each received a dilution of 100 %, 4 %, or 2 % in physiological saline solution. Three intact skin test sites per animal/concentration were evaluated. Each test site was treated with 0.5 mL of the appropriate test substance solution. Site one was dosed for 3 min, then observed. Dose site two was wrapped for 1 h, then both first and second test sites were observed. Dose site three was wrapped for 4 h. One hour after unwrapping the third site, all three test sites were observed for skin irritation and/or corrosion, and again at 24, 48 and 72 h after final unwrap. Based on the 4 -h dose scores through 72 h, the primary irritation index (PII) for Cytoreg is 0.00 at 2 % and 4 %, with a descriptive rating of non-irritating, and 0.25 PII with slightly irritating rating at 100 %.

Involvement of insula and cingulate cortices in control and suppression of natural urges.

The physiology of control and suppression of natural urges is not well understood. We used [(15)O]H(2)O positron-emission tomography imaging to identify neural circuits involved in suppression of spontaneous blinking as a model of normal urges. Suppression of blinking was associated with prominent activation of bilateral insular-claustrum regions, right more than left; activation was also found in bilateral anterior cingulate cortex (ACC), supplementary motor areas, and the face area of the primary motor cortex bilaterally. These results suggest a central role for the insula possibly together with ACC in suppression of blinking.

Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19.

Previously, we showed that 3% (31/1032)of asymptomatic healthcare workers (HCWs) from a large teaching hospital in Cambridge, UK, tested positive for SARS-CoV-2 in April 2020. About 15% (26/169) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive for SARS-CoV-2 (Rivett et al., 2020). Here, we show that the proportion of both asymptomatic and symptomatic HCWs testing positive for SARS-CoV-2 rapidly declined to near-zero between 25th April and 24th May 2020, corresponding to a decline in patient admissions with COVID-19 during the ongoing UK 'lockdown'. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent 'hubs' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organizations in other sectors may be able to resume on-site work safely.

Fighting for time: Spillover and crossover effects of long work hours among dual-earner couples.

Drawing upon the spillover-crossover model, this study examined the extent to which one's work time demands spilled over to the family domain and crossed over to his or her spouse, utilizing data of 365 dual-earner couples from the 500 Family Study. The results of the distinguishable actor-partner interdependence model indicated that there was gender symmetry in the spillover processes such that the effects of work hours were identical between men and women. Further, although there was more bidirectional crossover between partners within couples, we observed some unidirectional crossover from husbands to wives. Specifically, husbands only increased their contribution to domestic work in response to wives' work fatigue, whereas wives increased their contribution to domestic work in response to husbands' work fatigue and high workloads. Finally, husbands' housework hours negatively related to wives' marital satisfaction and positively related to wives' depression, whereas wives' housework hours negatively related to husbands' marital satisfaction and depression. These findings have practical implications for improving the work-family balance, health, and well-being of dual-earner couples.

Neurophysics Assessment of the Muscle Bioenergy Generated by Transcranial Magnetic Stimulation.

The content of the rectified motor evoked potential (MEP) induced by transcranial magnetic stimulation (TMS) has ambiguously been assessed without the precision that energy calculation deserves. This fact has misled data interpretation and misguided biomedical interventions. To definitively fill the gap that exits in the neurophysics processing of these signals, we computed, in Walls ( W ^ ), the bioenergy within the rectified MEP recorded from the human first digitorum index (FDI) muscle at rest and under isometric contraction. We also gauged the biowork exerted by this muscle. Here we show that bioenergy and biowork can accurately and successfully be assessed, validated, and determined in W ^ from MEP signals induced by TMS, regardless of knowing the mathematical expression of the function of the signal. Our novel neurophysics approach represents a dramatic paradigm shift in analysis and interpretation of the content of the MEP and will give a true meaning to the content of rectified signals. Importantly, this innovative approach allowed unveiling that women exerted more bioenergy than men at the magnetic stimulations used in this study. Revisitation of conclusions drawn from studies published elsewhere assessing rectified EMG signals that have used ambiguous units is strongly recommended.

Pre- and post-synaptic dopamine imaging and its relation with frontostriatal cognitive function in Parkinson disease: PET studies with [11C]NNC 112 and [18F]FDOPA.

Frontostriatal cognitive dysfunction is common in Parkinson disease (PD), but the explanation for its heterogeneous expressions remains unclear. This study examined the dopamine system within the frontostriatal circuitry with positron emission tomography (PET) to investigate pre- and post-synaptic dopamine function in relation to the executive processes in PD. Fifteen non-demented PD patients and 14 healthy controls underwent [(18)F]FDOPA (for dopamine synthesis) and [(11)C]NNC 112 (for D(1) receptors) PET scans and cognitive testing. Parametric images of [(18)F]FDOPA uptake (K(i)) and [(11)C]NNC 112 binding potential (BP(ND)) were calculated using reference tissue models. Group differences in K(i) and BP(ND) were assessed with both volume of interest and statistical parametric mapping, and were correlated with cognitive tests. Measurement of [(18)F]FDOPA uptake in cerebral cortex was questionable because of higher K(i) values in white than adjacent gray matter. These paradoxical results were likely to be caused by violations of the reference tissue model assumption rendering interpretation of cortical [(18)F]FDOPA uptake in PD difficult. We found no regional differences in D(1) receptor density between controls and PD, and no overall differences in frontostriatal performance. Although D(1) receptor density did not relate to frontostriatal cognition, K(i) decreases in the putamen predicted performance on the Wisconsin Card Sorting Test in PD only. These results suggest that striatal dopamine denervation may contribute to some frontostriatal cognitive impairment in moderate stage PD.

Correlation between putative indicators of primary restless legs syndrome severity.

BACKGROUND AND PURPOSE: Several methods of assessing disease severity in restless legs syndrome (RLS) have been suggested. The purpose of this study was to examine the relationship between the suggested immobilization test (SIT), the International RLS Study Group rating scale (IRLS), sleep efficiency, and periodic leg movements of sleep index (PLMI). PATIENTS AND METHODS: Forty primary RLS patients with periodic leg movements of sleep were included in this prospective study. Study procedures were all performed during the same night, beginning with IRLS administration and following with SIT and polysomnography (PSG) evaluations, in that order. SIT was composed of two parameters: SIT mean discomfort score (SIT-MDS) and SIT periodic leg movements of wakefulness index (SIT-PLMW). PSG target measures were PLMI and sleep efficiency. Pearson's correlation was used for analysis at a P<0.01 significance level. RESULTS: PSG-PLMI correlated with IRLS (r=0.462; P=0.003) and with SIT-PLMW (r=0.681; P=0.0004). A correlation was also found between IRLS and SIT-MDS (r=0.447; P=0.004), even though SIT-PLMW and IRLS did not correlate with each other (P=0.286). A negative correlation was found between PSG-PLMI and sleep efficiency (r=-0.435; P=0.005). Neither SIT nor IRLS correlated with sleep efficiency. Only SIT discomfort scores from the second half of SIT correlated with SIT-PLMW (r=0.457, P=0.004), and they had a stronger correlation with IRLS (P=0.003). CONCLUSIONS: This study attempted a much needed comprehensive evaluation of the relationship between various RLS severity indicators. Our findings support a strong role of motor dysfunction on sleep quality in RLS, as well as the potential use of SIT-PLMW as a sensitive indicator of RLS severity.

Visual deprivation effects on human motor cortex excitability.

Single and paired-pulse transcranial magnetic stimulation (TMS) were applied to the motor cortex of 12 healthy volunteers, who were instructed to relax under eyes-open and eyes-closed conditions with room lights on and after 30 min of blindfolding. Compared to the eyes-open condition, significantly larger motor-evoked potentials and less intracortical inhibition were observed during blindfolding. Visual deafferentation changes resting human motor cortex excitability and might be a novel way to promote brain plasticity. These results raise the issue of how widespread the effects of temporary deafferentation may be and whether they are mediated by discrete or diffuse systems. These findings also illustrate an important potential confound in TMS studies of the motor cortex.

Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Experience of a Peritoneal Surface Malignancy Center.

Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon malignancy, which can be difficult to treat. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have evolved as the treatment of choice when complete cytoreduction is to be achieved. This study reports the outcomes of CRS/HIPEC for peritoneal mesothelioma performed in a center for peritoneal surface malignancy. A retrospective analysis of a prospective database of 389 CRS/HIPEC procedures identified 23 patients who underwent CRS/HIPEC for DMPM from 1999 to 2014. Gender, age at diagnosis, age at surgery, previous surgeries, follow-up time, peritoneal cancer index (PCI) score, completeness of cytoreduction (CC), pathology, and overall survival (OS) were analyzed. The univariate analysis was used to determine the prognostic value of age, gender, neoadjuvant chemotherapy, histopathology of the tumor, PCI, CC, and lymph node status on survival. Mean follow-up time from surgery was 31 months (range = 0.5-124). The median PCI score was 28, and 77 per cent had PCI ≥20. CC 0-1 was achieved in 65 per cent of cases. One- and 5-year actuarial OS rates from diagnosis were 86 per cent and 60 per cent, respectively. One- and 5-year actuarial OS from HIPEC was 70 per cent and 64 per cent, respectively. The univariate analysis showed that the CC was the only significant prognostic factor. Patients with DMPM may achieve long-term survival when treated with CRS/HIPEC. The CC is the most significant prognostic factor for long-term survival.

Auditory and Lower Limb Tactile Prepulse Inhibition in Primary Restless Legs Syndrome: Clues to Its Pathophysiology.

The resting sensory discomfort transiently relieved upon movement of the affected area in restless legs syndrome suggests that sensorimotor integration mechanisms, specifically gating, may be altered in the disease. The authors sought to determine the effects of prepulse auditory and tactile stimulation applied to lower limbs on the blink reflex of patients with restless legs syndrome and healthy subjects. Seventeen patients with restless legs syndrome and 17 age- and sex-matched healthy controls were investigated. Auditory stimuli and tactile lower limb stimulation were applied as prepulses. The R2 response of the blink reflex induced by electrical stimulation applied to the right supraorbital nerve was selected as the test stimulus. Time intervals between prepulses and response-eliciting stimuli were 40, 70, 90, 110, and 200 milliseconds. There were no differences in either the auditory or tactile prepulse conditions between patients and controls and no differences between these measures within subject groups. We concluded that the tactile lower limb and the auditory prepulse effects on the brainstem interneurons mediating the blink reflex share common neural pathways. Because forebrain interneurons mediate these prepulse effects, they are likely not involved in the disordered sensorimotor interaction of restless legs syndrome.

State dependent excitability changes of spinal flexor reflex in patients with restless legs syndrome secondary to chronic renal failure.

OBJECTIVE: Periodic limb movement in sleep (PLMS) is a common dysfunction of motor control during sleep, occurring either in isolation or associated with a variety of neurological disorders including restless legs syndrome (RLS). Although the PLMS generators have not been established, their occurrence in patients with spinal cord injury and their clinical resemblance to the spinal cord flexor withdrawal reflex (FR) suggest that PLMS may originate in the circuitry that mediates the FR. The significantly increased spinal cord excitability noted in primary RLS/PLMS patients may play an important role in the pathophysiology of primary RLS. The aim of this study is to establish whether the enhanced spinal cord excitability, which is represented by a lower threshold and/or greater spatial spread of the FR, is also true for the RLS/PLMS patients whose RLS is secondary to chronic renal failure (CRF). METHODS: Twenty patients with RLS/PLMS secondary to CRF have been compared with matched controls according to the state dependent changes in FR excitability. All patients met the diagnostic criteria for RLS and PLMS. They had CRF for 5.2+/-3.5 years, and were under the hemodialysis treatment. Twenty healthy, age and sex matched subjects were tested as controls. The electrophysiological testing of the FR was performed during wakefulness (9:30-10:30 p.m.) and sleep (beginning of stage II, the first sleep cycle). RESULTS: A significant increase in FR excitability was found in RLS/PLMS patients with CRF. This abnormality was prominent during sleep, which was also true for the primary RLS. CONCLUSIONS: Our results suggest that similar neuronal pathways are involved in primary and secondary RLS/PLMS patients. Our results also support that RLS/PLMS and FR share a common spinal mechanism.