Restless legs - vanligt sjukdomstillstånd som ofta missas. Möjligheter till framgångsrik behandling finns idag

Restless legs syndrome (RLS) is characterized by intense restlessness and unpleasant creeping sensations deep inside the lower legs. The symptoms appear when the limbs are at rest and are worst in the evening and at night. They force the patients to keep moving their legs, and sometimes to get out of bed and wander about. Periodic limb movements of the extremities (PLM) are common during sleep thus causing severe reduction in sleep efficiency. In many cases RLS may be an inherited disorder and there is a common association with iron deficiency anemia and chronic renal failure. The pathophysiology of RLS is multifactorial and incompletely understood. Results of dopaminergic treatment and recent data by advanced neuroimaging suggest that symptoms of RLS may be generated in the central nervous system, notably in substantia nigra, putamen and by rhythmically active nuclei in the thalamus, brainstem and cerebellum. RLS is a very common disorder but has not seldom been under-diagnosed and poorly treated for many years in general practice. At present there is a wide range of treatment options including levodopa, dopamine agonists, opioids, antiepileptic drugs and benzodiazepines

Quality of life and trust among young people with narcolepsy and their families, after the Pandemrix (R) vaccination : protocol for a case-control study

Background: The extensive vaccination programme against swine flu resulted in an increased incidence of narcolepsy among children and adolescents. There is a need to explore if these young persons' experiences have affected their trust in healthcare, their willingness to participate in future prevention programmes, and their contacts with the healthcare system. The overall aim is to identify factors important for the life-situation of children and adolescents with narcolepsy and their families, and factors that correlate with trust in healthcare. Methods/design: Data will be collected via questionnaires from all available children with narcolepsy following the vaccination and their families, as well as a control group of children with diabetes and their families. Longitudinal descriptive interviews will also be conducted with a selection of 20-25 children and their families. Techniques from media research will be used for Internet-based data collection and analysis of information relating to narcolepsy from social media. Discussion: This project will use the situation of young persons with narcolepsy after the swine flu vaccination as a case to build a model that can be used in situations where trust in healthcare is essential. This model will be based on findings from the included studies on how trust is influenced by support, quality of life, burden of disease, impact on family, and use of social media. The model developed in this project will be beneficial in future situations where trust in healthcare is essential, such as new pandemic outbreaks but also for " everyday" adherence to health advice

The e-mental health treatment in Stockholm myocardial infarction with non-obstructive coronaries or Takotsubo syndrome study (E-SMINC) : a study protocol for a randomised controlled trial

Background: In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. Methods: The study is a randomised controlled trial, where 90 patients with a discharge diagnosis of MINOCA or TS who also report symptoms of stress or anxiety will be randomised 2-6 weeks after their cardiac event. The treatment consists of 10 weeks of Internet-based cognitive behaviour therapy (CBT) and starts immediately after randomisation for the treatment group. The control group receives usual care. Main outcomes are symptoms of anxiety measured with the Hospital Anxiety and Depression scale, anxiety subscale, and perceived stress measured with the Perceived Stress Scale, 14-item version, 10 weeks after randomisation. Secondary measures include cardiac specific anxiety, symptoms of post-traumatic stress, quality of life, cortisol measured in hair and physiological stress responses (heart rate variability, blood pressure and saliva cortisol) during a stress procedure. Ten weeks after randomisation, the control group will also receive treatment. Long-term followup in the self-report measures mentioned above will be conducted 20 and 50 weeks after randomisation where the total group's development over time is followed, and the groups receiving intervention early versus late compared. Discussion: At present, there are no randomised studies evaluating psychological treatment for patients with MINOCA or TS. There is an urgent need for treatment alternatives aiming at relieving stress and anxiety considering the high mental stress and anxiety levels observed in MINOCA and TS, leading to decreased quality of life. CBT aiming at reducing mental stress has been shown to be effective regarding prognosis in patients with coronary artery disease. The current protocol describes a randomised open-label controlled trial evaluating an Internet-based CBT program for reduction of stress and anxiety in patients with increased mental stress and/or anxiety with a discharge diagnosis of either MINOCA or TS