The effect of vitamin D on restless legs syndrome: prospective self-controlled case study

Purpose To evaluate the effect of vitamin D on severity of restless legs syndrome in patients with idiopathic restless legs syndrome (RLS). Methods Patients with idiopathic RLS completed questionnaires including the International Restless Legs Severity Scale (IRLSS) and were evaluated for vitamin D deficiency. Patients with deficiency of vitamin D were treated with 50,000 units per week for 2 months. At the end of the 2 months, vitamin D levels were re-measured and disease severity was re-evaluated in patients who reached adequate vitamin D level. Subgroups of IRLSS questionnaire were also analyzed. Results Of 35 patients enrolled, 21 (60%) had vitamin D deficiency and received vitamin D therapy. In 2 patients, vitamin D levels did not rise to sufficient levels with supplementation and these 2 patients were excluded from analysis. The remaining 19 patients showed vitamin D levels increased from 13.2 +/- 4.0 to 42.8 +/- 9.6 ng/mL while IRLSS improved from 24.9 +/- 5.1 to 21.1 +/- 2.9 points (p <0.001). Selected subscores of the IRLSS were also improved including symptom severity (p <0.001), impact on sleep (p <0.001), symptom measures (p =0.002), and disease impact measures (p <0.001). There were trends toward improvement in subscores of frequency (p =0.11) and mood (p =0.051). Conclusions The findings suggest that vitamin D levels should be evaluated in patients with RLS and if vitamin D deficiency is revealed, consideration should be given to replacement therapy.

Determinants of Disability in Progressive Onset Multiple Sclerosis

Introduction: To describe the clinical and socio-demographic profiles of the patients with the progressive onset Multiple Sclerosis (MS) and to explore the determinants of disability

Factors Predictive of Severe Multiple Sclerosis Disease Reactivation After Fingolimod Cessation

Background:Fingolimod withdrawal may trigger the return of pretreatment disease activity. It is difficult to identify patients at risk of disease reactivation. We compared the demographic and clinical features of patients experiencing severe disease reactivation (SDR) after fingolimod cessation with those of patients who did not.Methods:All patients who commenced fingolimod and who continued therapy for at least 6 months were included. The demographic and clinical features of the 2 groups (SDR vs. no SDR) were assessed.Results:Forty-four of 303 patients discontinued fingolimod for various reasons. Among these, 31 fulfilled our inclusion criteria and 8 (25.8%) exhibited SDR after drug cessation. The mean time for SDR was 2.6 months (range, 2 to 3mo). The annualized relapse rate before fingolimod therapy was higher in the SDR than in the non-SDR group (1.59 vs. 0.81) (P=0.018). Although statistical significance was not attained, the mean Expanded Disability Status Scale score at the time of fingolimod cessation was higher in the non-SDR than in the SDR group (2.5 vs. 1.12) (P=0.074).Conclusions:SDR may develop within the first 3 months after cessation of fingolimod. Patients with higher annualized relapse rates and lower Expanded Disability Status Scale scores before commencing fingolimod treatment were more likely to exhibit SDR

Relationship Between Sleep-related Violence and NREM Parasomnia: A Case Report

Parasomnia constitutes an important group among the situations that can lead to sleep-related violence scene. Parasomnia attacks are characterized by complex motor behaviors of various degrees, violent behaviors may result in life-threatening and rarely lethal conditions for patients and their relatives. Here is presented a patient with right temporoparietal bone fracture, pneumocephalus and hemotympanum in right ear due to head trauma during a parasomnia attack. The diagnosis could be made by a detailed history taking and polysomnography only after many other investigations. In this context, we aimed to emphasize that not only nocturnal epilepsies, especially frontal lobe epilepsies, but also parasomnia attacks should be kept in mind in differential diagnosis of sleep-related violence

Apparent diffusion coefficient characteristics of parenchymal neuro-Behcet's disease

Aim To evaluate apparent diffusion coefficient (ADC) characteristic of parenchymal neuro-Behcet's disease (NBD). Methods We retrospectively reviewed cranial magnetic resonance imaging (MRI) examinations of NBD patients with acute or chronic parenchymal lesions. ADC measurements of the lesions and contralateral normal brain parenchyma were performed by a consensus of two radiologists. To compare the ADC value of the chronic and acute lesions, relative ADC values (rADC) were calculated. The ratio of the lesions' ADC to contralateral normal brain parenchyma ADC yielded a rADC value of the lesions. Contrast enhancement patterns and the locations of the lesions were also noted. Results A total of 24 NBD patients with 45 parenchymal lesions, 25 acute, and 20 chronic, were enrolled in the study. A significant difference was observed between the mean ADC value of the acute lesions (1074.48 +/- 138.31 m/s) and the mean ADC value of the contralateral normal brain parenchyma (841.20 +/- 142.96 m/s; P < 0.0001). A significant difference was observed between the mean ADC value of the chronic lesions (1069.95 +/- 143.95 m/s) and the mean ADC value of the contralateral normal brain parenchyma (793.90 +/- 96.71 m/s; P < 0.0001). No significant difference was observed between the mean rADC (1.35 +/- 0.20) and the mean rADC value of the chronic lesions (1.29 +/- 0.15; P = 0.22). Conclusions ADC measurements might provide substantial information about the histopathological aspect of parenchymal NBD lesions

Myoclonus in the elderly: A retrospective analysis of clinical and electrophysiological characteristics of patients referred to an electrophysiology laboratory

Background and objective: Late-onset myoclonus in the elderly is mainly related to dementia or systemic disease. In this report, we aimed to investigate the clinical and electrophysiological features of patients with late-onset myoclonus