Mauro Manconi

Background: Pramipexole and ropinirole have become the first‐line treatment for restless legs syndrome. The aim of this study was to perform the first direct comparison between these two molecules in restless legs syndrome. Methods: A double‐blind, placebo‐controlled, double‐night and prospective investigation was carried out in 45 consecutive naïve patients with idiopathic restless legs syndrome. Each patient underwent two consecutive full‐night polysomnographies: the first baseline recording was performed without premedication and, before the second recording, first group received a single oral dose of 0.25 mg pramipexole, second group a single oral dose of 0.5 mg ropinirole, and the remaining patients received placebo.Results and Discussion: Both dopamine agonists improved restless legs syndrome symptoms and markedly suppressed periodic leg movements during sleep compared to placebo, without significant differences between pramipexole and ropinirole. No significant side effects, except for mild morning nausea (2 patients treated with ropinirole, 3 with pramipexole, and 1 with placebo), were reported. © 2011 Movement Disorder Society

The aims of this study were to measure the error in sleep estimation in normal controls and subjects with primary insomnia to establish the minimum amount of sleep needed for reliable subjective estimation and to depict the distribution of the error in sleep estimation in both groups. A two‐step retrospective (study 1) and prospective (study 2) validation study was carried out. Study 1 included 288 normal subjects [176 females and 112 males, mean age 58.5 years, standard deviation (SD) 7.23]. Study 2 included 159 patients (98 females and 61 males; mean age 49.1 years, SD 12.71) with primary insomnia. Participants underwent a full‐night polysomnographic study, followed by a morning assessment of subjective sleep parameters. A misperception index (MI) was computed using the following formula: MI = [objective total sleep time (oTST)−subjective total sleep time (sTST)]/oTST. The statistical properties of this index were analysed in detail in both groups. In controls, the Bland–Altman test demonstrated the reliability of this index for values of oTST >120 min. Healthy subjects estimated their sleep time correctly, while insomniacs largely underestimated their sleep time. Statistical analysis of the distribution of MI in insomnia patients disclosed the presence of two subgroups, one with moderate sleep misperception (132 patients) and the other with high sleep misperception (27 patients). The latter presented MI values ≥0.9, exhibiting statistical properties different from those with MI <0.9 and from normal subjects. The MI gives a reliable and immediate description of sleep misperception in healthy and insomnia subjects. Its application supports the existence of the high misperception of insomnia as a separate pathological entity.

Periodic leg movements during sleep (PLMS) are repetitive jerks of the lower limbs. Their occurrence can be isolated or part of various sleep disorders, such as restless legs syndrome (RLS), narcolepsy and obstructive sleep apnoea. Dopamine agonists are very effective in suppressing PLMS in RLS from the first night of administration. PLMS are often associated with cortical and autonomic arousals and may contribute to sleep disruption.Herein, a case of association between PLMS, Cheyne-Stokes respiration (CSR) and severe insomnia is described.Repeated polysomnographic studies demonstrated a clear synchronisation between PLMS and hyperventilation episodes, and the complete recovery of CSR, sleep quality and PLMS during nocturnal ventilation. In the same patient, pharmacological treatment with a dopamine agonist was ineffective on both PLMS and CSR.These results suggest that periodic leg movements during sleep coupled with central breathing events, similar to those observed in conjunction with obstructive events, may have a different origin in terms of neurotransmitter and pathway implicated, compared with periodic leg movements during sleep in restless legs syndrome, and are resolved by treatment of the respiratory abnormalities.