title: Time structure of leg movement activity during sleep in untreated Parkinson disease and effects of dopaminergic treatment.
abstract: OBJECTIVE
  To evaluate the specific time structure of periodic leg movements during sleep (PLMS) in untreated Parkinson disease (PD) patients by means of an advanced analysis; and to evaluate the effects of treatment on this activity, in a cross-sectional comparison and in a prospective follow-up study, in a subgroup of previously untreated patients.
  
  
  METHODS
  Forty-four consecutive PD patients were enrolled in the study; 19 had not yet started any drug therapy for PD (PDnother); 10 out of these patients were re-evaluated after an average time lag of 19.6months from baseline. The remaining 25 patients (PDther) were taking l-dopa and/or dopamine agonists. Eighteen age-matched normal controls were also included. All subjects underwent a polysomnographic recording and the time structure of their sleep leg movement activity was analyzed by means of the periodicity index and other advanced measures.
  
  
  RESULTS
  Both PD groups tended to show increased PLMS and decreased isolated limb movement activity with respect to controls. PLMS index >15/h was found in 26.3% of PDnother patients, 24.0% of PDther subjects, and in 16.7% of controls; none of the three PDnother patients who had PLMS index >15/h at baseline sustained this level at follow-up, nor did the other seven patients. The intermovement interval distribution showed a clear peak at 10-40s in the PDnother group; a suppression of this peak was observed after the introduction of dopaminergic treatment in the subgroup of 10 PDnother patients. Both groups of PD patients showed a progressively decreasing number of PLMS through the night; an almost complete abolition of PLMS was seen in the first 2h of sleep after the introduction of dopaminergic drug therapy.
  
  
  CONCLUSIONS
  Our data do not seem to support the hypothesis that PLMS are particularly frequent in PD but seem to indicate an interaction between PD pathophysiology and genetic predisposition for PLMS, producing a slightly increased number of patients with this sleep motor phenomenon when compared to controls.
authors.affiliation: Sleep Center - Neurophysiology Unit, University of Cagliari, Monserrato (CA), Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Puligheddu
authors.affiliation: Sleep Center - Neurophysiology Unit, University of Cagliari, Monserrato (CA), Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Figorilli
authors.affiliation: Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.
authors.forename: Debora
authors.initials: D
authors.lastname: Aricò
authors.affiliation: Neurology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Raggi
authors.affiliation: Sleep Center - Neurophysiology Unit, University of Cagliari, Monserrato (CA), Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marrosu
authors.affiliation: Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy. Electronic address: rferri@oasi.en.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ferri
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D020189:Nocturnal Myoclonus Syndrome / Q000453:epidemiology / Q000209:etiology*; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D017286:Polysomnography; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000978:Antiparkinson Agents; D018492:Dopamine Antagonists; D007980:Levodopa
keywords: Dopamine agonists; Parkinson disease; Periodic leg movements during sleep; Periodicity index; Sleep; Time structure