Neurophysiologische und Bildgebungsstudien beim Restless-legs-Syndrom und bei periodischen Beinbewegungen
Tóm tắt
Die Diagnose des Restless-legs-Syndroms (RLS) basiert auf den von der International Restless Legs Syndrome Study Group (IRLSSG) festgelegten vier essenziellen Kriterien. Eine idiopathische Form wird von einer symptomatischen Form unterschieden. Bislang wurden zahlreiche neurophysiologische und Bildgebungsstudien zur Untersuchung der Pathophysiologie des idiopathischen RLS oder zum Ausschluss symptomatischer Ursachen, insbesondere einer Polyneuropathie, durchgeführt. Neurophysiologische Studien fokussierten sich auf die Untersuchung von kortikalen Veränderungen, kortikomotorischen, somatosensorischen und auditorischen Bahnen, veränderter Exzitabilität des Rückenmarks, B-Wellen und „cycling alternating patterns“ sowie Reflexmechanismen. Elektroenzephalographie, evozierte Potenziale, Bereitschaftspotenziale, Nervenleitgeschwindigkeits- und Temperaturschwellenmessungen, Elektromyographie, transkranielle Dopplersonographie, Untersuchungen des spinalen Flexorreflexes sowie unterschiedliche Techniken der zerebralen Bildgebung kamen dabei zur Anwendung. Bei immer noch unbekannter Ätiologie des RLS liefern neurophysiologische Studien sowohl ein besseres Verständnis der zugrunde liegenden Pathophysiologie als auch einen Ausschluss einer Polyneuropathie oder anderer symptomatischer Ursachen. Eine Polyneuropathie kann mit einer routinemäßigen Nervenleitgeschwindigkeitsmessung nicht vollständig erfasst oder ausgeschlossen werden, sobald eine sog. „Small-fiber-Neuropathie“ vorliegt, die möglicherweise bei RLS-Patienten häufiger als bisher vermutet auftritt. Diese Arbeit gibt eine Übersicht über bisherige pathophysiologische Untersuchungen und trennt zwischen wissenschaftlichen Aspekten und in der Praxis notwendigen Untersuchungen.
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