Differential therapy of nocturnal motor complications: case reports

Patients with Parkinson's disease (PD) and restless legs syndrome (RLS) oft en suffer from severe sleep disruption with frequent and prolonged awakenin gs and daytime sleepiness. Sleep disturbances gradually worsen with disease progression, and therapy may be difficult, especially in advanced stages. The most troublesome sleep complaints in patients with Parkinson's disease consist of nocturnal motor problems with difficulty in turning over in bed and painful leg cramps (Lees et al., 1988). Sleep disturbances in PD are al so a complication of chronic levodopa therapy and are less likely to occur with controlled-release preparations. In RLS, the main causes of night-time problems are sensory features and motor symptoms, such as restlessness and involuntary periodic leg movements (PLM) during sleep and wakefulness. Lev odopa is currently considered the therapy of first choice in RLS; however, its short half-life and associated daytime augmentation of RLS symptoms may complicate therapy Strategies that will help to succeed in these patients are demonstrated in case reports.