Definicija i ij Sindrom nemirnih nogu - neurološki poremećaj karakteriziran nekontroliranim senzacijama (parestezijama i disestezijama) ij zbog kojih
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1 SINDROM NEMIRNIH NOGU prikaz slučaja Restless legs syndrome Mario Josipović, dr.med. Klinika za ortopediju KBC Zagreb
2 Definicija i ij Sindrom nemirnih nogu - neurološki poremećaj karakteriziran nekontroliranim senzacijama (parestezijama i disestezijama) ij zbog kojih postoji neodoljiva potreba za micanjem nogu
3 Zašto ova tema?
4 prijem na četvrti odjel za bolesnicu X.Y. (63) radi ugradnje endoproteze kuka dijagnoza: Reumatoidni artritis Koksartroza Amiloidoza Kronična bubrežna insuficijencija Osteoporoza Hipertenzija
5 iz anamneze: apendektomija, kolecistektomija, srčana aritmija alergije na Tramal i soli zlata lijekovi: Concor cor 2,5 mg Decortin 5 mg Controloc 20 mg Citalon 10 mg Lexaurin 1,5 mg Sanval 10 mg
6 operativni zahvat at protekao uredno spinalna anestezija (0,5% Marcain) gubitak krvi 450 ml analgezija: morfin, analgin, dolantin
7 Povijesne crtice - prvi se put spominje u medicinskoj literaturi godine, watching watching evil (T (T. Willis, Engleska) - 19.st. anxietas anxietas tibiarum (Njemačka) - impatience impatience musculaire (Francuska) godine Karl Ekborg opisao bolest i dao joj naziv sindrom nemirnih nogu
8 Patogeneza bazalni gangliji supstancija nigra poremećaj u središnjem dopaminergičnom sustavu Dopamin je neurotransmiter koji je neophodan za kontrolu i koordinaciju tjelesnih kretnji
9 Etiologija Ei ij RLS-a Primarni RLS idiopatski (50 75%) uzrok nepoznat poremećaj u postsinaptičkim receptorima dopamina važna uloga nasljedja geni na kromosomima 9, 12, 14
10 Sekundarni RLS: - Nedostatak željeza - Bubrežno zatajenje j uremija - Periferna neuropatija - Parkinsonova bolest - Reumatoidni artritis - Kronična bolest vena - Nedostak folata/b12, trudnoća, diabetes, hipotireoza, - Lijekovi: antidepresivi (poglavito SSRI), blokatori Ca-kanala, antagonisti dopamina
11 Epidemiologija i ij prevalencija u općoj populaciji oko 7-9 (2 15%) mediteranski bazen oko 4% odnos žene : muškarci 2:1 u 1/3 bolesnika simptomi se očituju prije 10. godine života u ½ bolesnika simptomi se očituju prije 20. godine života
12 Klinička ičk slika Parestezije i disestezije u nogama: trganje, probadanje, mravinjanje, j gmizanje, bockanje, grčenje, trzanje, udar struje, bol u kostima, svbež kostiju, žarenje, bolne noge, trzanje nogu Simptomi se javljaju u mirovanju, a prestaju kretanjem Otežano uspavljivanje Budjenje noću umor, pospanost, gubitak koncentracije, tjeskoba, depresija, smanjenje radne sposobnosti
13 Dijagnoza Dijagnosticira se tek u srednjoj ili starijoj životnoj dobi Često t se previdi ili krivo dijagnosticira i Za ispravnu dijagnozu važno je uzeti temeljitu anamnezu
14 NIH kriteriji: 1. nagon za pomicanjem nogu, često t praćen ć parestezijama i disestezijama 2. simptomi se pogoršavaju ili su prisutni samo u mirovanju 3. simptomi se pogoršavaju noću (cirkadijani ritam) 4. simptomi se djelomično ili privremeno smanjuju s aktivnošću
15 Neurološki pregled Vaskularni pregled Osnovna laboratorijska obrada KKS, GUK, dušikovi spojevi, Fe, feritin, transferin, B12, folati, hormoni štitnjače
16 Diferencijalna ij dijagnoza - Grčevi u nogama - Akatizija (pretjerane kretnje udova bez parestezija) - PLMD - Periferna neuropatija - Intermitentne klaudikacije - Artralgije - ADHD
17 Što je imala naša bolesnica? Pozitivna obiteljska anamneza Reumatoidni artritis Kronična bubrežna insuficijencija Spinalna anestezija Intraoperativni gubitak krvi
18 Liječenje č j Nemedikamentno: hodanje i istezanje hladno/tople kupke vježbe opuštanja (joga) masaža donjih udova promjena načina života izbjegavanje kofeina, alkohola, nikotina
19 Medikamentno: opravdano je samo kod bolesnika koji imaju simptome najmanje tri dana u tjednu ne dovode do izlječenja - Agonisti dopamina a ( ropinirol, o pramipexol) pe - Benzodiazepini (clonazepam) - Alfa-agonisti agonisti (clonidin)
20
21 Zaključak č k Sindrom nemirnih nogu je senzorni i motorni poremećaj Uvećini slučajeva nepoznatog uzroka Karakteristična klinička slika i simptomi Liječnici često imaju poteškoće u postavljanju ispravne dijagnoze Smanjuje kvalitetu života
22 Zaključak č k Sindrom nemirnih nogu je doživotno zdravstveno stanje za koje ne postoji izlječenje. Simptomi se mogu postupno pogoršavati s godinama. Sadašnja terapija omogućuje kontrolu bolesti, smanjenje simptoma i produljuje remisiju.
23 Literatura Kendel E.R., Schwarz J.H., Jessell T.H.: Principles of neural science Ropper A.H., Brown R.H.: Adams and Victor s principles of neurology Cynthia L. Comella, MD:Restless legs syndrome - Treatment with dopaminergic agents M. Manconi, MD; V. Govoni, MD; A. De Vito, MD; N.T. Economou, MD; E. Cesnik, MD; I. Casetta, MD; G. Mollica, MD; L. Ferini-Strambi, MD; and E. Granieri, MD: Restless legs syndrome and pregnancy Birgit Hogl and Werner Poewe:Restless legs syndrome B. Högl, MD, B. Frauscher, MD, K. Seppi, MD, H. Ulmer, PhD and W. Poewe, MD : Transient restless legs syndrome after spinal anesthesia C.H. Adler, MD, PhD; R.A. Hauser, MD; K. Sethi, MD; J.N. Caviness, MD; L. Marlor, BSN; W.M. Anderson, MD; and J.G. Hentz, MS : Ropinirole for restless legs syndrome, J.R. Connor, PhD; X.S. Wang, MD, PhD; S.M. Patton, PhD; S.L. Menzies, BA ; J.C. Troncoso, MD; C.J. Earley, MD, PhD; and R.P. Allen, PhD : Decreased transferrin receptor expression by neuromelanin cells in restless legs syndrome
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