Restless legs

Alan J. Robinson robin073 at maroon.tc.umn.edu
Fri Sep 22 09:24:11 EST 1995


On Thu, 21 Sep 1995 17:24:11 GMT, 
Eric Wassermann  <ewass at codon.nih.gov > wrote:

>In article <41699.robin073 at maroon.tc.umn.edu>, "Alan J. Robinson"
><robin073 at maroon.tc.umn.edu> wrote:
>
>
>Yes.  Sinemet (DOPA/carbidopa) or bromocryptine is usually quite effective
>in treating this syndrome and is an accepted treatment with relatively
>mild side effects.  I don't know about phentermine and fenfluramine.  I
>wonder what basis the writer has for classifying restless leg syndrom as a
>"neuropsychiatric immune functional disorder", whatever that means.  As
>far as I know, there is no evidence of a psychiatric, immune or functional
>component.  Like many neurological disorders, of which restless leg
>syndrome is certainly one, it could be arise from a single abnormal gene.
>

Eric:

There is growing evidence from many lines of research 
(epidemiological, theraupeutic, etc.) that the majority of functional 
neurological, psychiatric, and immune disorders are more or less 
related to one another in various ways.  Individual disorders do tend 
to "breed true", but almost invariably for both the proband and the 
rest of the lineage there will be other comorbid symptoms and 
disorders (e.g. migraines, photophobia etc, etc.)

Thus it is quite possible that there could be genes which strongly 
determine whether an individual will develop a particular disorder or 
syndrome, but many other genes will have an effect too, leading to the 
appearance of reduced penetrance and expression.  That these are 
multigene disorders is finally starting to sink in (see the special 
issue of Science 264 (Jun 17) 1994 - Genetics and behavior.)

This whole area of medicine is ripe for revolutionary change in 
our concepts of nosology, etiology etc., but even basic terminology 
is not standardized yet.  For example Chrousos and Gold use the term 
"stress system disorders", but that is really somewhat misleading and 
doesn't get to the heart of the matter.  A couple of references which 
illustrate these themes are:

GP Chrousos & PW Gold (1992).  "The concepts of stress and stress 
system disorders: overview of physical and behavioral homestasis".  
JAMA 267(9): 1244-1252.

JI Hudson & HG Pope (1990).  "Affective spectrum disorder: does 
antidepressant response identify a family of disorders with a 
common pathophysiology?"  American Journal of Psychiatry 147(5): 
552-564.

BTW, I was wondering from your address if you are involved in the 
Human Genome Project? 

AJR




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