Made available in DSpace on 2015-07-22T20:49:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-01-26 / Objetivo: O objetivo do presente estudo foi avaliar o perfil da densidade do transportador dopaminérgico utilizando SPECT em pacientes com Movimento Periódico das Pernas (MPP) e a influência do exercício físico agudo na concentração do DAT após um teste de esforço máximo (TEM). Métodos: Para isso 16 pacientes (8 grupo CTRL e 8 grupo Experimental) realizaram uma polissonografia (PSG) basal para a avaliação do padrão de sono e do índice do MPP. Após a PSG basal foi realizado o SPECT basal. Posteriormente os voluntários realizaram um TEM no período da manhã, após 2 horas, um novo exame de SPECT, e na mesma noite uma PSG para avaliar o efeito do exercício físico agudo no DAT e no padrão do sono. Resultados: Os resultados encontrados demonstraram que o grupo experimental apresentou valores menores no perfil da densidade do DAT no momento basal na região do estriado (p=0,03), foi demonstrado também uma redução do índice de MPP no grupo experimental (p=0,01) e um aumento da porcentagem do estagio 1 do sono NREM em ambos os grupos após o TEM (p=0,02). O estagio 2 do sono (p=0,02) e sono de ondas lentas (p=0,01) apresentaram diferenças entre os grupos no momento basal. Conclusão: Nossos resultados mostram que pacientes com MPP apresentaram uma menor densidade de DAT na região do putâmen esquerdo comparado ao grupo CTRL e uma sessão de exercício físico agudo (TEM) não alterou este perfil. Esses achados sugerem que alterações na densidade do DAT, talvez estejam relacionados a prática de exercício físico crônico. / Restless legs syndrome and periodic leg movement are sleep-related movement disorders and studies have shown changes in striatal dopaminergic activity in patients with these disorders. Physical exercise has been shown to improve the symptoms of restless legs syndrome and periodic leg movement, as has treatment with dopamine agonists. However, the mechanism by which physical exercise acts as a nonpharmacological treatment in improving symptoms of restless legs syndrome and periodic leg movement remains unknown. We evaluated dopamine transporter density profiles in 16 sedentary patients (control and experimental - with periodic leg movement, groups) and the influence of acute physical exercise on its concentration after a maximal exercise test. Each patient underwent baseline polysomnography to evaluate sleep patterns and periodic leg movement index values. After obtaining the polysomnography baseline, the single photon emission computer tomography baseline was determined. Subsequently, the volunteers performed a maximal exercise test in the morning, followed by a single photon emission computer tomography two hours later and polysomnography that night, to assess the effect of acute physical exercise on dopamine transporter and sleep patterns. The results showed significant lower dopamine transporter baseline densities in the striatum region for the experimental group. The results also showed a significant reduction in the periodic leg movement rate in the experimental group and a significant increased percentage of stage-1 non-REM sleep in both groups after maximal exercise test. Significant differences between the groups were only observed for Stage 2 sleep and slow wave sleep. Our results show that patients with periodic leg movement had a lower dopamine transporter density in the left putamen region compared to the control group and an acute physical exercise (maximal exercise test) did not alter this profile, providing evidence that this improvement is the result of chronic physical exercise. / TEDE / BV UNIFESP: Teses e dissertações

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La sécrétion de mélatonine chez des patients atteints du syndrome d’impatience musculaire de l’éveil (SIME) débute approximativement 2 heures avant l’aggravation des symptômes en soirée (Michaud et al., 2004). Le but de ce projet était de préciser le rôle de la mélatonine dans l’augmentation de la sévérité des symptômes en soirée. Huit sujets atteints de SIME primaire ont été étudiés dans trois conditions : contrôle, avec administration de mélatonine, avec exposition à la lumière vive. La sévérité des symptômes a été évaluée par l’administration de tests d’immobilisation suggérée (TIS). Les résultats ont démontré une augmentation significative des mouvements périodiques des jambes durant l’éveil (MPJE) lorsque de la mélatonine avait été administrée comparativement à la condition contrôle et celle où les sujets étaient exposés à la lumière vive. La lumière vive n’a pas eu d’effet significatif sur les symptômes moteurs comparativement à la condition contrôle mais elle a amélioré significativement les symptômes sensoriels comparativement à la condition contrôle. Ainsi, bien que la mélatonine exogène ait un effet aggravant sur les symptômes moteurs du SIME, l’augmentation de la sécrétion endogène au cours de la soirée ne saurait expliquer à elle seule les variations de la sévérité des symptômes du SIME. / A close temporal relationship was shown between the onset of melatonin secretion at night and the worsening of restless legs syndrome (RLS) symptoms, suggesting that melatonin may play a role in the genesis of this phenomenon. Thus, we studied the effects of the administration of exogenous melatonin and the suppression of endogenous melatonin secretion by bright light exposure on the severity of RLS symptoms. Eight RLS subjects were studied in three conditions: at baseline, after administration of melatonin and during bright light exposure. The severity of RLS symptoms was assessed by the Suggested Immobilization Test (SIT), which allows quantification of both sensory and motor manifestations (SIT-PLM – periodic leg movements) of RLS. Analyses showed a significant increase of SIT-PLM index when subjects received exogenous melatonin compared to both baseline and bright light conditions, but bright light exposure had no effect on leg movements compared to the baseline condition. Analyses also revealed a small but significant decrease in sensory symptoms with bright light exposure compared to baseline. Although that exogenous melatonin may have a detrimental effect on motor symptoms, the augmentation of endogenous secretion during the evening is insufficient to explain the variations of the severity of the RLS symptoms.

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Les mouvements périodiques des jambes sont de courts mouvements involontaires qui surviennent de façon périodique au cours du sommeil ou de l’éveil. Ils sont présents dans certains troubles du sommeil, mais également chez des sujets sans plainte reliée au sommeil. Le premier objectif de cette thèse visait une meilleure description de la prévalence de ces mouvements. Nous avons montré que chez les sujets sans plainte de sommeil, la prévalence des mouvements périodiques des jambes en sommeil augmentait de façon importante à partir d’environ 40 ans, tandis que l’index des mouvements périodiques des jambes à l’éveil évoluait avec l’âge selon une courbe en U. Chez les sujets atteints de narcolepsie, on retrouvait davantage de mouvements périodiques des jambes que chez les sujets témoins, mais leur patron d’évolution avec l’âge était similaire. Le deuxième objectif de cette thèse visait l’étude des mouvements périodiques des jambes en relation avec le système nerveux autonome cardiovasculaire. Nous avons non seulement confirmé la présence d’une tachycardie suivie d’une bradycardie lors des mouvements périodiques des jambes durant le sommeil chez les patients atteints du syndrome d’impatiences musculaires à l’éveil et chez les sujets sans plainte de sommeil, mais nous avons également décrit ces mêmes changements de la fréquence cardiaque, quoiqu’avec une plus faible amplitude, chez les sujets atteints de narcolepsie. Finalement, nous avons montré pour la première fois que les mouvements périodiques des jambes en sommeil des sujets atteints du syndrome d’impatiences musculaires à l’éveil et des sujets sans plainte de sommeil étaient aussi associés à des augmentations importantes et significatives de la pression artérielle. / Periodic leg movements are short involuntary movements occurring periodically during sleep or wakefulness. They occur in some sleep disorders, but also in healthy subjects not complaining of sleep problems. The first objective of this thesis was to provide a better description of the prevalence of these movements. In healthy non-complaining subjects, the prevalence of periodic leg movements during sleep increased dramatically from about age 40, whereas the age-related evolution of periodic leg movements during wakefulness followed a U curve. In narcoleptic patients there were more periodic leg movements than in control subjects, but their evolution with age showed the same pattern. The second objective of this thesis was to study periodic leg movements in relationship with cardiovascular autonomic nervous system. We not only confirmed that periodic leg movements during sleep were associated with a tachycardia followed by a bradycardia in restless legs syndrome patients and in healthy non-complaining subjects, but that these heart rate changes were also present in narcoleptic patients, albeit of a lower amplitude. Finally, we showed for the first time that periodic leg movements during sleep in restless legs syndrome patients and in healthy non-complaining subjects were also associated with significant and important rises of blood pressure.