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The purpose of the research presented in this article was to characterize restless legs syndrome (RLS) in a headache population and correlate treatment induced risks with dopamine blockers. Fifty patients with severe headache who were admitted to an outpatient infusion center were enrolled. The diagnosis of RLS was established using the International Restless Legs Syndrome Study Group criteria. Patients were screened for baseline akathisia using an akathisia scale and reexamined for akathisia after receiving intravenous infusion with one of four dopamine receptor blocking agents as treatment for their headaches. A change from baseline to post-infusion assessment of two points on a global assessment of akathisia was considered positive for drug-induced akathisia. Our results indicated that 41 (82%) of patients had episodic or chronic migraine. The rest had new daily persistent headache, cluster, or posttraumatic headache. Seventeen subjects (34%) met the criteria for RLS. Nineteen (38%) of the subjects developed drug-induced akathisia. Thirteen (76.5%) of the subjects with RLS developed akathisia compared with only 6 of the 33 (18.2%) without RLS (P<.0001). Finally, we concluded that headache patients with RLS are at a greatly increased risk of developing drug-induced akathisia when treated with intravenous dopamine receptor blocking agents.
This chapter talks about a 41-year-old man who was referred to memory clinic because of memory loss, poor verbal expression, loss of interest, and blunted response to environment. Cognitive status was evaluated by the mini-mental state examination (MMSE) and a detailed neuropsychological battery for assessment of memory, language and executive function, attention, and concentration. The examination documented moderate dementia with moderate amnesia and dysexecutive syndrome. Neuropsychological tests showed evidence of cognitive impairment of multiple domains, including memory, executive function, and attention and speed of information processing. He received 3-week penicillin therapy at an Infectious Diseases Hospital. During the follow-up check-up 3 months after penicillin therapy, the serum Rapid Plasma Reagin (RPR) was negative. Performance of verbal fluency and color trail making test was improved dramatically, suggesting executive function was restored after anti-syphilitic therapy. The follow-up magnetic resonance imaging (MRI) scan was unaltered compared with the initial visit.