Navegando por Palavras-chave "Restless legs syndrome"
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- ItemSomente MetadadadosIs Neuropathy Involved with Restless Legs Syndrome in Machado-Joseph Disease?(Karger, 2011-01-01) Pedroso, Jose Luiz [UNIFESP]; Escorcio Bezerra, Marcio Luiz [UNIFESP]; Braga-Neto, Pedro [UNIFESP]; Pinheiro, Denise Spinola [UNIFESP]; Minett, Thais [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Manzano, Gilberto Mastrocola [UNIFESP]; Barsottini, Orlando Graziani Povoas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To evaluate a group of spinocerebellar ataxia type 3 (SCA3) or Machado-Joseph disease (MJD) (SCA3/MJD) patients and assess whether there is an association between neuropathy and serum ferritin levels and restless legs syndrome (RLS). Methods: Twenty-six SCA3/MJD patients underwent electromyography studies to check for neuropathy. Their serum ferritin levels were measured as well. These findings were evaluated based on the presence or not of RLS and its severity. Results: the proportion of neuropathy in the RLS group was not significantly higher compared to the non-RLS group (23 vs. 15%, Fisher's exact test, p = 1.000). Furthermore, no association was found between RLS and ferritin levels. Conclusion: We found no correlation between neuropathy or ferritin levels and RLS in SCA3/MJD patients. Copyright (C) 2011 S. Karger AG, Basel
- ItemSomente MetadadadosPlasma iron levels appraised 15 days after spinal cord injury in a limb movement animal model(Nature Publishing Group, 2011-03-01) Reis, F. M. [UNIFESP]; Esteves, Andrea Maculano [UNIFESP]; Tufik, Sergio [UNIFESP]; Mello, Marco Tulio de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Associacao Fundo Incent PsicofarmacolStudy design: Experimental, controlled trial.Objectives: the purpose of this study was to evaluate plasma iron and transferrin levels in a limb movement animal model with spinal cord injury (SCI).Setting: Universidade Federal de São Paulo, Departamento de Psicobiologia.Methods: in all, 72 male Wistar rats aged 90 days were divided into four groups: (1) acute SCI (1 day, SCI1), (2) 3 days post-SCI (SCI3), (3) 7 days post-SCI (SCI7) and (4) 15 days post-SCI (SCI15). Each of these groups had corresponding control (CTRL) and SHAM groups. Plasma iron and transferrin levels of the different groups were analyzed using a one-way analysis of variance (ANOVA) followed by Tukey's test.Results: We found a significant reduction in iron plasma levels after SCI compared with the CTRL group: SCI1 (CTRL: 175 +/- 10.58 mu gdl +/-; SCI: 108.28 +/- 11.7 mu gdl(-1)), SCI3 (CTRL: 195.5 +/- 11.00 mu gdl(-1); SCI: 127.88 +/- 12.63 mu gdl(-1)), SCI7 (CTRL: 186 +/- 2.97 mu gdl(-1); SCI: 89.2 +/- 15.39 mu gdl(-1)) and SCI15 (CTRL: 163 +/- 5.48 mu gdl(-1); SCI: 124.44 +/- 10.30 mu gdl(-1)) (P < 0.05; ANOVA). the SHAM1 group demonstrated a reduction in iron plasma after acute SCI (CTRL: 175 +/- 10.58 mu gdl(-1); SHAM: 114.60 +/- 7.81 mu gdl(-1)) (P < 0.05; ANOVA).Conclusion: Reduced iron metabolism after SCI may be one of the mechanisms involved in the pathogenesis of sleep-related movement disorders. Spinal Cord (2011) 49, 361-364; doi:10.1038/sc.2010.121; published online 7 September 2010
- ItemSomente MetadadadosPrevalence and quality of life and sleep in children and adolescents with restless legs syndrome/Willis-Ekbom disease(Elsevier Science Bv, 2017) Sander, Heidi Haueisen; Eckeli, Alan Luiz; Passos, Afonso Diniz Costa; Azevedo, Leila; do Prado, Lucila Bizari Fernandes [UNIFESP]; Fernandes, Regina Maria FrancaObjective: To estimate the prevalence of restless legs syndrome/Willis-Ekbom disease (RLS/WED) and its impact on sleep and quality of life in children and adolescents. Methods: This was a cross-sectional study conducted in the Municipality of Cassia dos Coqueiros, Brazil. Participants included 383 children and adolescents 5-17 years of age. A comparison group was randomly matched by gender and age with the RLS/WED-affected individuals, pairing one by one. Results: Interviews were conducted for 383 individuals by a neurologist experienced in sleep medicine. RLS/WED was diagnosed using the essential clinical criteria for definitive RLS/WED in children recommended by the International Restless Legs Syndrome Study Group. Sleep and quality of life were evaluated using the Sleep Behavior Questionnaire (SBQ) and the Health-related Quality of Life Questionnaire ePediatric Quality of Life Inventory (PedsQL). Comparisons were established with a group of randomly selected individuals without RLS/WED, matched by age and gender (control group). The prevalence of RLS/WED symptoms that manifested at least twice a week was 1.9%. The average age of children with RLS/WED was higher compared to the general population (11.5 +/- 2.3 vs 9.9 +/- 2.5, p < 0.005). A family history of RLS/WED was detected in 90.9% of the patients. The scores obtained by SBQ were higher (53.9 +/- 9.4 vs 47.6 +/- 10.9, p < 0.047), whereas the scores achieved by PedsQL were lower (69.8 +/- 14.8 vs 81.9 +/- 10.4, p < 0.003) in children with RLS/WED compared to controls. Conclusion: The prevalence of RLS/WED symptoms manifested at least twice in the preceding week was 1.9% in children and adolescents. Worsened sleep and quality of life were observed in the study. (C) 2016 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosPrevalence of restless legs syndrome in the rural town of Cassia dos Coqueiros in Brazil(Elsevier B.V., 2011-09-01) Eckeli, Alan Luiz; Goes Gitai, Livia Leite; Dach, Fabiola; Ceretta, Henrique; Sander, Heidi Hausein; Costa Passos, Afonso Dinis; Prado, Gilmar Fernandes do [UNIFESP]; Franca Fernandes, Regina Maria; Universidade de São Paulo (USP); Univ Fed Alagoas; Universidade Federal de São Paulo (UNIFESP)Objective: To estimate the prevalence and evaluate the characteristics and severity of restless legs syndrome (RLS) in an urban Brazilian community.Methods: A transversal study was conducted over an 18-month period. A neurologist conducted 1155 interviews using the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG).Results: the lifetime prevalence of RLS was found to be 6.40%. Prevalence during the last year, the last month, and the last week were found to be 5.71%, 5.36%, and 4.15%, respectively. A greater proportion of women met diagnostic criteria for RLS compared to men (OR: 2.63, CI 95%: 1.54-4.51). Furthermore, participants with low monthly family income (<$1575 USD) had a lower prevalence of disease compared to those with a high monthly family income (>$1575 USD) (OR: 2.91, CI 95%: 1.41-5.98).Conclusions: This is the first epidemiologic study of RLS conducted in a Brazilian population. the overall prevalence of disease and the greater proportion of RLS in women found in this study are similar to the findings of other studies conducted in western countries. the association of RLS with high family income is unpublished and should be confirmed in subsequent studies. (C) 2011 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Prevalência de distúrbios do sono na pós-menopausa(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2005-12-01) Campos, Helena Hachul de [UNIFESP]; Bittencourt, Lia Rita Azeredo [UNIFESP]; Haidar, Mauro Abi [UNIFESP]; Tufik, Sergio [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: to evaluate the prevalence of reported sleep disturbances through polysomnographic recording (PSG) in a sample of postmenopausal women. METHODS: thirty-three postmenopausal women with a mean age of 56 years, a mean body mass index (BMI) of 27 kg/m², with 7.7 years of recognized postmenopausal period, and a mean Kupperman index of 17, were selected. The inclusion criteria were: age range from 50 to 65 years, at least one year of amenorrhea and an FSH which equaled or exceeded 30 mU/ml; they should not be undergoing hormone therapy, and should display normal laboratory test results. The patients with severe clinical diseases and/or decompensated were excluded; also the ones with suspicion of carcinoma of endometrium and/or breast cancer, a BMI over 30 kg/m² and those who ingested hypnotic drugs. The patients followed a routine climacteric check-up, answered a questionnaire about sleep and underwent an all-night PSG recording. Frequencies in percentage of emerging sleep complaints based on the questionnaire and those pertaining to PSG diagnosis were then calculated separately. RESULTS: the subjective prevalence of insomnia was 61% against 83% in the PSG recordings. The prevalence of apnea reported was 23% against 27% in the PSG. The subjective restless legs syndrome prevalence was 45%, and the objective, 27%. CONCLUSION: there was a high prevalence of sleep disturbances in postmenopausal patients, specially insomnia, apnea and restless legs.
- ItemSomente MetadadadosRestless Legs Syndrome and Pain Disorders: What's in common?(Springer, 2014-11-01) Goulart, Leonardo Ierardi; Delgado Rodrigues, Raimundo Nonato; Peres, Mario Fernando Prieto [UNIFESP]; Hosp Israelita Albert Einstein; Universidade de Brasília (UnB); Universidade Federal de São Paulo (UNIFESP)Between 10 % and 30 % of the population report chronic pain. More than half of these also have sleep complaints. From considering these data, it can be inferred there is a significant overlapping between these conditions. Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is characterized by complaints of an urge to move frequently associated with dysesthesias. From that perspective, these sensations can also have painful characteristics. By the same token, the presence of comorbid diseases as predicted by a higher prevalence RLS/WED, have many of them with pain as an important complaint. Pain is a multidimensional response involving several levels of expression ranging from somatosensory to emotional. the potential shared mechanisms between RLS/WED and pain may involve sleep deprivation/fragmentation effect, inducing an increase in markers of inflammation and reduction in pain thresholds. These are modulated by several different settings of neurotransmitters with a huge participation of monoaminergic dysfunctional circuits. A thorough comprehension of these mechanisms is of utmost importance for the correct approach and treatment choices.
- ItemSomente MetadadadosRestless legs syndrome associated with Guillain-Barre syndrome: A report of two cases(Elsevier B.V., 2010-07-01) Marin, Luis Fabian [UNIFESP]; Celso dos Santos, William Adolfo [UNIFESP]; Pedroso, Jose Luiz [UNIFESP]; Ferraz, Henrique Ballalai [UNIFESP]; Coin de Carvalho, Luciane Bizari [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp & Maternidade Sao Camilo Pompeia
- ItemSomente MetadadadosRestless legs syndrome during pregnancy in Brazilian women(Elsevier B.V., 2010-12-01) Galdino Alves, Debora A. [UNIFESP]; Coin de Carvalho, Luciane Bizari [UNIFESP]; Morais, Jose Fausto de [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Ctr Univ LavrasObjective: the objective of this study was to identify the prevalence of restless legs syndrome (RLS) among pregnant Brazilian women, with individual diagnostic clinical interviews during the trimesters of pregnancy, and to determine the severity.Methods: It was a cross-sectional study. We interviewed 524 pregnant women (18-45 years old) who came to the prenatal outpatient clinic to consult an obstetrician. We used a RLS clinical-diagnostic interview and the International RLS Study Group rating scale (IRLS).Results: the prevalence of RLS during pregnancy was 13.5% in our sample, among which 90.1% of the cases started with their symptoms during pregnancy. More than half of the patients (53.5%) presented severe or very severe symptoms and the largest proportion of them (15.2%) were in their third trimester. We did not observe any demographic differences among the trimesters for RLS prevalence and RLS severity.Conclusion: RLS during pregnancy is more frequent than in the general population, such that more than half of the pregnant women with RLS present it severely or very severely. It occurs especially in the third trimester. (C) 2010 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosRestless legs syndrome in post-polio syndrome: A series of 10 patients with demographic, clinical and laboratorial findings(Elsevier B.V., 2011-08-01) Marin, Luis F. [UNIFESP]; Carvalho, Luciane B. C. [UNIFESP]; Prado, Lucila B. F. [UNIFESP]; Quadros, Abrahao A. J. [UNIFESP]; Oliveira, Acary S. [UNIFESP]; Prado, Gilmar E. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Few studies have described the occurrence of restless legs syndrome in post-polio syndrome.Methods: We studied 10 consecutive patients with post-polio syndrome and symptoms of restless legs syndrome. We look at demographic, clinical and laboratorial data.Results: A remarkable finding was the concomitant onset of symptoms of both diseases, suggesting a possible underlying mechanism. Severity of restless legs symptoms was moderate to very severe.Conclusion: Epidemiological studies with larger samples are needed to better establish the relationship and the incidence of restless legs syndrome in post-polio syndrome. (C) 2011 Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosRestless legs syndrome is highly prevalent in patients with post-polio syndrome(Elsevier Science Bv, 2017) Marin, Luis Fabiano; Carvalho, Luciane B. C.; Prado, Lucila B. F.; Oliveira, Acary S. B. [UNIFESP]; Prado, Gilmar F.Objective: Few studies have quantified the prevalence of restless legs syndrome (RLS) in patients with post-polio syndrome (PPS). Our objective was to assess the prevalence and severity of RLS in patients with PPS and to examine the demographic characteristics of this population. Method: This was a cross-sectional study conducted from April 2010 to May 2012 at the outpatient Neuromuscular Disorders clinic of Universidade Federal de Sao Paulo, Sao Paulo, Brazil. We evaluated 119 patients with PPS, consecutively recruited, and investigated for RLS based on the diagnostic criteria established by the International Restless Legs Syndrome Study Group (IRLSSG). Patients were evaluated with the Brazilian version of the IRLSSG severity scale. Results: The prevalence of RLS was 36% (n = 43
- ItemSomente MetadadadosSeverity of restless legs syndrome is inversely correlated with echogenicity of the substantia nigra in different neurodegenerative movement disorders. A preliminary observation(Elsevier B.V., 2012-08-15) Pedroso, Jose Luiz [UNIFESP]; Bor-Seng-Shu, Edson; Felicio, Andre C. [UNIFESP]; Braga-Neto, Pedro [UNIFESP]; Dutra, Livia A. [UNIFESP]; Aquino, Camila C. de [UNIFESP]; Ferraz, Henrique B. [UNIFESP]; Prado, Gilmar F. do [UNIFESP]; Teixeira, Manoel J.; Barsottini, Orlando G. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); HIAEObjective: Hyperechogenicity of the substantia nigra is a frequent observation on transcranial sonography in Parkinson's disease and Machado-Joseph disease patients. Additionally, restless legs syndrome is a sleep disorder that is also frequently found in both diseases. Autopsy studies have demonstrated increased SN iron content in hyperechogenic substantia nigra. Iron storage is also known to be involved in restless legs syndrome. We formally compared echogenicity of the substantia nigra with restless legs syndrome in Parkinson's disease and Machado-Joseph disease patients.Methods: Transcranial brain sonography was performed in a sample of Parkinson's disease and Machado-Joseph disease patients, and findings then correlated with the presence and severity of restless legs syndrome.Results: There was a continuum of substantia nigra echogenicity among groups (Parkinson's disease versus Machado-Joseph disease versus controls) and sub-groups (Parkinson's disease with and without restless legs syndrome versus Machado-Joseph disease with and without restless legs syndrome) as well as a statistically significant negative correlation between restless legs syndrome severity and substantia nigra echogenicity (p<0.001).Conclusions: These preliminary observations demonstrate that the severity of RLS may be influenced by nigral iron load reflected by substantia nigra echogenicity in different neurodegenerative movement disorders. (C) 2012 Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)Síndrome das pernas inquietas em pacientes brasileiros: uma análise qualitativa sobre o sofrimento psicossocial e a atenção interdisciplinar(Universidade Federal de São Paulo (UNIFESP), 2015-02-29) Varela, Maria Jose Vilela de [UNIFESP]; Carvalho, Luciane Bizari Coin de [UNIFESP]; Carvalho, João Eduardo Coin de [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; http://lattes.cnpq.br/0873354243134229; http://lattes.cnpq.br/2617510083171521; http://lattes.cnpq.br/4508875707983155; http://lattes.cnpq.br/6751318718805176; Universidade Federal de São Paulo (UNIFESP)Resumo do Artigo 1 Objetivos: O objetivo deste estudo é investigar os fatores psicossociais relacionados ao diagnóstico e tratamento de pacientes com a síndrome das pernas inquietas. Métodos Quinze pacientes com diagnóstico de SPI foram entrevistados no Ambulatório Neuro-Sono da disciplina de Neurologia da Universidade Federal de São Paulo (UNIFESP). Resultados Os resultados foram submetidos à análise de conteúdo qualitativo. Identificamos quatro categorias relevantes: Descrição da doença, História da doença, Experiência da doença e Relação com os outros. O descontrole sobre o corpo, aliado ao seu não reconhecimento pelo profissional, produz um estigma sobre os indivíduos e leva ao sofrimento dos pacientes. Conclusão A pesquisa ressalta a importância de fatores psicossociais para o diagnóstico e tratamento de pacientes com síndrome das pernas inquietas e a importância de ter equipes interdisciplinares para o atendimento de pacientes com síndrome das pernas inquietas. Resumo do Artigo 2 Introdução: A síndrome das Pernas Inquietas (SPI) é um distúrbio neurológico que afeta o sono e a qualidade de vida de seus portadores, sendo caracterizado por uma necessidade irresistível em mover as pernas, pelas sensações desagradáveis. Objetivos O objetivo deste estudo é investigar como o entendimento e os manejos desta enfermidade, tendo em vista suas dimensões socioculturais, especialmente as de gênero/sexualidade, são constituídos a partir do tratamento e cuidados de um grupo de pacientes em São Paulo, Brasil. Métodos Quinze pacientes foram entrevistados no Ambulatório de Neuro-Sono, da Universidade Federal de São Paulo. Resultados Os resultados encontrados foram submetidos à análise qualitativa e o estudo identificou na condução da temática da sexualidade destes pacientes duas categorias importantes: Corpo-Movimento e O olhar dos outros. Os participantes referem que a dimensão sexual surge como um organizador do olhar do outro sobre a doença: no caso da mulher, quando a doença aponta para a sexualidade há um desvio para o descuido e, portanto, sofrimento. Conclusão Concluímos que esta condição no tratamento e no cuidado exige, assim, uma retificação do olhar do profissional de saúde para atender integralmente às demandas trazidas pelos sujeitos, especialmente as mulheres, considerando os limites e as possibilidades de sua inserção cultural e social, com importantes consequências para a atenção e o tratamento.
- ItemSomente MetadadadosSleep Disorders in Machado-Joseph Disease: Frequency, Discriminative Thresholds, Predictive Values, and Correlation with Ataxia-Related Motor and Non-Motor Features(Springer, 2011-06-01) Pedroso, Jose Luiz [UNIFESP]; Braga-Neto, Pedro [UNIFESP]; Felicio, Andre Carvalho [UNIFESP]; Dutra, Livia Almeida [UNIFESP]; Santos, William A. C. [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Barsottini, Orlando Graziani Povoas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Sleep disorders are common complaints in patients with neurodegenerative diseases such as spinocerebellar ataxia type 3 (SCA3) or Machado-Joseph disease (MJD)-SCA3/MJD. We evaluated the frequency of sleep disorders in SCA3/MJD patients against controls matched by age and gender, and correlated data with demographic and clinical variables. the main sleep disorders evaluated were rapid eye movement (REM) sleep behavior disorder (RBD), restless leg syndrome (RLS), and excessive daytime sleepiness (EDS). We recruited 40 patients with clinical and molecular-proven SCA3/MJD and 38 controls. We used the following clinical scales to evaluate our primary outcome measures: RBD Screening Questionnaire, International RLS Rating Scale, and Epworth Sleepiness Scale. To evaluate ataxia-related motor and non-motor features, we applied the International Cooperative Ataxia Rating Scale, the Scale for the Assessment and Rating of Ataxia, and the Unified Parkinson's Disease Rating Scale part III. Psychiatric manifestations were tested with the Hamilton Anxiety Scale, and Beck Depression Inventory. the frequency of RBD and RLS were significantly higher in the SCA3/MJD group than in the control group (p < 0.001). There was no difference between both groups with regard to EDS. the accuracy of RDBSQ to discriminate between cases and controls was considered the best area under the ROC curve (0.86). Within-SCA3/MJD group analysis showed that anxiety and depression were significantly correlated with RDB, but not with RLS. Additionally, depression was considered the best predictive clinical feature for RDB and EDS.
- ItemSomente MetadadadosSleep-related movement disorder symptoms in SHR are attenuated by physical exercise and an angiotensin-converting enzyme inhibitor(Pergamon-Elsevier Science Ltd, 2016) Frank, Miriam Kannebley; Mello, Marco Tulio de; Lee, Kil Sun [UNIFESP]; Daubian-Nose, Paulo; Tufik, Sergio [UNIFESP]; Esteves, Andrea MaculanoThe relationship between hypertension and sleep-related movement disorders has been hypothesized for humans, but the causes and mechanisms have not been elucidated. We investigated whether an alteration in blood pressure (BP) induced by physical exercise and/or an angiotensin-converting enzyme inhibitor (enalapril) could affect locomotor activity in spontaneously hypertensive rats, with emphasis on the dopaminergic system. We used SHR and normotensive Wistar rats distributed into 4 groups for each strain: control, physical exercise, enalapril and physical exercise + enalapril. Physical exercise was performed on a treadmill, and enalapril was administered by gavage, both for 8 weeks. During this period, locomotor activity was evaluated in an open field test, and BP was evaluated by tail plethysmography. Dopaminergic receptors, dopamine transporter and tyrosine hydroxylase levels at the striatum were evaluated by Western blotting. The control group of spontaneously hypertensive rats showed higher BP, increased activity in the open field test and lower levels of D2 receptors and tyrosine hydroxylase compared with all other groups throughout the experimental period. In general, physical exercise and enalapril attenuated these alterations. This study suggested the existence of comorbidity between hypertension and sleep-related movement disorders in spontaneously hypertensive rats. Physical exercise and enalapril conferred protection for both hypertension and the observed behavioral changes. In addition, these treatments led to changes in dopaminergic signaling in the striatal region (i.e., D2 receptor, TH and DAT). (C) 2015 Elsevier Inc All rights reserved.
- ItemAcesso aberto (Open Access)Sonolência excessiva(Associação Brasileira de Psiquiatria - ABP, 2005-05-01) Bittencourt, Lia Rita Azeredo [UNIFESP]; Santos-Silva, Rogerio; Santos, Ruth Ferreira; Pires, Maria Laura Nogueira; Mello, Marco Tulio de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Associação Fundo Incentivo à Psicofarmacologia Instituto do SonoSleepiness is a physiological function, and can be defined as increased propension to fall asleep. However, excessive sleepiness (ES) or hypersomnia refer to an abnormal increase in the probability to fall asleep, to take involuntary naps, or to have sleep atacks, when sleep is not desired. The main causes of excessive sleepiness is chronic sleep deprivation, sleep apnea syndrome, narcolepsy, movement disorders during sleep, circadian sleep disorders, use of drugs and medications, or idiopathic hypersomnia. Social, familial, work, and cognitive impairment are among the consequences of hypersomnia. Moreover, it has also been reported increased risk of accidents. The treatment of excessive sleepiness includes treating the primary cause, whenever identified. Sleep hygiene for sleep deprivation, positive pressure (CPAP) for sleep apnea, dopaminergic agents and exercises for sleep-related movement disorders, phototherapy and/or melatonin for circadian disorders, and use of stimulants are the treatment modalities of first choice.