The Corpus Callosum

href="http://www.ninds.nih.gov/disorders/restless_legs/restless_legs.htm">Restless
Legs Syndrome has been more in the public eye lately.
I understand this is because of aggressive direct-to-consumer
advertising. I’m not much of a consumer, so I haven’t seen
the ads, but people tell me about them.

Whatever you think of DTC advertising, RLS is real, and it is a
significant problem for some people.

Years ago, it was discovered that RLS can be alleviated for some people
with carbidopa/levodopa. But that was an off-patent medicine.
When patented medicines [Requip (ropinirole) and Mirapex
(pramipexole)] became available, RLS became an opportunity, hence, the
ads.

Not all patients required medication. Sometimes, it was
possible to try an underlying cause. Iron deficiency is one
example, easily corrected. Others could benefit from
lifestyle changes. Quiting caffeine and/or alcohol helped
some people. Others benefited from sleep hygiene.
But some, particularly those with severe symptoms, do require
medication.

It seems that the focus for most people has been on interventions
involving medication. But if lifestyle and nutritional
interventions don’t solve the problem, is there any other
nonpharmacological intervention that is worthwhile?

The cause of RLS is not known, in that the precise pathophysiology has
not been determined. Heredity plays a big role in about half
the cases.

Part of the pathophysiology involves dopamine. Some people
seem to have not enough in part of the central nervous system.
Some evidence points to a dopaminergic tract that descent to
the spinal cord. Other evidence points to the caudate nucleus
and putamen. Although the details are not known, it is
tempting to think that if a neurotransmitter is involved, then
medication is going to be the best solution.

Perhaps that temptation is misleading. Now there is a study
that shows pretty good results from group therapy.

href="http://jnnp.bmj.com/cgi/content/full/79/7/823">Cognitive
behavioural group therapy to improve patients’ strategies for coping
with restless legs syndrome: a proof-of-concept trial
Journal of Neurology, Neurosurgery, and Psychiatry
2008;79:823-825
doi:10.1136/jnnp.2007.138867

Background: Restless legs syndrome (RLS) is a
usually chronic disorder accompanied by clinically relevant
psychosocial impairment. To date, no psychologically based approach is
available to improve the coping strategies and quality of life of RLS
sufferers.

Objective: To develop cognitive behavioural
therapy tailored to this disorder (the RELEGS coping therapy programme)
and present the results of this proof-of-concept study.

Methods: Twenty-five patients (five men, 20 women;
15 medicated, 10 unmedicated; mean (SD) age 56.1 (12.3) years) with
subjective psychosocial impairment due to RLS participated in one of
three consecutive therapy groups. The severity scales (IRLS and RLS-6)
indicated moderate to severe RLS symptoms at baseline. Exclusion
criteria were secondary RLS, foreseeable change of RLS medication
during the study period, serious physical or psychiatric comorbidity,
and severe cognitive deficits. Each group took part in eight group
sessions (90 min each with a break).

Results: At the end of the treatment, both the
RLS-related quality of life and the mental health status of the
subjects had improved significantly (QoL-RLS scale: from 28.6 (12.8) to
23.4 (13.1); SCL-90-R: from 51.3 (37.0) to 45.9 (32.9)). The
improvement remained at follow-up 3 months later. Subjective ratings of
RLS severity had improved at the end of therapy and at follow-up.
Psychometric scales not specific for RLS-related impairment remained
unaffected by the treatment.

Conclusions: The study establishes the feasibility
and high acceptance of the newly devised therapy programme. The
application of RLS-oriented specific psychological strategies is a step
toward an integrated treatment approach in RLS.

There are notable study limitations. The study was small, and
subjects comprised a highly-selected group. Also, the study
included both medicated and unmedicated patients.

The therapy was a modified form of cognitive-behavioral therapy.
It would not be likely that therapists trained in general CBT
could replicate this outcome without specialized training.

The programme integrates cognitive behavioural
elements and acceptance-based mindfulness approaches.

It sounds as though the initial intent was to improve coping in the
patients. The authors did not expect to see changes in
symptom severity.

It is notable that the symptoms that improved were symptoms experienced
in the daytime; nighttime symptoms did not change. Even so,
patients felt better overall.

I particularly like the last paragraph in the discussion section:

A better understanding of the bio-psycho-social
consequences of chronic diseases over the last few years has resulted
in recognition of the importance of patient self-management and health
literacy. Increasing evidence shows that adequate coping strategies –
that is, adequate self-management — improves outcome and reduces
overall managed-care costs in chronically ill patients. Current
treatment trials in RLS still focus on drug therapy, and comprehensive
psycho-biological management strategies have yet to be developed for
this patient population. The therapy presented in this paper may be an
important step in the development of an integrated treatment approach
to RLS management.

This is an important point. It is important in many chronic
illnesses, not just RLS. Many chronic conditions can be
ameliorated — but only partly — with medication. Addition
of psychosocial interventions can make a big difference with the
disease burden that is not relieved by medication.

Sometimes, the additional interventions are obvious: better nutrition,
better sleep, more exercise, improved support. But sometimes
it takes detailed knowledge of the specific condition to refine the
precise interventions that are most needed.

Over the next few decades, health care probably is going to move away
from advanced, highly biomedical interventions. There will be
greater emphasis on simple interventions. However, that does
not mean that we can dispense with a full understanding of the disease
process.

Comments

#1 J0-Dog
July 15, 2008

It looks to me like the “highly selected group” talked themselves into feeling better – a positive feedback loop, or a self-fulfilling prophecy.

Please give me a pill, and I’ll be fine.

Thanks,
#2 Wendi
July 16, 2008

Jo-Dog obviously doesn’t live with RLS. Thank you for painting it the way many people see it. Visit http://www.rls.org for more information on this debilitating condition.
#3 jessica forester
June 28, 2011

After 6 months of offering stem cell therapy in combination with the venous angioplasty liberation procedure, patients of CCSVI Clinic have reported excellent health outcomes. Ms. Kasma Gianopoulos of Athens Greece, who was diagnosed with the Relapsing/Remitting form of MS in 1997 called the combination of treatments a “cure”. “I feel I am completely cured” says Ms. Gianopoulos, “my symptoms have disappeared and I have a recovery of many functions, notably my balance and my muscle strength is all coming (back). Even after six months, I feel like there are good changes happening almost every day. Before, my biggest fear was that the changes wouldn’t (hold). I don’t even worry about having a relapse anymore. I’m looking forward to a normal life with my family. I think I would call that a miracle.”

Other recent MS patients who have had Autologous Stem Cell Transplantation (ASCT), or stem cell therapy have posted videos and comments on YouTube. http://www.youtube.com/watch?v=jFQr2eqm3Cg. For more information visit www(dot)ccsviclinic(dot)ca/?p=838
#4 Steph
July 19, 2011

Ar ôl un diwrnod ar ddeg heb idiot o’r enw Sam, ei fod yn ôl yn y gwaith. Pan fydd y penaethiaid o gwmpas, ei fod yn frown ymyl flaen. Gwneud unrhyw esgus i fynd i mewn i’r ystafell ydynt mewn, fel pe dweud “edrych arna. Wyf yn gweithio”. Roedd ei agwedd at ffrindiau gwaith arall pan nad yw’r meistri yn cael eu gwmpas yn “Yr wyf yn well na chi”. Mae’n tynnu jôc ac mae’n ddoniol (yn ei feddwl). Ond os ydych yn tynnu yn jôc arno. Rydych yn yr isaf o’r holl ffurfiau bywyd ac efe yells ei ben i ffwrdd fel strancio bedair oed. Parc o fewn 6 troedfedd (2 fetr) ar ei gar smart ac rydych yn ei blocio.
#5 Jade
July 25, 2011

Stellen Sie sich folgende Fragen. (1) In welchem Teil der Vergangenheit würden Sie gerne leben? (2) Warum möchten Sie in dieser Zeit leben? (3) Können Sie in dieser Zeit nur mit den Werkzeugen und Geräten zur Verfügung zu jener Zeit überleben?
#6 Steve
July 28, 2011

Die Dächer sind aus unterschiedlichen Materialien hergestellt. Holz, Stroh, Schiefer, Stein, Metall, Kunststoff und alles andere, die verwendet werden können. Meistens hängt, wo Sie sind in der Welt und wie viel Sie kaufen können, um welche Art von Dach haben Sie.
#7 Steph
August 1, 2011

Where are we now on the evolution path ? Are we becoming civilized or still going down the path of increasing destructive powers ? Our medical knowledge increases with leaps and bounds of each war, but not as greatly as our destructive weapons.
#8 Duncan
August 2, 2011

Kuhu me nüüd arengust teed? Me oleme muutumas tsiviliseeritud või ikka läheb teele suurendada hävitava võimu? Meie meditsiiniliste teadmiste suureneb hüppeliselt iga sõda, kuid mitte nii palju kui meie hävitusrelvade. Kui meie meditsiinilisi teadmisi tõusnud nii kiiresti kui meie relvad, suudame elada kaks või enam sajandeid.
#9 Frankie
August 3, 2011

Pam mae pobl yn newynu i farwolaeth mewn byd sy’n cynhyrchu mwy o fwyd nag y mae’n ei angen? Ar dudalen we ei ddweud ei fod yn ganlyniad i logisteg o symud yr bwyd. Rwy’n dweud, mae’n fwy i’w wneud ag elw na diffyg y gallu i symud yr bwyd i lle mae ei angen. Hefyd, mae rhai gwledydd y trydydd byd yn allforio bwyd sydd eu hangen arnynt er mwyn iddynt gael arian ar gyfer pethau eraill. Os ydym i gyd yn hyd yn oed hanner ffordd at yr hyn a alwn yn ddynoliaeth, fyddai neb yn llwgu. Ond rydym yn bobl ac yn methu â byw hyd at ein delfrydau da.
#10 Simon
August 9, 2011

Yalnız Londonda iğtişaşlar və BBC saytda digər sahələr barədə oxu olmuşdur. Bu rioters incapacitated qədər Onlar rezin güllə, CS qaz və bibər spreyi istifadə etməlidirlər. Sonra Əfqanıstana onlara gəmi onlar davranmaq necə öyrənə bilərsiniz.
#11 Levi
August 11, 2011

Mellakoita kerran repiä läpi useissa kaupungeissa Englannissa. Monet ihmiset kääntyvät jopa heidän työpaikallaan tänään löytää sen tuhonneet tai pahempaa, tuhotaan. Kuinka monet muut ovat menossa menettävät työpaikkansa heidän työpaikoillaan tuhoutui? Tuo armeijassa ja on mitään aiheita käsiteltäessä mellakoijia. He haluavat vahingoittaa muita heittämällä tiili ja muita asioita, niin pitäisi olla sama väkivalta takaisin heille.
#12 Sean
August 15, 2011

Meine letzte Woche von der Arbeit an der Regierung Schema. Zurück zur Arbeitslosigkeit Warteschlange nächste Woche. Das Programm war nur für 13 Wochen und endet in vier Tagen. Langeweile und kaum genug Geld zum Leben. : ( .
#13 Levi
August 16, 2011

Minu viimane nädal kallal valitsuse kava. Tagasi töötuse järjekorda järgmisel nädalal. Kava oli ainult kolmteist nädalat, mis lõpeb nelja päeva pärast. Igavus ja vaevalt piisavalt raha, et elada. .
#14 Kevin
August 18, 2011

Dim ond dau ddiwrnod yn fwy ar ôl y diwrnod hwn o weithio ar y cynllun llywodraeth. Yna yn ôl ar y ciw diweithdra wythnos nesaf wythnos tri ar ddeg o wneud gwaith a dim ond yn cael 45 y cant o’r isafswm cyflog ar ei gyfer a’r llywodraeth ryfeddodau pam nad yw’r cynllun yn boblogaidd Os byddaf yn cael ei dalu isafswm cyflog fyddai gen i! fwynhau yn fwy ac yn cael rhywfaint o arian a arbedir i fyny.
#15 Bob
August 19, 2011

Olen visted Monet sivustot viime kolmetoista viikko sen kanssa työni, niin on tylsää ja muut mistyfing. Onko saada jonkin verran tietoa. Kuten, kun Japanissa muutama vuosi sitten, tulin niin lähellä Bamboo Forest Kiotossa. Se ärsytti minua, koska olisin halunnut visted sitä.
#16 Stan
August 22, 2011

I dont comment frequently, but when I do it’s usually for some thing thats informative and brilliant.
#17 Peter
August 23, 2011

You actually managed to truly emphasize the key aspects that ultimately matter, great article.
#18 Stan
August 24, 2011

Employers, employees and manufactures of equipment or supplies are responsible in some way for health and safety.
#19 Lenny
August 30, 2011

An elderly couple were having dinner one evening when the husband reached across the table, took his wife’s hand in his and said , “Clara, soon we
will be married 50 years and there’s something I have to know. In all of these 50 years, have you ever been unfaithful to me?”
Clara replied, “Well, Paul, I have to be honest with you. Yes, I’ve been unfaithful to you three times during these 50 years, but always for a good reason.”
Paul was obviously hurt by his wife’s confession, but said, “I never suspected. Can you tell me what you mean by ‘good reasons?”
Clara said, “The first time was shortly after we were married, and we were about to lose our little house because we couldn’t pay the mortgage. Do you remember that one evening I went to see the banker and the next day he notified you that the loan would be extended?”
Paul recalled the visit to the banker and said, “I can forgive you for that. You saved our home, but what about the second time?”
Clara asked, “And do you remember when you were so sick, but we didn’t have the money to pay for the heart surgery you needed? Well, I went to see your doctor one night and, if you recall, he did the surgery at no charge.”
“I recall that,” said Paul. “And you did it to save my life, so of course I can forgive you for that. Now tell me about the third time.”
“All right,” Clara said. “So do you remember when you ran for president of your golf club, and you needed 73 more votes?”
#20 Darren
September 1, 2011

Doctor Dave had slept with one of his patients and felt guilty all day long.

No matter how much he tried to forget about it, he couldn’t.

The guilt and sense of betrayal was overwhelming. But every once in a while he’d hear an internal, reassuring voice that said:

“Dave, don’t worry about it. You aren’t the first doctor to sleep with one of their patients and you won’t be the last. And you’re single. Just let it go..”

But invariably the other voice would bring him back to reality, whispering:

“Dave you’re a vet.”
#21 Darren
December 6, 2011

This is a very interesting blog.
#22 Frankie
January 23, 2012

Your observations and comments are very astute and profund, the entertaining way you get that message across is commendable, did you copy this from someone else.
#23 Abe
May 10, 2012

Tom jumped from the plane, he just loved parachuting. He got to the optimum height and pulled the cord for the parachute to open but he got a big surprise. Something had come out of the sack but it was not a parachute and it was not slowing him down. He twisted his neck and seen that it was a set of purple curtains that was coming out of his sack and trailing in the wind. Well thats it, its curtains for Tom.