AcuteCare Telemedicine Blog


Think of Your Brain!

It is without a doubt the most vital organ in the human body, but too often we neglect the importance of taking good care of our brain. The development and organization of the brain are incredibly complex, but the intricacies of this central body belie the simplicity of its proper day to day caretaking. We only get one – why not give some thought (pun intended) to it.

Prevention of traumatic head injuries is likely the most obvious consideration for avoiding significant damage to the brain. Unfortunately, we cannot always predict when an accident might occur, but we can take basic steps like fastening our seat belts while riding in automobiles and wearing helmets when engaging in physical activities carrying risk of trauma. Beneath the skull, we must be concerned with degenerative disorders of the brain affecting motor skills and cognition, such as Alzheimer’s Disease and Parkinson’s. Depression and anxiety also afflict millions of individuals across the country. It is important to remember that although our fast paced, high-stress lives can seem overwhelming, these conditions are chemical, and there are measures we can take to mitigate their negative effects.

Perhaps the most severe threat to the brain is stroke and other cardiovascular disease. The American lifestyle has taken a significant toll on the health of the blood vessels that deliver vital oxygen and nutrients to the brain. We have seen it most exaggerated throughout the southeastern US, a part of the country known as the ‘Stroke Belt,’ where residents face significantly higher rates of stroke morbidity and mortality.

The experts offering advice to citizens on how to minimize their risk of stroke sound like a veritable broken record; sleep more. Eat better. Exercise. Although stroke care has made huge advances in technology and technique over the course of the past decade, there is truthfully no more powerful plan of action than that of prevention. Telemedicine may soon be able to play a bigger role in opening lines communications between physicians and patients at risk of having a stroke, helping them take the necessary steps to avoid an emergency situation where the health of their brain and their life are in danger. As neurologists become more familiar with the advantages of new telemedicine technologies, they are realizing that the “ounce of prevention” is more readily available than ever before.



RLS in Four Easy Questions

Restless Leg Syndrome (RLS) is an often undiagnosed or misdiagnosed, yet relatively common, sensorimotor disorder, with a prevalence rate of 7.2% in the United States and Western Europe (a prevalence rate as high as 29% has also been reported). The effect of RLS on one’s quality of life can be significant. Furthermore, RLS can be a harbinger of other disease processes and therefore prompt and accurate diagnosis is essential.

Diagnosis of RLS is based on four clinical findings; an often indescribable sensation in the legs (or arms) causing an urge to move, an increase in symptoms with rest, symptom relief with movement, and symptom worsening at night. It is more prevalent in women than men (2:1) and although RLS can be genetic, the etiology in many cases is unknown. Research has suggested that the cause of RLS may be due to the brain’s inability to correctly utilize dopamine and or iron. Although causative effects are not clear, RLS is often seen in patients with chronic disorders such as diabetes mellitus, uremia, autoimmune disorders, thyroid disease and iron deficiency. Thorough laboratory evaluation in adult patients, especially with recent symptom onset should be pursued. In particular, ferritin levels should be checked in all men and post-menopausal women as iron deficiency is present in about 20% of those with RLS. Iron deficiency in this population can be the result of occult bleeding, which can be a sign of an underlying malignancy, such as colon cancer.

In 2005, the Restless Legs Syndrome Prevalence and Impact General Population study was published in the Archives of Internal Medicine. Of the 416 study participants found to have a clinical diagnosis consistent with RLS, 81% had discussed their symptoms with a primary care physician and 74% of these received a diagnosis. However, RLS was actually the second least common diagnosis comprising only 6.2% of all diagnoses. The most common diagnosis was “poor circulation” comprising 18.3% of the diagnoses. Other diagnoses in descending percentages included arthritis, back/spinal injury, varicose veins, depression/anxiety, and nerve entrapment. Although these may have been accurate, “secondary” diagnoses, in approximately 94% of patients, the diagnosis of RLS was not made. Unfortunately, the treatment of most of the above conditions would not effectively alleviate symptoms of RLS and in some cases may exacerbate them. (ie antidepressants).

Given reported prevalence rates, RLS it is not a rare disorder. The potential negative impact upon the lives of those with RLS has been found to be as high as in those with diabetes and clinical depression. Because the symptoms of RLS are more prevalent in the evenings, it can have a significant impact upon sleep onset and sleep maintenance. This in turn can lead to complaints of insomnia, daytime sleepiness and fatigue, cognitive dysfunction and poor daytime performance, all of which tend to lower quality of life. If not diagnosed and treated effectively, the cumulative impact of untreated RLS may lead to an increased economic burden due to work absenteeism and increased health care utilization.

Once RLS is diagnosed, there are several effective treatment options available, including behavior modification, discontinuation of offending agents, and medications such as dopamine agonists, gabapentin enacarbil, and iron supplementation.

To diagnose RLS is quick, easy, and done without the cost of diagnostic studies or procedures. Hopefully, increased healthcare provider and patient awareness will lead to fewer undiagnosed or misdiagnosed cases of RLS. It takes only four easy questions to diagnose a patient with RLS; a seemingly but not so benign disorder.