事件记录
面试官: Do you suffer from restless legs or you think you might? 好吧，大发娱乐将在接下来的《大发娱乐提供》节目中讨论这个问题.
Dr. 克里斯·琼斯是……方面的专家 神经学 也是睡眠和运动障碍专家. 和 today, we want to dive into the topic of restless leg syndrome. Dr. Jones, let's start off first of all, what is restless leg syndrome?
Dr. 琼斯: 没人知道.
面试官: 今天的谈话可真难啊.
Dr. 琼斯: But every person with restless legs knows how bad it can be and that it's real even though there are no physical signs of illness.
面试官: 好吧. So you could do all sorts of physical examinations and you wouldn't find anything with somebody reporting restless legs at night?
Dr. 琼斯: 完全. 医生很容易忽视这一点.
面试官: 好吧. So what do most patients report as the symptoms that you would define as restless leg syndrome?
Dr. 琼斯: An urge to move the legs particularly in the evening, usually it's below the knees. It's very difficult to describe what this is because it's not an itch, 这并不痛苦, 一个麻木, 刺痛或痉挛. 我只能告诉你，这太令人沮丧了, 到了晚上就更糟了, 就在他们想睡觉的时候. There's a wide range of severity of restless legs symptoms and, 在某种程度上, it may just be part of the human experience to have a little of this.
面试官: 是的. 如果有人得了这种病，他们会怎么做?
Dr. 琼斯: 首先, they would find the nearest sleep center that advertises experience with restless legs syndrome, because it is very difficult to treat and very easy for the doctor to make it worse.
面试官: 好吧. 通常是一个专家吗, 或者它是一个多学科的团队, 我应该说是一个跨学科的团队?
Dr. 琼斯: It gets interdisciplinary when the restless legs facilitates the development of a chronic insomnia that's quite apart from the restless legs but instead is a learned inability to fall asleep at night.
面试官: So what could start out as just a physical sort of manifestation of the symptoms could then turn into a mental manifestation affecting your sleep?
Dr. 琼斯: 完全.
面试官: 和 is that when most people tend to seek help when it's affecting their sleep, 或者他们应该更早来找你?
Dr. 琼斯: 是的, they should come as soon as it's making an impact in their life, 因为年纪越大，越难治疗.
面试官: 哦,好吧. So when you first started noticing those symptoms you would find somebody, 比如你自己, 他是这方面的专家. 然后约会会是什么样子? How do you track down a condition that is not easy to track down?
Dr. 琼斯: You should expect and request a thorough history rather than emphasizing the physical exam, 这是第一点. Number two, you should expect them to ask for a positive family history of leg problems at night. 和 if you're a female and there's any reason that you might be iron deficient, you need to have your iron status measured because low iron, 即使稍微低一点也会让不宁腿变得更糟. Iron deficiency is a major exacerbator of restless legs.
So if you are donating blood in any fashion to your hospital blood bank, 对你子宫里的胎儿, 经期大出血, 那么你患不宁腿的风险就会高得多. 你可能需要提高铁含量, 不管这意味着什么, 所以治疗会更有效一点.
然后医生会问你用什么药, 包括你服用的非处方药, because over-the-counter antihistamines and many antidepressants actually make restless legs worse. 和, 当然, 不安分的腿会让人情绪低落, 所以人们倾向于服用抗抑郁药, 这就形成了一个恶性循环.
面试官: Is there a cure for restless legs syndrome, or can you just manage it as best you can?
Dr. 琼斯: Not only is there no cure, but it's very easy for physicians to make restless legs worse. Prescribing a category of medication called dopamine agonist, it slowly makes the brain have even more restless legs, which requires higher doses which makes the legs worse. 和 this can take a long, long time to resolve after stopping the dopamine agonist. 所以第一条规则就是不要, 恕我直言, do not let your primary care provider try to treat this. 这真的很复杂, 困难的睡眠药物问题, and you should go to a sleep center that has experience with restless legs.
面试官: 和 out of the patients that you see with restless legs syndrome, what percentage find some relief?
Dr. 琼斯: Well, I think most people find some relief early on in treatment. But 再一次。, the best medications we have gradually make the symptoms worse. 和 when those medications fail, the backup are opioid drugs, and those are potentially addicting. 它们会导致睡眠时呼吸变浅. 所以, 再一次。, you have to be working with a sleep center that understands these things and will keep you safe.
面试官: 大发娱乐还是，我再试一次. 大发娱乐不知道是什么原因造成的.
Dr. 琼斯: There's only been one genetic alteration that's strongly related to restless legs, but we do not have right now as a clear picture of all the genetics of restless legs and how that might inform a more fundamental cure for this.
面试官: 大发娱乐知道这是神经上的还是身体上的?
Dr. 琼斯: 这绝对是神经学的问题, and it's been linked in mice to a part of the brain where dopamine and leg movements are coordinated.
面试官: So after you see a sleep specialist and they are able to help you manage your restless legs, 如果你仍然失眠, 这时你该怎么做呢?
Dr. 琼斯: 在这一点上, 你很可能患有习得性慢性失眠症, and cognitive behavioral therapy for insomnia is far and away the cheapest, 最安全的, 从长远来看是最有效的. 不幸的是, there are not very many cognitive behavioral therapists for insomnia out there so you have to hunt around for a sleep center that has one.
更新日期：2022年4月13日
最初发布日期：2017年5月3日