Week 6 Assigned Reading (Buzzing Bees) Flashcards
Assigned reading: Buzzing Bees: Who is the author and what is his profession?
Guy Leschziner - Consultant Neurologist and Sleep Physician
What does it mean to medicalise a behaviour? [You may need to do a quick search.] Do you think RLS is a medicalised behaviour? Why or why not? Why is RLS tricky to diagnose?
- Medicalisation refers to the process of defining and treating non-medical issues as medical problems, often as illnesses or disorders.
- RLS has physiological basis and significant impacts, suggesting it’s not simply medicalised behaviour
- Lack of objective diagnostic test makes some skeptical
- Wide variety of symptom descriptions complicates diagnosis
- Often misdiagnosed as other conditions
- Symptoms can be mistaken for normal restlessness
“In fact, the year before, I had also written a review article for the very same journal on restless legs syndrome, only to be told by a retired physician from Eagle Rock, Missouri, that: Restless legs are a redundancy. Our legs have large muscle groups, which are designed for movement.”
___________ refers to the process of defining and treating non-medical issues as medical problems, often as illnesses or disorders.
Medicalisation
Consider the two patients discussed – Mary Rose and David. How did RLS affect their lives? their Quality of Life? their partner’s life?
Mary Rose:
- Severely disrupted sleep - only 3-4 hours per night in short bursts
- Unable to enjoy sitting activities like reading or theatre
- Gardening became main coping mechanism
- Had to sleep in separate bedroom from husband
David:
- Only 2-3 hours of disrupted sleep per night
- Arm movements disturbed partner’s sleep
- Cycling and sailing impacted
- Dramatic quality of life improvement with treatment
“I began to dread sleep. I was finding more and more things to put off actually going to bed because as soon as I lay down and my head hit the pillow, then this twitching started up. I felt quite hopeless about how I was going to get through the night.”
What are the main drugs used to treat RLS, as discussed in the article? Consider mechanisms of action, side effects, clinical uses, and routes of administration.
- Dopaminergic agents (e.g. levodopa, ropinirole)
- Increase dopamine levels or mimic dopamine
- Side effects: augmentation, impulse control disorders
- Administered orally or via skin patch
- Anti-epileptic drugs
- Opiates (e.g. codeine, methadone)
- Concern for dependency, but minimal evidence in RLS patients
“The standard drug treatment for RLS is a group of medications that increase levels of a neurotransmitter called dopamine in the brain.”
What is augmentation? Describe it clinically (behaviourally) and mechanistically (at the neuronal/neurochemical level). Does augmentation involve circadian or perhaps homeostatic mechanisms?
Augmentation refers to the enhancement or increase in the activity or output of a neural system, often due to external stimuli or internal physiological conditions, leading to intensified behaviors or responses.
Clinically:
- Earlier onset of symptoms during the day
- Increased symptom intensity
- Spread to other body parts
- Less relief from movement
Mechanistically:
- Chronic high dopamine levels reduce receptor numbers
- When dopamine drops in evening, insufficient receptors cause worsened symptoms
- Involves circadian mechanisms - dopamine levels naturally drop in evening
“Giving people large doses of dopamine-boosting drugs may cause the brain to reduce receptor numbers further, driving this imbalance as normal dopamine levels drop, meaning that symptoms worsen and start earlier in the day.”
How was RLS treated in the ancient China?
Iron dust administered after meals
How was RLS treated in the 1950s AD?
Intravenous iron infusions
How is RLS treated in the 2020s AD?
Dopaminergic agents, iron supplements, anti-epileptics, opiates
How is the treatment of RLS in ancient China, the 1950s AD and the 2020s interlinked mechanistically?
The treatments are interlinked mechanistically through iron’s role in dopamine synthesis:
- Iron is crucial for dopamine production
- Iron deficiency leads to dopamine dysfunction
- Modern treatments target dopamine system directly or indirectly
“Even ancient Chinese texts, attributed to the Yellow Emperor in discussion with his physician Qui Bo, describe a condition very much like RLS being treated by the administration of ‘iron dust to the patient following meals’.”
Is RLS due to nature, nurture, or situation?
Nature: Strong genetic component identified
- 19 genes associated with increased risk
- Higher concordance in identical vs fraternal twins
Nurture/Situation: Environmental factors play a role
- Iron deficiency
- Pregnancy
- Kidney problems
- Certain medications
Likely a combination of genetic predisposition and environmental triggers
“At the latest count, these have involved 45,000 patients with RLS across multiple countries, and have identified nineteen genes that appear to raise the risk of developing this disorder.”
Why is the chapter called Buzzing Bees?
- Mary Rose describes her RLS sensation as like “bees buzzing inside the skin of your legs”
- This vivid description captures the uncomfortable, restless nature of the condition
- Highlights the difficulty patients have in describing their symptoms
“Well, it’s very difficult to describe, but I think the best way is like having bees buzzing inside the skin of your legs. You can’t get at them and it makes you want to scratch your legs.”
Guy Leschziner is a Consultant ________ and ________ Physician, specializing in ________ disorders.
Neurologist, Sleep, sleep
Medicalisation refers to the process of defining and treating _________ issues as _________ problems
non-medical, medical
RLS is tricky to diagnose due to the lack of an _________ diagnostic test and a wide variety of _________ descriptions
objective, symptom
