Poster Abstracts Thursday, November 10, 2005 $467

Method: The records of 16 children who met strict National Institutes of Health Consensus Conference diagnostic criteria for childhood RLS were analyzed retrospectively. The mean age of onset of RLS was 9.4 years (range 1-16) and the mean duration of symptoms was 3.4 years (range 0.25 to 14). All 16 had received oft-label pranfipexole at bedtime in doses of 0.125 to 0.375 mg. Response to pramipexole was gauged by chart review and a parent -patient questionnaire survey (0 -- no improvement in RLS symptoms, 1 -- somewhat improved, 2 -- greatly improved). Serum ferritin levels (reference value for RLS > 50 ug/L; n -- 15) and the periodic limb movement index (reference value < 5; n -- 12) were also recorded. Results: RLS remained unimproved on pramipexole in 6/16 (37.5%), but improved in 10/16 (62.5%; somewhat in 6, greatly in 4). The mean treatment duration was 7.1 months (range 3-22). Side effects consisted of tremor (11/16), confusion (11/16) and shift in the onset of RLS into the early afternoon (augmentation; 1/16). The augmentation resolved upon switching to ropinirole. The median serum ferritin was 23 ug/L and the median PLM index was 22, but neither correlated with favorable response. Conclusion: In this pilot study, two thirds of children with RLS improved with pramipexole therapy. Side effects were tolerable. Prospective, multi-center treatment trials are indicated.

I447 Prevalence of Restless Legs Syndrome at a Neurology clinic in Korea

Lee, DH l, Jang, JH 1, Kim, BJ 1, Park, KW 1, Kim jy1, Hart, JK 1 1Korea University College of Medicine, Seoul, Korea

Background: Restless legs syndrome (RLS) is a sensory-motor disorder characterized by a distressing urge to move the legs, onset or exacerbation with rest, relief with movement, and circadian pattern. Although treatment of RLS is available, this disorder has been frequently unrecognized. This study was performed to evaluate the prevalence and clinical characteristics of RLS in new patients who visited a neurology clinic. Method: New patients, who visited neurology clinic in a university affiliated hospital for various problems except RLS for one month period, were asked to complete a questionnaire including RLS diagnostic criteria and the Pittsburgh Sleep Quality Index. The responses of questionnaires by the patients were reviewed by a sleep disorder specialist. Other previous medical history was recruited and laboratory study including blood test (Fe, TIBC, Ferritin, Hb), lumbosacral spine x-ray, and electrophysiologic study were performed. Results: Of 231 patients (86 men and 145 women) who completed the questionnaire, 23 (10g';) patients were diagnosed as RLS. The prevalence in women (15.2°,5) was higher than men (1.2°,5), and tfighest at patients aged 40 to 49 (13.2"/o). All RLS patients reported sleep disturbance: initiation disturbance (65.2"/0) and frequent waking (95.7%). Thirteen patients (156.5%) had low serum Ferritin (mean 33.1 ng/di: norm > 50 ng/dl). In lumbar x-ray, 8 patients (34.8%) had intervertebral disc space narrowing. Three patients (13%) had a radiculopathy. Conclusion: The prevalence of RLS is not uncommon in patients who visited a clinic for other problems titan RLS. The more education about RLS is needed in public.

1448 Wolnan alleges rape in sleep

Puvanendran, K 1. Z Sleep Disorders Unit, Singapore General Hospital, Singapore

The man says it was sex with consent. The court seeks opinion to answer the question whether the woman could have been raped in sleep. Was she experiencing confussional arousal giving the accused the impression that size responded to sex or was it a false accusation? Method: A detailed history from the woman did not suggest previous sleep walking or sleep drunkenness. She had not taken alcohol, or

any sedative drug on that night or had been sleep deprived. She had a full polysomnogram with video recording over 3 nights and an MSLT. On the subsequent 2 nights we enacted her sleep experience o f the night site alleged rape by physical battering though civil. Results: Sleep test on first night confirmed that site went into deep sleep around the alleged time of crime. EEG showed no arousal out of slowwave sleep (SWS) or seizures. No disorders of confusional arousal, narcolepsy or OSA. She showed EEG arousal and waking behavior in 6 of 15 and 3 of 10 occasions in SWS and REM respectively when battered. She remembered these events next morning on 3 of 25 occa- sions. She requested and her sleep recordings were shown and des- cribed to her. She withdrew her complaint to the police the next day. Conclusion: She was aware of physical battering in some instances even in deep sleep. This could have brought some doubt to the court regarding her accusation. Only she had the answer to the unanswerable question.

1449 Correlation between Epworth Sleepiness Scale and Drowsy Driving

Sayed, M ~. 1Cascade Valley Sleep Disorders Center, Arlington, USA

Sleep disorders are common medical disorders, yet they are widely under-estimated amongst the public and healthcare professionals as well. Background: More than 100,000 motor vehicle accidents annually are sleep-related. An estimated 70 million Americans have significant sleep problems. The annual indirect cost of sleep-related problems is $50 $100 billion. More efforts needed to increase public awareness of the magnitude of this public health burden. Methods: We have retrospectively reviewed the charts of 50 patients (120 females, 30 males, aged 29-77 year-old) who were referred to the Cascade Valley Sleep Disorders Center for evaluation of sleep disorders. After obtaining a comprehensive sleep history, all patient underwent a thorough general and neurological exanfination, followed by an over-night in-lab Polysomnogram, some patients underwent a Multiple Sleep Latency Test as well. Results: 60% of patients scored over 9 in Epworth Sleepiness Scale (ESS), yet only 40% were complaining drowsy driving. Of those 20 patients, 10g';) scored less than 9 in ESS. The mean age of those 20 patients was 49.05 year-old. Amongst them, 95"/0 were diagnosed with Obstructive Sleep Apnea Syndrome, 30°,5 with Psychophysiologic Insomnia, 15"/o with Restless Legs Syndrome, 15°,5 with Idiopathic Hypersomnia, 10g'; with REM Behavior Disorder, 10% with Non- REM Parasomnia, and 5% with Narcolepsy. Conclusion: Epworth Sleepiness Scale may not be always an accurate indication for drowsy driving. Clinicians need to specifically ask their patients about drowsiness wlfile driving. Federal regulations need to be developed and implemented. Such a step is necessary in order to make our roads safer and prevent further loss of lives.

1450 A typical presentation of the Kleine Levin syndrome: a prospe¢~ve series of 13 patients

Shulda G ~, Bhatia M ~, Singh S 1, Goyal V 1, Srivastava T ~, Tripattfi M ~ , Behari M 1. 1Department of Neurology, All India Institute of Mediea! Sciences, New Delhi, India

Background: Kleine Levin syndrome is an uncommon disorder with recurrent episodic disturbance of sleep and appetite with or without other associated abnormalities. Many patients may not necessarily fulfill minimum criteria described for diagnosis. We aim to report some such patients with a typical presentation esembling the Kleine Levin syndrome. Method: We studied all patients with episodic disturbance in sleep and /or appetite lasting few days to weeks, not fulfilling all minimal criteria laid down by the ICSD for diagnosis of the Kleine Levin syndrome, attending the Sleep disorders clinic at our institute over 4 years.