PURPOSE: Transcranial sonography (TCS) in the B-mode has the ability to image, infratentorial and supratentorial brain structures.Up to date neuroimaging is known to complement clinical findings in the diagnostic work up mostly of parkinsonian syndromes. However no investigation was performed to evaluate the transcranial ultrasound findings (TCS) in sarcoidosis.In this study we wanted to elucidate the TCS findings and the correlation between the sensation of fatigue, depressive feelings, anxiety,restless legs syndrome (RLS) and sleep disorders in sarcoidosis patients.
METHODS: TCS was used to measure the hypoechogenicity of substrantia nigra (SN right or left <0.2cm2), hyperechogenicity of nucleus ruber ( NR right or left) and hypoechogenicity of raphe.(0.00cm2) 22 biopsy positive sarcoidosis patients 13 female/ 9 male), mean age 49.90 ±9.64 years , were enroled into the study. TCS was performed in the Neurology Clinic , Clinical Center of Serbia, Belgrade. Prior to TCS patients were evaluated for fatigue, depression and anxiety using : Fatigue Assessment Scale, (FAS), Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD). RLS was evaluated using the Restless Legs Syndrome Rating Scale (RLRS) and the quality of sleep with the Pittsburgh Sleep Quality Index (PSQI).
RESULTS: Statistically significant correlation was found between PSQI mean score and FAS mean score (B=1.20; t=14.97 ;p<0.001; Rsquare=0.91); PSQI and BDI (B=0.83; t=9.80 ;p<0.001; Rsqare=0.82); PSQI and HAMA (B=0.75; t=15.38; p<0.001; Rsquare=0.92); PSQI and HAMD (B=0.71; t=13.13 ;p<0.001; Rsquare=0.89);and PSQI with RLRS (B=0.85; t=12.76 ;p<0.001; Rsqare=0.89).Hypoechogenicity of SN , with hyperechogenicity of NR coexisted in 20/22 patients. TCS of raphe however in 15/22 sarcoidosis patients was normal.
CONCLUSIONS: The level of fatigue, depression, anxiety and movement disorders (RLS) significantly correlate with the quality of sleep in sarcoidosis patients. TCS showed the co existence of pathological findings of SN and NR.
CLINICAL IMPLICATIONS: TCS may be useful non invasive method for evaluating movements disorders in sarcoidosis. Revealing the structural changes of the brain the TCS can also help in achieving the adequate therapy modalities in sarcoidosis.
DISCLOSURE: The following authors have nothing to disclose: Violeta Vucinic, Nadezda Sternic, Milija Mijailovic, Mira Vukovic, Jelica Videnovic, Maja Omcikus, Mihailo Stjepanovic, Snezana Filipovic
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