Abstract
Restless legs syndrome (RLS) is a prevalent sleep disorder affecting quality of life and is often comorbid with other neurological diseases, including peripheral neuropathy. The mechanisms related to RLS symptoms remain unclear, and treatment options are often aimed at symptom relief rather than etiology. RLS may present in distinct phenotypes often described as "primary" vs. "secondary" RLS. Secondary RLS is often associated with peripheral neuropathy. Nerve decompression surgery of the common and superficial fibular nerves is used to treat peripheral neuropathy. Anecdotally, surgeons sometimes report improved RLS symptoms following nerve decompression for peripheral neuropathy. The purpose of this retrospective analysis was to quantify the change in symptoms commonly associated with RLS using visual analog scales (VAS). Forty-two patients completed VAS scales (0-10) for pain, burning, numbness, tingling, weakness, balance, tightness, aching, pulling, cramping, twitchy/jumpy, uneasy, creepy/crawly, and throbbing, both before and 15 weeks after surgical decompression. Subjects reported significant improvement among all VAS categories, except for "pulling" (P = 0.14). The change in VAS following surgery was negatively correlated with the pre-surgery VAS for both the summed VAS (r = -0.58, P < 0.001) and the individual VAS scores (all P < 0.01), such that patients who reported the worst symptoms before surgery exhibited relatively greater reductions in symptoms after surgery. This is the first study to suggest improvement in RLS symptoms following surgical decompression of the common and superficial fibular nerves. Further investigation is needed to quantify improvement using RLS-specific metrics and sleep quality assessments.
Highlights
BackgroundRestless legs syndrome (RLS) was originally described by Willis in 1685 (1) and was more fully medically characterized by Ekbom in 1950 (2)
While the mechanisms of improved RLS symptoms remain unclear, the author speculated that reduced radiculopathy pain improved the central imbalance of dopamine and cytokines associated with RLS symptoms
Pain reduction may play a role in RLS improvement; it is unlikely to explain the dramatic decompression-related improvement in RLS symptoms due to the fact that the median pain level associated with RLS is only 18/100 on a VAS scale (85)
Summary
Restless legs syndrome (RLS) was originally described by Willis in 1685 (1) and was more fully medically characterized by Ekbom in 1950 (2). Another report found that 3.5% of patients on ropinirole developed clinically significant augmentation, or worsening, of symptoms (43) Pramipexole, another dopamine agonist, has been found effective in treating RLS. Recent reports have found RLS improvement following lumbosacral decompression (78) as well as analogous improvement in upper extremity symptoms following surgical decompression for carpal tunnel syndrome (76) The purpose of this retrospective analysis was to assess patient-reported changes in symptoms associated with peripheral neuropathy and RLS following surgical decompression of the common and superficial fibular nerves. The subjects were included through a retrospective analysis of patients who underwent decompression of the common and superficial fibular nerves for either diabetic (n = 14) or nondiabetic (n = 28) peripheral neuropathy. An additional analysis was conducted to account for the multiple comparisons using the Holm–Bonferroni Method (81)
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