Restless Legs Syndrome Symptoms Research Articles

Spectral EEG and heart rate changes associated with leg movements during the suggested immobilization test in patients with restless legs syndrome.

Restless legs syndrome is usually associated with periodic limb movements during sleep, which are defined as repetitive, stereotyped movements in sleep. Changes in spectral analysis of electroencephalography and heart rate were shown to be associated with periodic limb movements during sleep and non-periodic leg movements in sleep. Considering the circadian distribution of symptoms of restless legs syndrome, we investigated spectral electroencephalography and heart rate accompanying periodic limb movements, isolated leg movements and short-interval leg movements during suggested immobilization test. The mean age of 53 patients was 51.9 ± 13 years, 54.7% were females. Prominent increases in electroencephalography activation were associated with periodic limb movements, isolated leg movements and short-interval leg movements during the suggested immobilization test, which were significant in all spectral bands (p < 0.001). An increase in all electroencephalography bands started ~10 s before periodic limb movements, isolated leg movements and short-interval leg movements; increases in delta and theta band activities ended ~10 s after the movements, while increases in alpha and beta band activities lasted for about ~20 s. Maximum increases in delta, theta, alpha and beta bands were all observed after periodic limb movements and short-interval leg movements, but before isolated leg movements in theta and alpha bands, and after isolated leg movements in delta and beta bands. A notably longer increase in alpha and beta bands was evident for periodic limb movements and short-interval leg movements. An increase in heart rate was prominent at 4-12 s after movement onset in short-interval leg movements, being significantly higher than those associated with periodic limb movements and isolated leg movements. Our study shows that, in patients with restless legs syndrome, periodic limb movements, isolated leg movements and short-interval leg movements during suggested immobilization test are associated with prominent cortical and cardiac activation, which warrants confirmation in larger restless legs syndrome cohorts and requires long-term follow-up studies to delineate its possible clinical consequences.

Self-care behaviours in patients with restless legs syndrome (RLS): development and psychometric testing of the RLS-Self-care Behaviour questionnaire.

Restless legs syndrome (RLS) is a highly prevalent condition that significantly disrupts sleep and causes reduced quality of life. While previous RLS research has mainly focused on the pharmacological treatment, this study presents the first instrument to measure self-care, the RLS-Self-care Behaviour questionnaire (RLS-ScBq). Self-care, defined as an active decision-making process, can empower patients to effectively participate in their own healthcare through awareness, self-control, and self-reliance to cope with their disease. Self-care can in a RLS context include actions such as physical exercise, meditation, and massage. Hence, the aim of this study is to explore the psychometric properties of the RLS-ScBq in patients with RLS. A cross-sectional design, including 788 patients with RLS (65% women, mean age 70.8 years, [standard deviation (SD) =11.4]) was used. Sociodemographics, comorbidities, and RLS-related treatment data, including insomnia symptoms (i.e., Insomnia Severity Index), daytime sleepiness (i.e., Epworth Sleepiness Scale) and RLS symptoms (i.e., RLS-6 scale) were collected. The validity and reliability of the RLS-ScBq were investigated using exploratory factor analysis and Rasch models. The two-factor solution (i.e., physical, and mental actions) showed an explained variance of 32.33% for The Self-care Behaviour Frequency part and 36.28% for The Benefit of Self-care Behaviour part. The internal consistency measured by Cronbach's α was 0.57 and 0.60, and McDonald's ω was 0.60 and 0.67, respectively. No differential item functioning was identified for gender, age, insomnia, daytime sleepiness, or RLS severity. The eight-item RLS-ScBq can serve as a tool enabling healthcare personnel to explore use and benefit of self-care activities in patients with RLS.

Polysomnographic Findings into Sleep Disorders in Essential Tremor and Essential Tremor Plus: A Comparison with Healthy Controls.

To explore sleep patterns in individuals with Essential Tremor (ET) and Essential Tremor Plus (ET-Plus), compared to healthy controls, and assess differences between ET and ET-Plus, given the lack of established polysomnography (PSG) data on these groups and the potential for sleep disturbances to serve as clinical markers. We conducted a prospective cross-sectional study at NIMHANS, Bengaluru, from November 2021 to August 2023 on 45 patients (26 ET, 19 ET-Plus) and 45 controls. Tremor severity was assessed using TETRAS and FTMTRS, and sleep symptoms with ESS, PSQI, Mayo Sleep Questionnaire, RLS-Q, BQ, GAD-7 and PHQ-9. All cases and controls underwent overnight video PSG. Sleep scoring was manually done by a technically adequate sleep researcher and the first author following AASM (2022) guidelines with data analysed using R studio. ET patients exhibited younger onset age (30.8 ± 16.7 years) compared to ET-Plus patients (46.8 ± 11.1 years). ET-Plus had higher TETRAS and FTMRS scores (P < 0.001) than ET. Both ET and ET-Plus patients exhibited poorer sleep quality, excessive daytime sleepiness, REM sleep behavior disorder (RBD), and Restless Legs Syndrome (RLS) symptoms compared to controls. PSG findings supported these clinical observations, showing elevated Apnea-Hypopnea Index (AHI), reduced Total Sleep Time (TST), prolonged REM latency, decreased sleep efficiency, increased N1 stage duration, and reduced N2/N3 durations and percentages in patients versus controls. The study highlights significant sleep architecture abnormalities in both ET and ET-Plus patients as compared to healthy controls, with no differences between the ET groups.

Development of a German version of a single-question restless legs syndrome screening questionnaire

Abstract Background The “Single Question for the Rapid Screening of Restless Legs Syndrome (RLS Single Question) ©” is a questionnaire specifically designed to screen for restless legs syndrome (RLS). This research article describes the process of development and cultural adaptation of the German version of the questionnaire. Objective The primary objective of this study was to create a culturally appropriate and linguistically precise tool for evaluating RLS symptoms within German-speaking populations. Materials and methods The translation process involved meticulous forward and backward translations coupled with cognitive interviews conducted with patients to ensure the linguistic accuracy and cultural relevance of the instrument. Results The resultant final version of the questionnaire demonstrated an optimal level of comprehension and is anticipated to serve as an asset for the early detection and effective management of RLS among individuals who speak German. Conclusion The study highlights the successful development of the RLS questionnaire for the German-speaking context. Patient involvement in cognitive interviews proves pivotal in resolving minor comprehension issues. Its successful adaptation underscores the significance of comprehensive translation in diverse linguistic and cultural contexts, ultimately enhancing patient care. Future research will explore the validation of the test in larger populations and its integration into holistic diagnostic strategies.

Efficacy of Aerobic and Stretching Exercises in Managing Willis-Ekbom Disease (Restless Leg Syndrome) Among Hemodialysis Patients.

Restless legsyndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs, particularly during rest. It significantly affects the quality of life of hemodialysis patients with high prevalence in this population. While pharmacological treatments, especially dopamine agonists (DAs), are commonly used, they often come with side effects and augmentation phenomena. This systematic review examines the effectiveness of exercise interventions in managing RLS among hemodialysis patients. Eight studies, including randomized controlled trials and quasi-experimental studies, were analyzed. The interventions primarily consisted of aerobic exercises (cycling) and stretching exercises, with durations ranging from eight weeks to six months. The primary outcome measure was RLS severity, assessed using validated scales such as the International Restless Legs Syndrome Study Group (IRLSSG) scale or the Restless Legs Syndrome Questionnaire (RLSQ). Secondary outcomes included sleep quality, depression, and physical performance. The results consistently demonstrated that both aerobic and stretching exercises significantly reduced RLS severity and improved related outcomes. The intradialytic nature of some interventions offered a practical approach to incorporating exercise into patient routines. While exercise showed comparable efficacy to DAsin reducing RLS symptoms and improving depression scores, only DAs significantly enhanced sleep quality in one comparative study. These findings suggest that exercise interventions may be a viable non-pharmacological approach to managing RLS in hemodialysis patients, potentially complementing or reducing reliance on pharmacological treatments.

Improvement in self-reported, but not actigraphic, sleep measures with suvorexant in people with well-controlled Restless Legs Syndrome and persistent insomnia

BackgroundSleep disturbance remains common in people with Restless Legs Syndrome (RLS), even after RLS symptoms are sufficiently controlled with medication. We conducted a placebo-controlled crossover trial to examine the efficacy of suvorexant in improving sleep quality and quantity in people with well-controlled RLS and persistent insomnia. MethodsIn this double-blind, randomized, placebo-controlled crossover trial, 34 participants (70.6 % female, mean age = 62.7) with well-controlled RLS were randomized to placebo or suvorexant (10–20 mg) for 6 weeks, followed by a 2-week washout and then the opposite treatment. Study inclusion required an IRLS score <15, insomnia diagnosis per DSM-5, and a diary-reported combined Sleep Onset Latency (SOL) and Wake After Sleep Onset (WASO) > 45 min and a Total Sleep Time (TST) < 7 h on 7/14 baseline nights. The primary outcome was actigraphically-derived TST, and secondary outcomes were Insomnia Severity Index (ISI) score and actigraphically-derived WASO. Data for all sleep metrics were collected at baseline and for the last two weeks of each treatment period. ResultsThere were no significant improvements in actigraphically-derived TST (p = 0.58) or WASO (p = 0.99) while taking suvorexant compared to placebo. However, there were significant reductions in insomnia symptoms, measured by the ISI, as well as increases in diary-reported TST (p = 0.01) while taking suvorexant compared to placebo. The most commonly reported side effect of suvorexant was fatigue (29.4 %). ConclusionsWe observed no significant differences between treatments in actigraphically-derived sleep measures, but support for suvorexant's benefit for overall insomnia and self-reported quantity of sleep in people with well-controlled RLS who continue to suffer from insomnia. Clinical trials registration numberNCT04706091.

Exercise protects impairments in memory recognition in the iron-deficient male rat model of Restless Legs Syndrome.

Restless Legs Syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs and is associated with decreased quality of life and sleep, and may result in cognitive changes. Physical exercise generates cognitive improvements and improves RLS symptoms. Our objective is to analyze recognition memory in the iron-deficient rodent model of RLS, and the effect of exercise. The animals (male Wistar rats) were distributed at 21 days of age into a control group (CTRL) (standard diet) or an ID group (iron-deficient diet). After performance classification (at 77 days of age), the animals were redistributed into CTRL (no exercise), CTRL EX (exercise), ID (no exercise) and ID EX (exercise), totaling 9 animals per group. The exercise groups performed treadmill exercise for four weeks. In the 14th week of the diet, the sleep recording of CTRL and ID animals was carried out to validate the RLS model. The Novel Object Recognition Memory test (NOR) was performed before the start of exercise (8th week of diet) and after the end (14th week) in all groups. The ID group demonstrated worsening sleep parameters and increased paw movements compared to the control group. The ID group demonstrated impairment of recognition memory after 14 weeks of diet compared to the CTRL group, and, the CTRL improved recognition memory in the 14th week compared to the 8th week. No differences were found for the exercise groups. Our findings indicate that the RLS animal model exhibited cognitive alterations associated with recognition memory, and long-term aerobic exercise intervention demonstrated a protective influence against these effects.

Associations between self-reported parasomnias and psychiatric illness in 370,000 patients with sleep disorders.

To assess self-reported parasomnias in patients with sleep disorders and explore relationships with psychiatric illness, comorbidities, subjective sleep assessments, and polysomnographic study results. Results from intake questionnaires and polysomnographic assessments, collected from 240 sleep centers across 30 US states between 2004 and 2019, were analyzed retrospectively. Of 540,000 total patients, 371,889 who answered parasomnia-specific questions were included. Patients responding "often" or "always" to parasomnia-specific questions were considered "symptom-positive," whereas a "few times" or "never" were considered "symptom-negative" (controls). The study sample was 54.5% male with mean age 54 years (range, 2-107 years). Frequencies for the different parasomnias were 16.0% for any parasomnia, 8.8% for somniloquy, 6.0% for hypnagogic hallucinations, 4.8% for sleep-related eating disorder, 2.1% for sleep paralysis, and 1.7% for somnambulism. Frequent parasomnias were highly associated with diagnosed depression (odds ratio = 2.72). All parasomnias were associated with being younger and female and with symptoms of depression, anxiety, insomnia, restless legs, pain, medical conditions, fatigue, and sleepiness. Associations with objective sleep metrics showed characteristics of consolidated sleep and differentiated weakly between nonrapid eye movement sleep and rapid eye movement sleep parasomnias. Machine learning accurately classified patients with parasomnia versus controls (balanced accuracies between 71% and 79%). Benzodiazepines, antipsychotics, and opioids increased the odds of experiencing parasomnias, while antihistamines and melatonin reduced the odds. Z-drugs were found to increase the likelihood of a sleep-related eating disorder. Our findings suggest that parasomnias may be clinically relevant, yet understudied, symptoms of depression and anxiety. Further investigation is needed to quantify the nature of multimorbidity, including causality and implications for diagnosis and treatment.

Association between inflammatory cytokines and disease severity in restless legs syndrome.

This study aims to evaluate serum cytokine levels in individuals with primary Restless Legs Syndrome (RLS) and analyze their correlation with RLS symptom severity, sleep disturbances, anxiety, and depression. A case-control study was conducted involving 87 primary RLS patients and 100 healthy individuals undergoing health check-ups. Serum cytokine levels were assessed, and RLS severity was evaluated using the International Restless Legs Syndrome Study Group (IRLSSG) rating scale. Additionally, the Pittsburgh Sleep Quality Index (PSQI), 24-item Hamilton Depression Rating Scale (HAMD24), and 14-item Hamilton Anxiety Rating Scale (HAMA14) were utilized to assess symptom severity, sleep disturbances, and emotional states in RLS patients. Serum cytokine levels, including IL-6 and TNF-α, were significantly higher in RLS patients compared to controls (P < 0.05). Adjustment for disease duration, sex, age, BMI, SBP, and DBP revealed an independent association between serum IL-6 and RLS (OR = 1.46; 95% CI = 1.02-1.93; P = 0.003). Linear regression analysis demonstrated a significant correlation between IL-6 levels and IRLS scores (β = 0.123, P = 0.008). Elevated circulating levels of inflammatory cytokines in RLS patients suggest a potential role of inflammation in the pathogenesis of primary RLS. Additionally, serum cytokine levels correlate closely with disease severity.

Efficacy and safety of TOMAC for treatment of medication-naïve and medication-refractory restless legs syndrome: A randomized clinical trial and meta-analysis

Objective/backgroundThere is a significant unmet need for safe and effective nonpharmacological therapies for restless legs syndrome (RLS). The objective was to evaluate the efficacy and safety of tonic motor activation (TOMAC) in patients with RLS. Patients/methodsA multicenter, randomized, participant-blinded, sham-controlled trial enrolled 45 adults with primary moderate-to-severe RLS who were either medication-naïve (n = 20) or medication-refractory (n = 25). Participants were 1:1 randomized to TOMAC (n = 22) or sham (n = 23) for two weeks and instructed to self-administer 30-min TOMAC sessions when they experienced RLS symptoms. The primary outcome was mean change in International RLS Study Group Rating Scale (IRLS) total score. A subsequent meta-analysis included the present trial and a previous randomized clinical trial that enrolled medication-naïve RLS patients. ResultsIRLS reduction was significantly greater for TOMAC than sham (TOMAC -6.59 vs. sham −2.17; mean difference (MD) = −4.42; 95 % confidence interval [CI] −1.57 to −7.26; p = 0.0040). Subgroup analysis showed similar IRLS mean difference for medication-refractory (MD = −4.50; p = 0.02) and medication-naïve (MD = −4.40; p = 0.08) cohorts, which was significantly different from sham only for the medication-refractory cohort. Meta-analysis of combined data from 33 medication-naïve RLS patients showed a significant reduction in mean IRLS score after two weeks for TOMAC compared to sham (MD = −4.30; 95 % CI -1.36 to −7.24; p = 0.004). ConclusionsThe present trial confirmed previous reports documenting efficacy and safety of TOMAC in refractory RLS and indicated similar effect sizes in refractory versus naïve subgroups. The meta-analysis demonstrated that TOMAC significantly improves RLS symptoms in naïve participants.

INVESTIGATION OF THE RELATIONSHIP BETWEEN BRUXISM SYMPTOMS AND RESTLESS LEG SYNDROME

Investigation of the Relationship Between Bruxism Symptoms And Restless Leg Syndrome Objective: This study aims to examine the relationship between bruxism symptoms and restless legs syndrome (RLS), focusing on the frequency and severity of RLS symptoms in patients with bruxism. Methods: Ethical approval was obtained from the Non-Interventional Clinical Research Ethics Committee of Recep Tayyip Erdoğan University (Protocol No: 2019/66). A total of 134 patients (50 males, 84 females) diagnosed with bruxism out of 212 patients presenting with jaw pain between April 10 and July 6, 2019, were included in the study. The average age of the participants was 47. Patients completed the Bruxism Determination Questionnaire and the RLS Severity Scale. Data were analyzed using SPSS (IBM SPSS for Windows, version 26). Relationships and correlations were determined using descriptive statistics and various statistical tests. Results: No statistically significant difference was found between bruxism symptoms and RLS severity (p&gt;0.05). However, a significant positive correlation was found between the number of bruxism symptoms and the RLS severity score (19.3%, p=0.025). Additionally, smoking was found to affect bruxism symptoms but not RLS severity. Conclusion: Bruxism symptoms increase with the severity of RLS, but no significant inverse relationship was observed. While smoking affects bruxism symptoms, it does not affect RLS severity. Further research with larger sample sizes and more objective evaluation criteria is needed to better understand the relationship between these two conditions. Keywords: Bruxism; sleep bruxism, restless leg syndrome; cigarette smoking

Long-term intrathecal infusion of low-dose morphine effectively relieves symptoms of severe restless legs syndrome/Willis-Ekbom disease without inducing opioid tolerance.

Restless legs syndrome/Willis-Ekbom disease (RLS/WED) causes a strong urge to move legs while resting. Restless legs syndrome/WED is an often-inherited disease occurring in 3% to 10% of adult populations, increasing with age. Severity varies from mild disturbance of sleep to painful restless legs and arms, loss of sleep, fatigue, and risk of suicide. Dopaminergic drugs relieve symptoms, but cause augmentation, ie, initially helpful but later increase the burden of symptoms. Oral gabapentinoids and opioids are often added, but opioid tolerance and adverse effects are common. With the high prevalence and incomplete help from oral drugs, significant unmet needs exist for effective therapy for severe RLS/WED. Ongoing spinal intrathecal infusion of low-dose morphine is effective, but not generally recognized, as only 12 cases have been published since 2002. We report 7 patients suffering from severe RLS/WED, who had no relief from oral dopaminergic, gabapentinoid, or opioid drugs; they all had excellent relief during ongoing spinal intrathecal infusion of morphine at only 1 to 5 μg/h, ongoing for 1 to 21 years without need of higher doses of morphine.. We suggest that morphine may be transported with the cerebrospinal fluid reaching and readjusting malfunctioning dopamine neuronal systems in the brain and spinal cord. The effects last only as long as the infusion continues. A patient with RLS/WED and persistent genital arousal disorder (PGAD) was relieved of both RLS/WED and PGAD symptoms. These case reports suggest that intrathecal infusion of low-dose morphine is an effective treatment of severe RLS.

The Relationship of Physical Activity with Restless Legs Syndrome in Chronic Kidney Disease Patients in the Hemodialysis Room of Subang District Hospital

Restless legs syndrome (RLS) is a sensorimotor disorder that affects a person's desire to move the legs. Physical activity is considered to be one way to reduce RLS symptoms. The purpose of this study was to analyze the relationship of physical activity with RLS in patients with chronic kidney disease (CKD) in the hemodialysis room of RSUD Kab Subang. This research is a type of quantitative research, correlational descriptive research design using cross-sectional. The sample in this study was 62 respondents, with purposive sampling techniques. Data collection using the Global Physical Activity Questionaire (GPAQ) and International Restless Legs Syndrome Group (IRLS) questionnaires, and data analysis using the spearmen rank test. The results showed that most respondents had a low level of physical activity, with a prevalence of 64.5%, and most respondents experienced severe symptoms of RLS, with a prevalence of 40.3%. Statistical tests show that there is a relationship between the physical activity variable and RLS (p-value 0.001), with the coefficient value is -0.741. It can be concluded that there is a solid relationship between physical activity and RLS in CKD patients in the hemodialysis room of RSUD Kab Subang with an antagonistic relationship direction. It is expected that nurses can intervene in chronic kidney disease patients to perform physical activity in accordance with their ability to reduce RLS.

Prevalence of restless legs syndrome during pregnancy and postpartum period.

Restless legs syndrome (RLS) is a disease from the spectrum of movement disorders, the prevalence of which increases significantly during pregnancy and is associated with poor sleep, a drop in daytime energy, and the development of psychological disorders during pregnancy and the postpartum period. The IRLSS scale was used to determine the presence of RLS symptoms. The total test sample that included the tested and control groups was (n=390) subjects. The examined group consisted of pregnant women (n=260), and the control group consisted of female students (n=130). In total, 260 pregnant women were monitored 6months after pregnancy. Three measurements were performed, first inthe third trimester of pregnancy, second two months afterdelivery, third 6months after delivery, while one cross-sectional measurement was performed for the controlgroup. The prevalence of RLS in pregnancy is highest in the third trimester and amounts to 26.5 %. In the postpartum period, a significant decrease in the prevalence of RLS was observed, measured two months after delivery (18.1 %). Postpartum, over time, a decrease in the prevalence of RLS was noticed, and six months after delivery it was (7.3 %), when it practically approached the prevalence of the control group (standard population) which was (6.2 %). The prevalence of RLS is highest during the third trimester of pregnancy and decreases after delivery so that 6months after delivery it approaches the prevalence of the standard population.

Effects of Dietary Supplementation in Patients with Restless Legs Syndrome: A Systematic Review.

Restless legs syndrome (RLS) is a common neurological disorder. It disrupts sleep and well-being and is often associated with other conditions. This review examines the potential of dietary supplements to manage RLS symptoms and reduce reliance on medications. A total of 10 randomized clinical trials involving 482 participants were analyzed, focusing on the impact of various supplements on symptom severity, sleep quality, and daytime sleepiness. Findings suggest some supplements may have positive results. Magnesium oxide and vitamin B6 significantly improved sleep quality and RLS symptoms, with magnesium showing greater effectiveness. Vitamin D supplementation did not show significant benefits. Oral iron has promising results, indicating potential efficacy but issues related to compliance and absorption. Both vitamins C and E positively affect RLS symptoms, likely due to their antioxidant properties. Valerian improved RLS and sleep but did not show a statistically significant improvement. Despite these encouraging results, a high risk of bias was noted in half of the studies, emphasizing the need for more rigorous research. Overall, this review suggests that dietary supplements may be a promising approach to managing RLS. However, further investigation is required to confirm the efficacy and safety.

Sleep duration, napping behaviors and restless legs syndrome during pregnancy and the trajectories of ultrasonographic measures of fetal growth: Findings from the NICHD Fetal Growth Studies–Singletons

ObjectivesGiven the plausible mechanisms and the lacking of empirical evidence, the study aims to investigate how gestational sleep behaviors and the development of sleep disorders, such as restless legs syndrome, influence ultrasonographic measures of fetal growth. MethodsThe study included 2457 pregnant women from the NICHD Fetal Growth Studies - Singletons (2009-2013), who were recruited between 8-13 gestational weeks and followed up to five times during pregnancy. Women were categorized into six groups based on their total sleep hours and napping frequency. The trajectory of estimated fetal weight from 10-40weeks was derived from three ultrasonographic measures. Linear mixed effect models were applied to model the estimated fetal weight in relation to self-reported sleep-napping behaviors and restless legs syndrome status, adjusting for age, race and ethnicity, education, parity, prepregnancy body mass index category, infant sex, and prepregnancy sleep-napping behavior. ResultsFrom enrollment to near delivery, pregnant women’s total sleep duration and nap frequency declined and restless legs syndrome symptoms frequency increased generally. No significant differences in estimated fetal weight were observed by sleep-napping group or by restless legs syndrome status. Results remained similar in sensitivity analyses and stratified analyses by women’s prepregnancy body mass index category (normal vs. overweight/obese) or by infant sex. ConclusionsOur data indicate that there is no association between sleep during pregnancy—assessed as total sleep duration and napping frequency, nor restless legs syndrome symptoms—and fetal growth from weeks 10 to 40 in healthy pregnant women.

Complementary advantages of microsurgical treatment for vertebral artery dolicoarteriopathies: Mitigating symptoms of restless leg syndrome in refractory vertebrobasilar insufficiency

Objective: This retrospective study examines the impact of microsurgical treatment on vertebral artery (VA) dolicoarteriopathies and associated restless leg syndrome (RLS) in patients with refractory vertebrobasilar insufficiency (VBI). Patients and Methods: We analyzed 78 patients with grade 2 and 3 kinks, and found out that the targeted microsurgical interventions, primarily designed to address VBI, improved secondary RLS symptoms in 12 patients. Procedures included arteriolysis and, depending on severity, grafting. Statistical analysis was conducted using Stata 16 (StataCorp LP, Texas, USA). Results: In twelve patients aged 55 to 72 years with refractory VBI and drug-resistant RLS, micro-neurosurgical correction of V1 segment dolicoarteriopathy, abnormal elongation and kinks in the artery, demonstrated promising outcomes. Postoperatively, 83.33% (10 patients) reported complete resolution of RLS symptoms, and 16.66% (2 patients) experienced partial symptom relief (p&amp;lt;0.05). Overall, 86.8% of various VBI-related symptoms were significantly improved or resolved (p&amp;lt;0.05). The microsurgical technique, avoiding traditional flow-arresting procedures, proved to be highly effective in this preliminary study with no mortality and minimal temporary complications, underscoring its potential treatment avenue for such complex neurovascular conditions. Conclusion: This study illuminates the relationship between VBI and RLS, proposing a potential vascular etiology for RLS, and highlights the need for a broader diagnostic approach for patients with refractory VBI.

Aerobic Exercise in Individuals with Restless Legs Syndrome: A Case Series Study

Purpose: Exercise has been demonstrated to alleviate restless legs syndrome (RLS) symptoms in individuals with RLS, but little studies are available on the physical health of primary RLS. This case series aim to describe outcome after the training of supervised aerobic exercise training in individuals with RLS. Case Report: Five individuals with RLS were received with a supervised aerobic exercise training 2 days per week for 12 weeks. The International Restless Legs Syndrome Study Group Rating Scale (IRLS) was used to detect the severity of RLS. The Turkish version of the Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. The functional effect of fatigue was evaluated with Fatigue Impact Scale (FIS). The Six-Minute Walk test (6MWT) were used to determine the functional exercise capacity. All assessments took place at baseline and post-intervention. Conclusion: Following aerobic exercise, clinically meaningful changes in the severity of RLS, PSQI, and 6MWT were reported in all individuals with severe RLS. Four of 5 patients improved their FIS at post-intervention. These results suggest that 24-session supervised aerobic exercise training might help to improve RLS severity, sleep quality, fatigue, and exercise capacity in an individual with RLS.

Approach to restless leg syndrome in hemodialysis patients

Restless legs syndrome (RLS) is an uncomfortable urge to move the legs while the person is at rest. This movement disorder is one of the problems that may develop in the follow-up of hemodialysis patients. It is important to recognize and treat these problems because they are closely related to mortality and morbidity. It is estimated that RLS symptoms occur in 3% of the adult population worldwide and in approximately 27% of hemodialysis patients. Although the pathophysiology of the disease and its relationship with its high prevalence in dialysis patients have not yet been clearly elucidated, it is predicted that pathologies such as central dopamine metabolism disorders, iron deficiency and uremia may underlie the disease. There are some pharmacological and non-pharmacological treatment methods developed based on available data. Current data in the literature regarding the effectiveness and superiority of these treatments are insufficient to clarify the treatment approach. Studies on the subject continue and the unknowns in treatment and pathophysiology are being clarified day by day.

Efficacy and Safety of Acupuncture for Restless Legs Syndrome in Patients with End-Stage Renal Disease: A Randomized-Controlled Trial at Hospital-Based Hemodialysis Center.

Background: Restless legs syndrome (RLS) is frequent in patients with hemodialysis (HD) and occurs predominantly in its most severe forms. The study was conducted to evaluate the efficacy and safety of acupuncture for RLS in patients with end-stage renal disease (ESRD) at hospital-based HD center. Methods: This single-blind, randomized controlled trial was performed on patients with HD and RLS who were randomly assigned to the experimental group and control group. Data were collected using the International Restless Legs Syndrome Rating Scale (IRLSRS), Insomnia Severity Index (ISI), and heart rate variability (HRV) records at baseline, after the therapeutic course (12 times/4 weeks), and 1-week follow-up. Result: A total of 47 patients were evaluated with IRLSRS score from 11 to 30 in this study. There were 41 patients enrolled in the study based on inclusion/exclusion criteria and allocated randomly into two groups. A total of 35 participants completed the trial, including 18 subjects in the experimental group and 17 subjects in the control group. The comparison of IRLSRS and ISI showed a significant reduction between two groups after acupuncture treatment (p = 0.002, p = 0.003). The ISI after 1-week follow-up also revealed significant decrease (p = 0.003). This HRV results showed that high frequency (HF%) increased significantly (p = 0.021) and low frequency (LF%) decreased significantly in the acupuncture group (p = 0.021). The generalized estimating equation showed that the IRLSRS improved by 2.902 points (p < 0.001) in the acupuncture group compared with the control group and by 1.340 points (p = 0.003) after 1-week follow-up. There were no adverse effects observed during HD in this study. Discussion: The authors conclude that acupuncture could effectively improve the symptoms of RLS significantly. The results from this study provide clinical evidence on the efficacy and safety of acupuncture to treat the patients with RLS at the HD center.