Restless Legs Syndrome Severity Research Articles

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.

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

Comparative analysis of cognitive and physical characteristics in late-onset, adult-onset and early-onset multiple sclerosis patients

BackgroundLate-onset multiple sclerosis (LOMS or L; MS) and early-onset MS (EOMS or E) are less common, and their prognosis can be different. To characterize the demographic and clinical features, and clinical outcomes of LOMS and EOMS patients, comparing them to adult-onset MS (AOMS or A) patients. MethodsThe study was conducted as a secondary analysis of a prospective study. The participants were divided into three groups according to age of MS onset: early onset (<18 years of age), adult-onset (20–40 years of age), and late-onset (>55 years of age). Demographic variables, oligoclonal bands, IgG index, and Expanded Disability Status Scale (EDSS) score in admission, first year, second year and current EDSS were evaluated. The Timed 25-Foot Walk Test (T25FW), Timed Up and Go (TUG), Multiple Sclerosis Walking Scale-12, Single Leg Standing Test, Activity-Specific Balance Confidence Scale, Nine-Hole Peg Test, Epworth Sleepiness Scale and Restless Legs Syndrome Severity Scale were performed. Appropriate statistical analysis was made. ResultsA total of 658 pwMS was included in the study and divided into three groups: EOMS (n = 117), AOMS (n = 499), and LOMS (n = 42). Statistically significant differences were determined between groups in terms of age [L (mean:59.86±5.45 years-y-)> A (36.87±9.12 y)> E(26.56±8.85 y), p < 0.001], education level, current EDSS score (L > E, p < 0.001), EDSS score in first admission, EDSS score in the first year, EDSS score in the second year (L > A > E, p < 0.001), reached an EDSS score 6 (E > L p = 0.001, E > A p = 0.015), disease duration (E > A, E > L, mean E = 11.66±9.7 y, A = 7.99±7.4 y, L = 6.31±4.67 y) time switching second-line treatment to the third line (E > L p < 0.001, A > L p = 0.002, mean E = 171.73±83.29 months-m-, A = 136.13±65.75 m, L = 65.85±45.96 m), number of relapses (A > E > L, median E = 4.0, A = 3.0, L = 2.0), distribution of MS type and oligoclonal band types. Significant differences were found in T25FW and TUG. Post-hoc analysis showed that participants in the LOMS group have longer T25FW (mean L = 7.8 ± 6.11, A = 6.25±5.09, E = 5.72±3.13, p = 0.011) and TUG (mean L = 11.01±5.53, A = 9.57±8.04, E = 8.38±5.51, p = 0.007) times than the AOMS and EOMS groups. ConclusionOur result revealed that individuals with LOMS face elevated disability levels and a heightened propensity to transition from first-line treatments to more advanced therapeutic interventions. LOMS have worse lower extremity functional status than AOMS and EOMS patient. Clinical evaluations and treatment choices require more attention in LOMS. However, according to the low number of LOMS in our cohort, these results were considered cautious, and more wide and multi-center studies must be designed.

Clinical impact of restless legs syndrome in patients with migraine: a 12-year, single-center, longitudinal study

AbstractAlthough many studies have indicated a significant association between migraine and restless legs syndrome (RLS), few long-term longitudinal studies have examined RLS in patients with migraine. We conducted a single-center, 12-year, longitudinal study of migraine patients and assessed whether RLS was present in 2010, 2017, or 2022 to evaluate its associations with clinical factors. Headache-related disability was assessed using the Migraine Disability Assessment (MIDAS). Sleep quality, daytime sleepiness, and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Beck Depression Inventory-II (BDI-II), respectively. Of the 262 patients included at baseline (2010), 101 were available after 7 years (2017), and 74 were available after 12 years (2022). The RLS incidence rates were 13.7%, 20.8%, and 24.3% in 2010, 2017, and 2022, respectively. The RLS severity score did not significantly differ among the three time points. The persistent RLS group, defined as those who were positive for RLS at the last evaluation in addition to the first and/or second evaluations, had significantly higher MIDAS, BDI-II, PSQI and ESS scores than did the never RLS group, defined as those who did not exhibit RLS at any of the three time points. Our 12-year longitudinal study revealed significant impacts of RLS on the burden of patients with migraine.

Alterations in functional brain connectivity following treatment for restless legs syndrome: The role of symptom improvement in restoring functional connectivity.

The pathophysiology of restless legs syndrome (RLS) remains incompletely understood. Although several studies have investigated the alterations of brain connectivity as one of the pathophysiological mechanisms of RLS, there are only few reports on functional connectivity changes after RLS treatment. Forty-nine patients with newly diagnosed RLS and 50 healthy controls were prospectively enrolled. The patients underwent resting-state functional magnetic resonance imaging (rs-fMRI) at baseline, and 39 patients underwent follow-up rs-fMRI, 3 months after treatment with pramipexole or pregabalin. Patients were divided into good or poor medication response groups. Functional brain connectivity was analysed using rs-fMRI and graph theoretical analysis. Significant differences in functional connectivity were observed between the RLS patients and healthy controls. The average path length, clustering coefficient, transitivity, and local efficiency were lower (2.02 vs. 2.30, p < 0.001; 0.45 vs. 0.56, p < 0.001; 3.08 vs. 4.21, p < 0.001; and 0.71 vs. 0.76, p < 0.001, respectively) and the global efficiency was higher (0.53 vs. 0.50, p < 0.001) in patients with RLS than in healthy controls. Differences in functional connectivity at the global level were also observed between post- and pre-treatment RLS patients who showed a good medication response. Transitivity in the post-treatment group was higher than that in the pre-treatment group (3.22 vs. 3.04, p = 0.007). Global efficiency was positively correlated with RLS severity (r = 0.377, p = 0.007). This study demonstrates that RLS is associated with distinct alterations in brain connectivity, which can be partially normalised following symptom management. These findings suggest that therapeutic interventions for RLS modulate brain function, emphasising the importance of symptom-focussed treatment in managing RLS.

Translation and Content Validation of the Self-Administered Version of the International Restless Leg Syndrome Severity Scale (sIRLS)

Translation and Content Validation of the Self-Administered Version of the International Restless Leg Syndrome Severity Scale (sIRLS)

Effects of Aerobic Exercise on Restless Legs Syndrome Severity in Individuals with Multiple Sclerosis: A Case report

Effects of Aerobic Exercise on Restless Legs Syndrome Severity in Individuals with Multiple Sclerosis: A Case report

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.

#1839 Evaluating the severity of restless legs syndrome in chronic kidney disease patients across different renal replacement therapies

Abstract Background and Aims Restless Legs Syndrome (RLS) is increasingly recognized as a significant comorbidity in chronic kidney disease (CKD) patients. This cross-sectional study evaluates the risk and severity of RLS in CKD patients across various renal replacement therapies (RRT). Method A total of 167 CKD patients were assessed, including those on hemodialysis (HD) (39%), peritoneal dialysis (PD) (22%), with kidney transplants (19%), and those with non-dialyzed CKD stages IV-V (20%)—the International Restless Legs Syndrome Study Group (IRLS) questionnaire measured RLS severity. Severity scales were categorized into mild (0-10), moderate (11-20), severe (21-30), and very severe (31-40). PTH, P, Ca, ALP, and Mg serum concentrations, as well as vascular calcification, were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Statistical analyses focused on differences in RLS severity across RRT modalities and associated risk factors. Results The cohort comprised 82 males and 85 females, averaging 58 years. Primary disease etiologies included nephroangiosclerosis (24%), diabetic nephropathy (12%), chronic pyelonephritis (24%), chronic glomerulonephritis (24%), and ADPKD (7%). RLS prevalence was 53.8%, with significant differences in IRLS scores across groups (p ≤ 0.001). HD patients showed a mean IRLS score of 21.8 ± 12.3, with 55% reporting severe or severe symptoms. PD patients scored 16.06 ± 13.02; non-dialyzed CKD patients scored 6.41 ± 6.04; and transplant recipients scored 3.1 ± 4.7. No correlation was found between RLS severity and age or time on RRT. However, significant correlations were observed between RLS severity with HD modality, and the high Adragaos score. Multivariate analysis showed high serum phosphorus p=0.018 and markers of inflammation as a risk factor for RLS severity (CRP levels p=0.034; ferritin (p=0.048). Conclusion This study underscores the disproportionately higher severity of RLS in HD patients, necessitating tailored management strategies for this subgroup. The significant association between RLS severity and calcification and inflammation markers in CKD patients, particularly those on HD, suggests that RLS severity should be a key consideration in the clinical management of CKD. Addressing RLS in these patients may improve their quality of life and influence the outcomes of their renal replacement therapy.

Large muscle group movements during sleep in restless leg syndrome: neurophysiological and clinical implications.

Recently, criteria have been drawn up for large muscle group movements during sleep (LMM), defined as movements lasting for 3-45 seconds in adults, which are often accompanied by changes in sleep stage, arousals, and increases in heart rate. The aim of this study was to characterize LMM in restless legs syndrome (RLS) in order to better evaluate their impact on the neurophysiology of the disorder and, therefore, the possible clinical implications. Consecutive, drug-free patients diagnosed with RLS and controls, aged 18 years or more, were retrospectively enrolled. Leg movement activity-short-interval (SILMS), periodic (PLMS), and isolated (ISOLMS) leg movements during sleep-and LMM were detected and scored. In total, 100 patients and 67 controls were recruited. All movement measures were significantly higher in RLS. A significant positive correlation was found between LMM and ISOLMS index but not PLMS index in both groups. LMM index showed a significant negative correlation with total sleep time, sleep efficiency, and percentage of sleep stages N3 and R, as well as a significant positive correlation with the number of awakenings, and percentage of sleep stages N1 and N2 only in patients with RLS. No significant correlation was found between either LMM or PLMS index and RLS severity. Different types of movements, including SILMS, ISOLMS, and LMM, play somewhat distinct roles in sleep neurophysiology in RLS. Notably, LMM, a newly recognized category of movements, demonstrates associations with sleep architecture instability and fragmentation, arousals, and awakenings, suggesting potential clinical implications.

The ethos brief index—validation of a brief questionnaire to evaluate wellness based on a holistic perspective in patients with restless legs syndrome

PurposeThe aim of this study was to validate the Ethos Brief Index (EBI) in patients with Restless Legs Syndrome (RLS).MethodsA cross-sectional design, including 788 subjects with RLS (65% women, 70.8 years, SD 11.3) from the Swedish RLS Association, was used. A postal survey was sent out to collect data regarding socio demographics, comorbidities, and RLS-related treatment data. Questionnaires included were EBI, the Restless Legs Syndrome-6 Scale (RLS-6), Restless Legs Syndrome—Quality of Life questionnaire (RLSQoL), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis (CFA) models. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age and gender groups, as well as insomnia, daytime sleepiness, RLS-related QoL and RLS severity were assessed.ResultsThe results supported the unidimensionality of the EBI in the CFA (i.e., explaining 61.5% of the variance) and the Rasch model. The reliability of the EBI was confirmed using composite reliability and Cronbach’s alpha. No DIF was identified for gender, age, insomnia, daytime sleepiness, RLS severity or RLS-related QoL.ConclusionThe EBI showed good validity and reliability and operated equivalently for male and female patients with RLS. Accordingly, healthcare professionals can use the EBI as a psychometrically sound tool to explore and identify patient-centered problems related to the whole life situation.

Compromised Dynamic Cerebral Autoregulation in Patients with Restless Legs Syndrome.

Restless legs syndrome (RLS) is a prevalent sensorimotor nervous system disorder in patients accompanied with insomnia, blood pressure fluctuation, and sympathetic dysfunction. These symptoms may disrupt cerebral hemodynamics. Dynamic cerebral autoregulation (dCA) describes the temporary response of cerebrovascular system to abrupt fluctuations in blood pressure, which keep cerebral blood flow stable and serve as a marker of cerebrovascular system ability. This research aimed to assess dCA in RLS patients. In this study, RLS patients were recruited and subsequently classified into four groups (mild, moderate, severe, and very severe) based on the International RLS Rating Scale (IRLS). Healthy controls matched for age and sex were enrolled. All participants were evaluated dCA by assessing phase difference (PD). A portion of patients with RLS was reassessed for dCA after one month of medication therapy (pramipexole [0.125 mg/day] and gabapentin [300 mg/day]). There were altogether 120 patients with RLS and 30 controls completed the polysomnography and dCA assessment. PD was lower in the moderate, severe, and very severe RLS groups than that in the controls and mild RLS groups. Periodic limb movement index (PLMI), arousal index, and IRLS all showed a linear correlation with PD in RLS patients. Additionally, PD increased in RLS patients after therapy. The dCA was compromised in moderate, severe, and very severe RLS patients and was negatively correlated with the IRLS, arousal index, and PLMI. After 1 month of therapy, dCA improved in RLS patients.

Use of Integrative Medicine Practices by Pregnant Women with Restless Legs Syndrome

Objective: To determine the use of integrative medicine practices in pregnant women with restless legs syndrome. Methods: This cross-sectional descriptive study was conducted in the perinatology service and outpatient clinic of a university hospital between 2 February-11 May 2022. The study included 148 pregnant women with restless legs syndrome who met the inclusion criteria. Data were collected using the Restless Legs Syndrome Diagnostic Criteria Questionnaire, the Restless Legs Syndrome Severity Rating Scale, a Personal Information Form, and an Integrative Medicine Use Form. Results: The pregnant women of the 61.4% were in their last trimester, and 75.7% had no information about restless legs syndrome. Symptoms started at an average of 20.29 ± 8.65 weeks of gestation and 81.1% of the pregnant women did not consult a physician. Of those who did consult a physician, 57.7% consulted a gynecologist and 81.0% were recommended vitamins/minerals as a treatment. For syndrome symptoms, 50.7% of pregnant women used integrative medicine practices. The four most commonly used methods were taking vitamins (55.9%), prayer (51.9%), brisk walking (45.2%) and massage (33.3%). There was no statistically significant difference between the use of integrative medicine practices and the severity of restless legs syndrome (P&amp;gt; .05). Conclusion: Restless legs syndrome is a condition that is not widely recognized by pregnant women. About half of pregnant women try to manage the condition by using integrative medical practices for syndrome. Nurses and other health professionals should provide information to pregnant women to raise awareness of the disease and provide effective treatment options.

Effect of Self-developed Ye'an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction Combined with Tramadol on TCM Symptom Scores and RLS Severity of patients with Restless Legs Syndrome.

To investigate the effect of self-developed Ye'an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction on Traditional Chinese Medicine (TCM) symptom scores and RLS Severity of patients with restless legs syndrome (RLS). This was a clinical comparative study. Eighty patients with RLS admitted to Baoding No.1 Central Hospital from January 2022 to December 2022 were randomly divided into observation group and control group(n=40). Patients in the control group were given basic and oral tramadol treatment, while those in the observation group were given self-developed Ye'an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction based on the treatment in the control group. The differences of TCM symptom scores, RLS severity (IRLS), quality of life (QOL-RLS), sleep quality (PSQI) and clinical efficacy between the two groups were compared. Before treatment, no statistically significant differences were observed in the TCM symptom scores, IRLS scores, QOL-RLS scores and PSQI scores between the two groups (p>0.05). After treatment, the above scores decreased significantly in both groups, with a higher degree of decrease in the observation group than in the control group, indicating statistically significant differences (p<0.05). The QOL-RLS scores were significantly higher in the observation group than in the control group, with a statistically significant difference (p<0.05). The overall response rate in the observation group was 95.00%, which was higher than that in the control group (80.00%), with a statistically significant difference (p<0.05). Self-developed Ye'an Analgetic Decoction/Jiawei Shaoyao Gancao Decoction leads to numerous benefits in the treatment of RLS, such as obviously ameliorating patients' clinical symptoms, reducing RLS severity, and improving their quality of life and sleep quality.

Restless legs syndrome in patients with obstructive sleep apnea: Association between apnea severity and symptoms of depression, insomnia, and daytime sleepiness

ObjectiveTo determine if the prevalence and severity of restless legs syndrome (RLS) varies with apnea severity and analyze differences between the sexes in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness in patients with obstructive sleep apnea (OSA). MethodsSymptoms of depression, insomnia, and daytime sleepiness were defined as Patient Health Questionnaire–9 score ≥10, Insomnia Severity Index score ≥15, and Epworth Sleepiness Scale score ≥11. Multivariate logistic and linear regression analyses were conducted. ResultsIn 707 adults with OSA (85.1% males), 16.1% (n = 114) had comorbid RLS. The prevalence of RLS was markedly lower in those with moderate and severe OSA than in those with mild OSA. Similarly, the odds of RLS significantly decreased with increasing apnea-hypopnea index. After controlling for age and sex, in patients with comorbid RLS, the International RLS Study Group Rating Scale scores were negatively correlated with apnea-hypopnea index and a nadir peripheral oxygen saturation during sleep. The presence of RLS was more likely to be associated with symptoms of depression, insomnia, and daytime sleepiness after controlling for confounding variables, but only in men. ConclusionsRLS is frequently noted in combination with OSA, with a female preponderance. The severities of OSA and RLS may be negatively associated. In patients with OSA, sex-related differences in terms of comorbid RLS with symptoms of depression, insomnia, and daytime sleepiness warrant further investigations.

The Melanocortin and Endorphin Neuropeptides in Patients with Restless Legs Syndrome.

Based upon similarities between the urge to move and sensory discomfort of restless legs syndrome (RLS) and properties of melanocortin hormones, including their incitement of movement and hyperalgesia, we assessed plasma and cerebrospinal fluid (CSF) α-melanocyte-stimulating hormone (α-MSH) and β-endorphin in RLS patients and controls. Forty-two untreated moderate-to-severe RLS patients and 44 matched controls underwent venipuncture at 19:00, 20:30, and 22:00; 37 RLS and 36 controls had lumbar puncture at 21:30. CSF and plasma were analyzed for pro-opiomelanocortin (POMC), adrenocorticotropin hormone (ACTH), α-MSH, β-MSH, and β-endorphin by immunoassay. RLS severity was assessed by International RLS Study Group Severity Scale. RLS participants were 52.7 ± 12.0 years old, 61.9% were women, 21.4% had painful RLS, and RLS severity was 24.8 ± 9.0. Controls had similar age and sex. Plasma ACTH, α-MSH, and β-endorphin were similar between groups. Plasma POMC was significantly greater in RLS than controls (17.0 ± 11.5 vs 12.7 ± 6.1fmol/ml, p = 0.048). CSF ACTH was similar between groups. CSF β-MSH was significantly higher in painful than nonpainful RLS or controls (48.2 ± 24.8 vs 32.1 ± 14.8 vs 32.6 ± 15.2pg/ml, analysis of variance [ANOVA] p = 0.03). CSF α-MSH was higher in RLS than controls (34.2 ± 40.9 vs 20.3 ± 11.0pg/ml, p = 0.062). CSF β-EDP was lowest in painful RLS, intermediate in nonpainful RLS, and highest in controls (8.0 ± 3.4 vs 10.8 ± 3.1 vs 12.3 ± 5.0pg/ml, ANOVA p = 0.049). The ratio of the sum of CSF α- and β-MSH to CSF β-endorphin was highest, intermediate, and lowest in painful RLS, nonpainful RLS, and controls (p = 0.007). CSF β-MSH is increased and CSF β-endorphin decreased in RLS patients with painful symptoms. ANN NEUROL 2024;95:688-699.

Non-invasive vagus nerve stimulation therapy for severe pharmacoresistant restless legs syndrome: efficacy and tolerance at 6 months

Non-invasive vagus nerve stimulation therapy for severe pharmacoresistant restless legs syndrome: efficacy and tolerance at 6 months

Restless leg syndrome as a complication of primary hyperparathyroidism: insights from a retrospective study.

Restless leg syndrome (RLS) is an invalidating neurological disorder with a complex, largely unknown pathophysiology. While RLS is observed in Parkinson's disease and in renal failure, idiopathic cases are common. Limited reports associate RLS with parathyroid hormone (PTH). This study analyzes a cohort of patients with primary hyperparathyroidism (PHPT) and chronic post-surgical hypoparathyroidism (hypo PTH), to investigate RLS prevalence, and associated risk factors. Ninety-five patients (54 PHPT, 41 hypo PTH) were consecutively enrolled at the bone metabolism outpatient clinic. The revised IRLSSG diagnostic criteria were used to diagnose RLS, with assessments conducted through face-to-face interviews and neurological examination. When RLS was confirmed, the RLS severity scale was applied. Retrospective records included calcium-phosphate metabolism-related parameters, surgery details, renal lithiasis, fragility fractures, and densitometric features (T-score). RLS was diagnosed in 22.2% PHPT patients, compared to 4.9% of patients with hypo PTH (p = 0.02). Of RLS diagnosed patients, 91.7% had a history of parathyroidectomy, compared to 47.6% of patients without RLS (p = 0.01). Most of the operated patients reported that surgery determined an improvement of symptoms; however, mean score severity of RLS at our evaluation was 15/40, defined as moderate. PTH and calcium levels were not statistically associated to the presence of RLS. Our study suggests that PHPT may be one of the etiologies of RLS. Parathyroidectomy alleviates symptoms in the vast majority of the cases but does not remove them.

Application of Repetitive Transcranial Magnetic Stimulation for the Treatment of Restless Legs Syndrome: A Pilot Study

ObjectiveTo explore effects of high frequency repetitive transcranial magnetic stimulation (rTMS) on restless legs syndrome (RLS) patients. Methods18 primary RLS patients were divided into rTMS group and sham stimulation group. rTMS treatment group received 15 Hz high-frequency rTMS to stimulate the leg motor representative area of the frontal cortex for 14 days and the sham stimulation group received 15 Hz high-frequency rTMS sham stimulation in primary motor cortex for 14 days. ResultsAfter rTMS, RLS severity scale score, Pittsburgh sleep quality index (PSQI), Hamilton anxiety scale (HAMA) as well as Hamilton depression scale (HAMD24) in rTMS treatment group are significantly lower than before treatment; 1 month and 2 months after treatment, the score remained at low level. Meanwhile, no significant changes have been observed in the above index before rTMS stimulation for the sham stimulation group after 14 days, after 1 month and 2 months. In addition, the results of correlation analysis suggested for all the 18 RLS patients, there was a positive correlation between PSQI score and HAMA as well as HAMD24 scores before and after rTMS stimulation. In addition, the RLS severity score was also positively correlated with PSQI, HAMA and HAMD24 scores. ConclusionsHigh frequency rTMS stimulation reduces the frequency and severity of RLS, improves the quality of sleep, anxiety as well as depression of the patients, and the curative effect can sustain for 2 months. High-frequency rTMS may be used as an alternative treatment option for improving the RLS patients’ quality of life.

A study of the correlation between magnesium and ferritin levels and the severity of the disease and sleep quality in restless legs syndrome

Background/Aim: Restless legs syndrome (RLS) is a chronic neurological disease that impairs sleep quality, causes emotional stress and affects daily activities. While the association between disease severity and low iron and ferritin levels is known, the magnesium (Mg) results are contradictory. This study aimed to investigate the influence of low Mg and ferritin levels on the severity of the disease and sleep quality. Methods: A case-control study included 50 RLS patients aged 18–78 years and 50 healthy control patients. Mg and ferritin levels were measured, considering values below &lt;1.8 mg/dL and 75 ng/mL as low. Both groups completed the International Restless Legs Syndrome Severity Rating Scale (IRLSSG) to assess the severity of RLS, as well as the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) to evaluate subjective sleep quality. Results: The mean age of RLS patients and the control group was 47.06 (13.35) years and 43.30 (15.43) years, respectively (P=0.196). The RLS patients had an IRLSSG score of 25.16 (6.85). The PSQI total scores, subscale scores, and ESS scores of RLS patients were significantly higher than those of the control group. However, no significant difference was observed in the IRLSSG score, PSQI, and ESS scores based on Mg and ferritin levels. Sleep latency was found to be shorter in individuals with Mg deficiency. Conclusion: Sleep disorders are prevalent among RLS patients. No correlation was found between Mg and ferritin levels and disease severity or sleep disorders. Furthermore, Mg deficiency did not appear to exacerbate the IRLSSG score or sleep disorder scores.