Restless Leg Syndrome

Treatment of restless leg syndrome by Deep Brain Stimulation

RLS symptoms are improving, and improvement is sustained up to two years despite significant decrease of dopaminergic treatment after deep brain stimulation surgery for Parkinson’s disease -Dr Olga Klepitskaya

People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body) and an irresistible urge to move their legs to relieve the sensations. The condition causes an uncomfortable, “itchy,” “pins and needles,” or “creepy crawly” feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting.

The severity of RLS symptoms ranges from mild to intolerable. Symptoms can come and go and severity can also vary. The symptoms are generally worse in the evening and at night. For some people, symptoms may cause severe nightly sleep disruption that can significantly impair their quality of life.

An intriguing study shows that deep-brain stimulation  may be an effective treatment for symptoms of restless leg syndrome (RLS).

restless legIn patients with Parkinson’s disease (PD), devices for DEEP BRAIN STIMULATION of the subthalamic nucleus (STN) were implanted. Among those who also had RLS, follow-up showed substantial reduction in RLS symptoms and benefit on RLS impact.

“This is the first observation on 22 patients, which is the largest number so far, that RLS symptoms are improving, and improvement is sustained up to 2 years despite significant decrease of dopaminergic treatment,” Olga Klepitskaya, MD, associate professor of neurology at the University of Colorado Denver Anschutz Medical Campus in Aurora, told Medscape Medical News.

The results were reported here at the 19th International Congress of Parkinson’s Disease and Movement Disorders (MDS).

RLS occurs in up to 50% of patients with PD and often responds well to dopaminergic therapy. DEEP BRAIN STIMULATION is an effective therapy for dopamine-responsive PD symptoms, so it is reasonable to think that RLS may respond to DBS surgery.

However, studies have been inconclusive with variable effects, including improvement in or emergence of RLS after STN DEEP BRAIN STIMULATION. There has also been moderate improvement or no effect after DBS surgery of other basal ganglia areas for various other movement disorders.

In the current study, all patients at this institution undergoing STN DEEP BRAIN STIMULATION surgery for PD between 2008 and 2013 filled out questionnaires about several conditions, including RLS and RLS quality of life preoperatively and out to 2 years after surgery. The study involved patients with moderate to severe RLS (International RLS Study Group rating scale [IRLS] sum scores >10).

In this study of 12 women and 10 men, patients had a mean age of 58.3 years and a baseline mean IRLS sum score of 19.59±6.95. At 6 months, the IRLS sum score diminished by 5.06 and further diminished slightly by 2 years.

We have also seen similar results in our patients undergoing dbs surgery in India.

Other RLS scores also reflected persistent benefit of the DBS out to 2 years. Quality-of-life scores trended toward benefit but were not significantly different from baseline.

Image Credit: goo.gl/T2OCzVgoo.gl/34kTWn

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