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Li C, Sun W, Xu L, Chen C, Fang L, Tang Y, Zhang Q, Shi H, Liu T. Cerebral blood flow changes in maintenance hemodialysis patients with restless legs syndrome and their clinical significance:a cross-sectional case-control study. BMC Neurol 2024; 24:128. [PMID: 38627680 PMCID: PMC11020200 DOI: 10.1186/s12883-024-03636-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE Restless legs syndrome (RLS) stands as a prevalent neurological complication within maintenance hemodialysis (MHD) patients. However, the alterations in cerebral blood flow (CBF) among MHD-RLS patients remain uncharted. Through the utilization of the arterial spin labeling (ASL) technique, we evaluated the fluctuations in CBF within distinct brain regions and analyzed the risk factors for the development of RLS in MHD patients in the context of the clinic. METHODS Thirty-one MHD patients with concomitant RLS (MHD-RLS group) and thirty-one non-RLS patients matched based on age, gender, as well as cognitive function (MHD-nRLS group) were included. Through image preprocessing and data analysis, the changes in CBF values in distinct brain regions were obtained, and the CBF values of brain regions with substantial differences between the two groups were correlated with the RLS scores. Furthermore, the differences in baseline data were compared, and through the utilization of multifactorial logistic regression, the independent risk factors for the development of RLS were examined. RESULTS Compared with the MHD-nRLS group, the MHD-RLS group had increased CBF in the right superior temporal gyrus, reduced CBF in the right hippocampus, left middle frontal gyrus, inferior frontal gyrus of right triangle, middle frontal gyrus of left orbit, left precentral gyrus, and left precuneus. Only left precentral gyrus CBF were negatively correlated with RLS scores after correction for dialysis duration(r = -0.436, P = 0.016). Accordingly, multifactorial regression analysis by stepwise method yielded that the left precentral gyrus CBF values(OR: 0.968, 95%CI: 0.944-0.993, P = 0.012) remained an independent risk factor for RLS in MHD patients. In addition, the results showed that hemodialysis duration (OR: 1.055, 95%CI: 1.014-1.098, P = 0.008) and serum iron levels (OR: 0.685, 95%CI: 0.551-0.852, P = 0.001) were also risk factors for the development of RLS. CONCLUSION Patients afflicted with MHD-RLS exhibit alterations in CBF across several brain regions. Notably, the left precentral gyrus might serve as a pivotal region influencing the onset of RLS among MHD patients. Furthermore, extended hemodialysis duration and a relative insufficiency in serum iron levels independently contribute as risk factors for RLS development within the MHD patient population.
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Affiliation(s)
- Chen Li
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
- Graduate College, Dalian Medical University, Dalian, China
| | - Wei Sun
- Graduate College, Dalian Medical University, Dalian, China
- Department of Radiology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Linfang Xu
- Hemodialysis Center, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Cheng Chen
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Li Fang
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Yushang Tang
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Qiaoyang Zhang
- Department of Psychology, The Affiliated Changzhou No. 2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China.
| | - Tongqiang Liu
- Department of Nephrology, The Affiliated Changzhou NO.2, People's Hospital of Nanjing Medical University , Changzhou, Jiangsu, China.
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Lanza G, Mogavero MP, Lanuzza B, Tripodi M, Cantone M, Pennisi M, Bella R, Ferri R. A Topical Review on Transcranial Magnetic Stimulation in Restless Legs Syndrome. CURRENT SLEEP MEDICINE REPORTS 2024; 10:207-216. [DOI: 10.1007/s40675-024-00282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 07/26/2024]
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Dirks CAH, Bachmann CG. From brain to spinal cord: neuromodulation by direct current stimulation and its promising effects as a treatment option for restless legs syndrome. Front Neurol 2024; 15:1278200. [PMID: 38333606 PMCID: PMC10850250 DOI: 10.3389/fneur.2024.1278200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Neuromodulation is a fast-growing field of mostly non-invasive therapies, which includes spinal cord stimulation (SCS), transcranial direct current stimulation (tDCS), vagal nerve stimulation (VNS), peripheral nerve stimulation, transcranial magnetic stimulation (TMS) and transcutaneous spinal direct current stimulation (tsDCS). This narrative review offers an overview of the therapy options, especially of tDCS and tsDCS for chronic pain and spinal cord injury. Finally, we discuss the potential of tsDCS in Restless Legs Syndrome as a promising non-invasive, alternative therapy to medication therapy.
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Zheng S, Feng S, Yao H, Dong L, Feng Z, Liu X, Zhang B, Jia H, Ning Y. Altered functional connectivity after acute sleep deprivation reveals potential locations for noninvasive brain stimulation techniques. Sleep Med 2023; 110:212-219. [PMID: 37634325 DOI: 10.1016/j.sleep.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/18/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUNDS Non-invasive brain stimulation (NIBS) techniques are emerging as efficacious treatments for sleep deprivation (SD). However, the stimulation location of NIBS (e.g. transcranial magnetic stimulation and transcranial direct current stimulation) on intervening acute SD is limited in previous studies. In this study, we aimed to investigate potentially effective targets of NIBS on intervening acute SD. METHODS We firstly performed a meta-analysis of 95 functional magnetic resonance imaging studies to find SD-related brain regions as regions of interest (ROI). Subsequently, we used resting-state functional connectivity analysis in 32 young individuals suffering from 24 h SD to identify brain surface regions associated with the ROIs. Finally, we applied 10-20 system coordinates to locate scalp sites for NIBS corresponding to the brain surface regions. RESULTS We identified the bilateral dorsolateral prefrontal cortex, bilateral inferior frontal gyrus, left supplementary motor area, precentral, right precuneus, bilateral inferior parietal gyrus, right middle temporal gyrus, and superior frontal gyrus as potential targets of NIBS for intervening SD. The 10-20 system coordinates corresponding to these brain surface regions were identified as potential sites for NIBS. CONCLUSIONS In conclusion, we identified several potential targets which could provide alternative stimulation locations for the use of NIBS on young patients suffering from acute SD.
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Affiliation(s)
- Sisi Zheng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Sitong Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Hao Yao
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Linrui Dong
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Zhengtian Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Xinzi Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Binlong Zhang
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
| | - Hongxiao Jia
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China.
| | - Yanzhe Ning
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China.
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Zhang J, Zhang J, Sun H, Yang J, Ma Y, Chen K, Su J, Yu X, Yang F, Zhang Z, Zhao T, Hu X, Zhai Y, Liu Q, Wang J, Liu C, Wang Z. Cerebellum drives functional dysfunctions in restless leg syndrome. Sleep Med 2023; 110:172-178. [PMID: 37595434 DOI: 10.1016/j.sleep.2023.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/04/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE Restless legs syndrome (RLS) has serious effects on patients' sleep quality, physical and mental health. However, the pathophysiological mechanisms of RLS remain unclear. This study utilized both static and dynamic functional activity and connectivity analyses approaches as well as effective connectivity analysis to reveal the neurophysiological basis of RLS. METHODS The resting-state functional MRI (rs-fMRI) data from 32 patients with RLS and 33 age-, and gender-matched healthy control (HC) were collected. Dynamic and static amplitude of low frequency fluctuation (ALFF), functional connectivity (FC), and Granger causality analysis (GCA) were employed to reveal the abnormal functional activities and couplings in patients with RLS. RESULTS RLS patients showed over-activities in left parahippocampus and right cerebellum, hyper-connectivities of right cerebellum with left basal ganglia, left postcentral gyrus and right precentral gyrus, and enhanced effective connectivity from right cerebellum to left postcentral gyrus compared to HC. CONCLUSIONS Abnormal cerebellum-basal ganglia-sensorimotor cortex circuit may be the underlying neuropathological basis of RLS. Our findings highlight the important role of right cerebellum in the onset of RLS and suggest right cerebellum may be a potential target for precision therapy.
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Affiliation(s)
- Jiang Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jingyue Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Hui Sun
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Jia Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Yingzi Ma
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Kexuan Chen
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Jing Su
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Xiaohui Yu
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Futing Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Zhiwei Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Tianyu Zhao
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Xiuying Hu
- Med-X Center for Informatics, Sichuan University, Chengdu, China; Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yiran Zhai
- College of Electrical Engineering, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Qihong Liu
- College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Jiaojian Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China.
| | - Chunyan Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neuromodulation, Beijing, China.
| | - Zhengbo Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China.
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Lanza G, Fisicaro F, Cantone M, Pennisi M, Cosentino FII, Lanuzza B, Tripodi M, Bella R, Paulus W, Ferri R. Repetitive transcranial magnetic stimulation in primary sleep disorders. Sleep Med Rev 2023; 67:101735. [PMID: 36563570 DOI: 10.1016/j.smrv.2022.101735] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a widely used non-invasive neuromodulatory technique. When applied in sleep medicine, the main hypothesis explaining its effects concerns the modulation of synaptic plasticity and the strength of connections between the brain areas involved in sleep disorders. Recently, there has been a significant increase in the publication of rTMS studies in primary sleep disorders. A multi-database-based search converges on the evidence that rTMS is safe and feasible in chronic insomnia, obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), and sleep deprivation-related cognitive deficits, whereas limited or no data are available for narcolepsy, sleep bruxism, and REM sleep behavior disorder. Regarding efficacy, the stimulation of the dorsolateral prefrontal cortex bilaterally, right parietal cortex, and dominant primary motor cortex (M1) in insomnia, as well as the stimulation of M1 leg area bilaterally, left primary somatosensory cortex, and left M1 in RLS reduced subjective symptoms and severity scale scores, with effects lasting for up to weeks; conversely, no relevant effect was observed in OSAS and narcolepsy. Nevertheless, several limitations especially regarding the stimulation protocols need to be considered. This review should be viewed as a step towards the further contribution of individually tailored neuromodulatory techniques for sleep disorders.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy; Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy.
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Mariagiovanna Cantone
- Neurology Unit, University Hospital Policlinico "G. Rodolico-San Marco", Catania, Italy; Department of Neurology, Sant'Elia Hospital, ASP Caltanissetta, Caltanissetta, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Bartolo Lanuzza
- Department of Neurology IC and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Mariangela Tripodi
- Department of Neurology IC and Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Rita Bella
- Department of Medical and Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
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Anguelova GV, Vlak MHM, Kurvers AGY, Rijsman RM. Pharmacologic and Nonpharmacologic Treatment of Restless Legs Syndrome. Sleep Med Clin 2022; 17:407-419. [PMID: 36150803 DOI: 10.1016/j.jsmc.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Restless legs syndrome (RLS) is a sleep-related disorder defined by an urgency to move the legs, usually combined with uncomfortable or unpleasant sensations, which occurs or worsens during rest, usually in the evening or at night, and disappears with the movement of the legs. RLS can be classified as idiopathic or primary, and secondary to comorbid conditions (eg, renal disease, polyneuropathy). The pathophysiology of RLS is still unclear. This article provides an updated practical guide for the treatment of primary RLS in adults.
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Affiliation(s)
- Galia V Anguelova
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, the Netherlands
| | - Monique H M Vlak
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, the Netherlands
| | - Arthur G Y Kurvers
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, the Netherlands
| | - Roselyne M Rijsman
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, the Netherlands.
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Wang J, Deng X, Hu Y, Yue J, Ge Q, Li X, Feng Z. Low-frequency rTMS targeting individual self-initiated finger-tapping task activation modulates the amplitude of local neural activity in the putamen. Hum Brain Mapp 2022; 44:203-217. [PMID: 36562546 PMCID: PMC9783468 DOI: 10.1002/hbm.26045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/11/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been used in the clinical treatment of Parkinson's disease (PD). Most of rTMS studies on PD used high-frequency stimulation; however, excessive nonvoluntary movement may represent abnormally cortical excitability, which is likely to be suppressed by low-frequency rTMS. Decreased neural activity in the basal ganglia on functional magnetic resonance imaging (fMRI) is a characteristic of PD. In the present study, we found that low-frequency (1 Hz) rTMS targeting individual finger-tapping activation elevated the amplitude of local neural activity (percentage amplitude fluctuation, PerAF) in the putamen as well as the functional connectivity (FC) of the stimulation target and basal ganglia in healthy participants. These results provide evidence for our hypothesis that low-frequency rTMS over the individual task activation site can modulate deep brain functions, and that FC might serve as a bridge transmitting the impact of rTMS to the deep brain regions. It suggested that a precisely localized individual task activation site can act as a target for low-frequency rTMS when it is used as a therapeutic tool for PD.
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Affiliation(s)
- Jue Wang
- Institute of Sports Medicine and HealthChengdu Sport UniversityChengduPeople's Republic of China
| | - Xin‐Ping Deng
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China,Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China,Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Yun‐Song Hu
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China,Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China,Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Juan Yue
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China,Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China,Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Qiu Ge
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China,Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China,Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Xiao‐Long Li
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China,Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China,Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
| | - Zi‐Jian Feng
- Institutes of Psychological SciencesHangzhou Normal UniversityHangzhouPeople's Republic of China,Zhejiang Key Laboratory for Research in Assessment of Cognitive ImpairmentsHangzhouPeople's Republic of China,Center for Cognition and Brain DisordersThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouPeople's Republic of China
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9
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Park KM, Kim KT, Lee DA, Cho YW. Structural brain connectivity in patients with restless legs syndrome: a diffusion tensor imaging study. Sleep 2022; 45:6575835. [PMID: 35485481 DOI: 10.1093/sleep/zsac099] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To evaluate alterations of global and local structural brain connectivity in patients with restless legs syndrome (RLS). METHODS Patients with primary RLS and healthy controls were recruited at a sleep center where they underwent diffusion tensor imaging (DTI) of the brain. We calculated the network measures of global and local structural brain connectivity based on the DTI in both groups using DSI studio program and a graph theory. RESULTS A total of 69 patients with primary RLS and 51 healthy controls were included in the study. We found a significant difference in the global structural connectivity between the groups. The transitivity in the patients with RLS was lower than that in healthy controls (0.031 vs. 0.033, p = 0.035). Additionally, there were significant differences in the local structural connectivity between the groups. The characteristic path length (r = 0.283, p = 0.018), radius of graph (r = 0.260, p = 0.030), and diameter of graph (r = 0.280, p = 0.019) were all positively correlated with RLS severity, whereas the mean clustering coefficient (r = -0.327, p = 0.006), global efficiency (r = -0.272, p = 0.023), small-worldness index (r = -0.325, p = 0.006), and transitivity (r = -0.351, p = 0.003) were negatively correlated with RLS severity. CONCLUSION We identified changes in the global structural connectivity of patients with RLS using graph theory based on DTI, which showed decreased segregation in the brain network compared to healthy controls. These changes are well correlated with RLS severity. We also found changes in local structural connectivity, especially in regions involved in sensorimotor function, which suggests that these areas play a pivotal role in RLS. These findings contribute to a better understanding of the pathophysiology of RLS symptoms.
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Affiliation(s)
- Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
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10
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Park KM, Kim KT, Kang KW, Park JA, Seo JG, Kim J, Chang H, Kim EY, Cho YW. Alterations of Functional Connectivity in Patients With Restless Legs Syndrome. J Clin Neurol 2022; 18:290-297. [PMID: 35589318 PMCID: PMC9163943 DOI: 10.3988/jcn.2022.18.3.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Restless legs syndrome (RLS) is a common neurological illness marked by a strong desire to move one’s legs, usually in association with uncomfortable sensations. Recent studies have investigated brain networks and connectivity in RLS. The advent of network analysis has greatly improved our understanding of the brain and various neurological disorders. A few studies have investigated alterations in functional connectivity in patients with RLS. This article reviews functional connectivity studies of patients with RLS, which have identified significant alterations relative to healthy controls in several brain networks including thalamic, salience, default-mode, and small-world networks. In addition, network changes related to RLS treatment have been found, including to repetitive transcranial magnetic stimulation, transcutaneous spinal cord direct-current stimulation, and dopaminergic drugs. These findings suggest that the underlying pathogenesis of RLS includes alterations in the functional connectivity in the brain and that RLS is a network disorder.
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Affiliation(s)
- Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Jung A Park
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jiyoung Kim
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
| | - Hyeyeon Chang
- Department of Neurology, Konyang University School of Medicine, Daejeon, Korea
| | - Eun Young Kim
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.
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11
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Wang H, Han X, Jin M, Wang LY, Diao ZL, Guo W, Zhang P, Wang Z, Lv H, Ding HY, Zhang ZY, Zhao PF, Li J, Yang ZH, Liu WH, Wang ZC. Cerebral blood flow alterations in hemodialysis patients with and without restless legs syndrome: an arterial spin labeling study. Brain Imaging Behav 2021; 15:401-409. [PMID: 32700257 DOI: 10.1007/s11682-020-00268-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hemodialysis with restless legs syndrome (HD-RLS) is associated with alterations in neuronal function, the blood-brain barrier and iron deposition, thus affecting cerebral metabolism and perfusion. This study utilized three-dimensional arterial spin labeling (ASL) to identify HD-RLS-related perfusion patterns and potential relationships with disease severity. Twenty-six HD-RLS patients, 30 hemodialysis patients without restless legs syndrome (HD-nRLS) and 30 age-, sex-, and education-matched healthy controls were included in this study. One-way analysis of covariance and post hoc analyses were used to assess differences in cerebral blood flow (CBF) values, demographics and clinical data among the three groups. Pearson's correlation analysis was conducted between altered CBF values in the HD-RLS group and clinical data. Compared with HD-nRLS patients, HD-RLS patients showed increased CBF in the right primary motor cortex (false discovery rate [FDR]-corrected P < 0.05). Compared with the normal controls, both HD subgroups (i.e., those with and without RLS) exhibited consistent CBF changes, including increased CBF in the left medial superior frontal gyrus and bilateral thalamus and decreased CBF in the left insular cortices (FDR-corrected P < 0.05). This abnormal hyperperfusion in the sensorimotor cortex and basal ganglia provides evidence for a sensory processing disorder in RLS that may be involved in the pathogenesis of RLS in HD patients.
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Affiliation(s)
- Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Xue Han
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Mei Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Li-Yan Wang
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Zong-Li Diao
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Wang Guo
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - He-Yu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Zheng-Yu Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Peng-Fei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Zheng-Han Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Wen-Hu Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China.
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong An Road, Xicheng District, Beijing, 100050, China.
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12
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Sheng L, Zhao P, Ma H, Qi L, Yi Z, Shi Y, Zhong J, Shi H, Dai Z, Pan P. Grey matter alterations in restless legs syndrome: A coordinate-based meta-analysis. J Sleep Res 2021; 30:e13298. [PMID: 33554365 DOI: 10.1111/jsr.13298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/18/2023]
Abstract
Brain structural abnormalities in idiopathic restless legs syndrome have long been debated. Voxel-based morphometry is an objective structural magnetic resonance imaging technique to investigate regional grey matter volume or density differences between groups. In the last decade, voxel-based morphometry studies have exhibited inconsistent and conflicting findings regarding the presence and localization of brain grey matter alterations in restless legs syndrome. We therefore conducted a coordinate-based meta-analysis to quantitatively examine whether there were consistent grey matter findings in restless legs syndrome using the latest algorithms, seed-based d mapping with permutation of subject images. We included 12 voxel-based morphometry studies (13 datasets, 375 patients and 385 healthy controls). Our coordinate-based meta-analysis did not identify evidence of consistent grey matter alterations in restless legs syndrome. Grey matter alterations via voxel-based morphometry analysis are not therefore recommended to be used as a reliable surrogate neuroimaging marker for restless legs syndrome. This lack of consistency may be attributed to differences in sample size, genetics, gender distribution and age at onset, clinical heterogeneity (clinical course, anatomical distribution of symptoms, disease severity, disease duration, abnormal sensory profiles and comorbidity), and variations in imaging acquisition, data processing and statistical strategies. Longitudinal studies with multimodal neuroimaging techniques are needed to determine whether structural changes are dynamic and secondary to functional abnormalities.
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Affiliation(s)
- LiQin Sheng
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - PanWen Zhao
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - HaiRong Ma
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Liang Qi
- Second People's Hospital of Huai'an City, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - ZhongQuan Yi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - YuanYuan Shi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - HaiCun Shi
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - ZhenYu Dai
- Department of Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China.,Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
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13
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Anguelova GV, Vlak MHM, Kurvers AGY, Rijsman RM. Pharmacologic and Nonpharmacologic Treatment of Restless Legs Syndrome. Sleep Med Clin 2020; 15:277-288. [PMID: 32386701 DOI: 10.1016/j.jsmc.2020.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article provides an updated practical guide for the treatment of primary restless legs syndrome (RLS). Articles that appeared after the American Academy of Neurology guideline search were reviewed according to the same evidence rating schedule. We found limited evidence for nonpharmacologic treatment options. In moderate to severe primary RLS, pharmacologic options may be considered, including iron suppletion, an α2δ ligand, a dopamine agonist, a combination of an α2δ ligand and a dopamine agonist, or oxycodone/naloxone. This article includes treatment options in case of augmentation.
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Affiliation(s)
- Galia V Anguelova
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands
| | - Monique H M Vlak
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands
| | - Arthur G Y Kurvers
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands
| | - Roselyne M Rijsman
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands.
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14
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Altered cortical gray matter volume and functional connectivity after transcutaneous spinal cord direct current stimulation in idiopathic restless legs syndrome. Sleep Med 2020; 74:254-261. [DOI: 10.1016/j.sleep.2020.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 01/18/2023]
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15
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Zeng M, Wang L, Cheng B, Qi G, He J, Xu Z, Han T, Liu C, Wang Y. Transcutaneous Spinal Cord Direct-Current Stimulation Modulates Functional Activity and Integration in Idiopathic Restless Legs Syndrome. Front Neurosci 2020; 14:873. [PMID: 32982669 PMCID: PMC7475652 DOI: 10.3389/fnins.2020.00873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
Idiopathic restless legs syndrome (RLS) is a sensorimotor disorder and is suggested to be caused by central nervous system abnormalities. Non-invasive transcutaneous spinal direct-current stimulation (tsDCS) was recently used for RLS therapy. However, the neurophysiological basis of tsDCS treatment is still unknown. In this study, we explored the neural basis of tsDCS in 15 RLS patients and 20 gender- and age-matched healthy controls using resting-state functional magnetic resonance imaging. We calculated the whole-brain voxel-wise fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), and weighted degree centrality (DC) to characterize the intrinsic functional activities and the local and global functional integration. We found that tsDCS can effectively improve the sleep and RLS symptoms in RLS patients. Moreover, after tsDCS therapy, the RLS patients showed decreased fALFF in the right anterior insula/temporal pole, decreased ReHo in the supplementary motor area, increased weighted DC in the left primary visual cortex, and decreased weighted DC in the right posterior cerebellum. The changed patterns were consistent with that found between RLS patients and healthy controls. The weighted DC in the left primary visual cortex after treatment and the fALFF in the right anterior insula/temporal pole before treatment were significantly and marginally correlated with sleep and RLS symptom scores, respectively. These results revealed that tsDCS can normalize the functional patterns of RLS patients and is an effective way for RLS therapy. Our findings provide the neurophysiological basis for tsDCS treatment and may facilitate understanding the neuropathology of RLS and directing other neuromodulation treatments.
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Affiliation(s)
- Min Zeng
- Department of Radiology, Pidu District People's Hospital, Chengdu, China
| | - Li Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Bochao Cheng
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Guiqiang Qi
- Department of Radiology, Pidu District People's Hospital, Chengdu, China
| | - Junwei He
- Department of Radiology, Pidu District People's Hospital, Chengdu, China
| | - Zhexue Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Tao Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Chunyan Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
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16
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Patterns of Gray Matter Volume Alterations in Hemodialysis Patients With and Without Restless Legs Syndrome: Evidence From a Voxel-Based Morphometry Study. J Comput Assist Tomogr 2020; 44:533-539. [PMID: 32697523 DOI: 10.1097/rct.0000000000001034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of this study was to investigate the differences of gray matter volume (GMV) alteration patterns between hemodialysis with restless legs syndrome (HD-RLS) and hemodialysis without restless legs syndrome (HD-nRLS) patients using voxel-based morphometry. METHODS Twenty-three HD-RLS patients, 27 HD-nRLS patients, and 27 age-, sex-, and education-matched healthy controls were included in this study. One-way analysis of covariance and post hoc analyses were used to assess differences in GMV, demographics, and clinical data among the 3 groups. Pearson correlation analysis was conducted between altered GMV in the HD-RLS group and clinical data. RESULTS Compared with HD-nRLS patients, HD-RLS patients showed decreased GMV in the left primary motor cortex (false discovery rate corrected, P < 0.05). Compared with the healthy controls, both HD subgroups (ie, those with and without RLS) exhibited consistent GMV changes, including decreased GMV in the bilateral anterior cingulate and paracingulate gyrus and left middle temporal gyrus (false discovery rate corrected, P < 0.05). The GMV values in the left precentral gyrus were negatively correlated with the RLS rating scores (r = 0.2138, P = 0.0263). CONCLUSIONS This abnormal decreased GMV in the sensorimotor cortex provides evidence for a sensory processing disorder in RLS that may be involved in the pathogenesis of RLS in HD patients.
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17
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Ma M, Zhang H, Liu R, Liu H, Yang X, Yin X, Chen S, Wu X. Static and Dynamic Changes of Amplitude of Low-Frequency Fluctuations in Cervical Discogenic Pain. Front Neurosci 2020; 14:733. [PMID: 32760245 PMCID: PMC7372087 DOI: 10.3389/fnins.2020.00733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023] Open
Abstract
Cervical discogenic pain (CDP) is a clinically common pain syndrome caused by cervical disk degeneration. A large number of studies have reported that CDP results in brain functional impairments. However, the detailed dynamic brain functional abnormalities in CDP are still unclear. In this study, using resting-state functional magnetic resonance imaging, we explored the neural basis of CDP with 40 CDP patients and 40 age-, gender-matched healthy controls to delineate the changes of the voxel-level static and dynamic amplitude of low frequency fluctuations (ALFF). We found increased static ALFF in left insula (INS) and posterior precuneus (PCu), and decreased static ALFF in left precentral/postcentral gyrus (PreCG/PoCG), thalamus (THA), and subgenual anterior cingulate cortex in CPD patients compared to healthy controls. We also found decreased dynamic ALFF in left PreCG/PoCG, right posterior middle temporal gyrus, and bilateral THA. Moreover, we found that static ALFF in left PreCG/PoCG and dynamic ALFF in THA were significantly negatively correlated with visual analog scale and disease duration, respectively. Our findings provide the neurophysiological basis for CDP and facilitate understanding the neuropathology of CDP.
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Affiliation(s)
- Mingyue Ma
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Zhang
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Run Liu
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hongsheng Liu
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiangchun Yang
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaohui Yin
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Song Chen
- Department of Radiology, The Affiliated Xi'an XD Group Hospital of Shanxi University of Traditional Chinese Medicine, Xi'an, China
| | - Xiaoping Wu
- Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China
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18
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Nardone R, Sebastianelli L, Versace V, Brigo F, Golaszewski S, Pucks-Faes E, Saltuari L, Trinka E. Contribution of transcranial magnetic stimulation in restless legs syndrome: pathophysiological insights and therapeutical approaches. Sleep Med 2020; 71:124-134. [PMID: 32088150 DOI: 10.1016/j.sleep.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 01/06/2023]
Abstract
Transcranial magnetic stimulation (TMS) may offer a reliable means to characterize significant pathophysiologic and neurochemical aspects of restless legs syndrome (RLS). Namely, TMS has revealed specific patterns of changes in cortical excitability and plasticity, in particular dysfunctional inhibitory mechanisms and sensorimotor integration, which are thought to be part of the pathophysiological mechanisms of RLS rather than reflect a non-specific consequence of sleep architecture alteration. If delivered repetitively, TMS is able to transiently modulate the neural activity of the stimulated and connected areas. Some studies have begun to therapeutically use repetitive TMS (rTMS) to improve sensory and motor disturbances in RLS. High-frequency rTMS applied over the primary motor cortex or the supplementary motor cortex, as well as low-frequency rTMS over the primary somatosensory cortex, seem to have transient beneficial effects. However, further studies with larger patient samples, repeated sessions, an optimized rTMS setup, and clinical follow-up are needed in order to corroborate preliminary results. Thus, we performed a systematic search of all the studies that have used TMS and rTMS techniques in patients with RLS.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Francesco Brigo
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Stefan Golaszewski
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | | | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
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19
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95125, Catania, Italy; Department of Neurology IC, Oasi Research Institute - IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy.
| | - Anna Scalise
- Clinical Neurology Unit, Department of Neurosciences, University Hospital of Udine, P.le Santa Maria della Misericordia, 15, 33100, Udine, Italy.
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20
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Effects of repetitive transcranial magnetic stimulation in subjects with sleep disorders. Sleep Med 2020; 71:113-121. [DOI: 10.1016/j.sleep.2020.01.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/06/2020] [Accepted: 01/31/2020] [Indexed: 01/08/2023]
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21
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de Paiva JPQ, Magalhães SC, Moura LM, Sato JR, Amaro E, Sterr A, Schlaffke L, Eckeli AL, do Prado GF, Conforto AB. Sensorimotor white matter projections and disease severity in primary Restless Legs Syndrome/Willis-Ekbom disease: a multimodal DTI analysis. Sleep Med 2020; 73:106-116. [PMID: 32805477 DOI: 10.1016/j.sleep.2020.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Restless Legs Syndrome, a potentially disabling sleep disorder, also known as Willis-Ekbom disease (RLS/WED), may be caused by loss of inhibitory modulation of descending central motor pathways, structural changes in the somatosensory cortex, abnormal connectivity between motor and sensory areas, as well as by subtle abnormalities in white matter micro-organization. OBJECTIVE To compare diffusion-tensor imaging (DTI) metrics in areas associated with sensory or motor function, as well as sensorimotor integration, between subjects with primary mild-to-severe RLS/WED and controls. METHODS DTI metrics were assessed in 38 subjects with RLS/WED (14 mild to moderate, 24 severe to very severe) and 24 healthy age-matched controls with whole-brain Tract Based Spatial Statistics (TBSS), Region-of-interest (ROI) and probabilistic tractography based analyses. The ROIs corresponded to the corticospinal tract (CST) at the level of the cerebral peduncle; the superior, middle and inferior cerebellar peduncles. Subgroup analyses were made according to the severity of RLS/WED symptoms. The corticospinal tract was evaluated with probabilistic tractography. We also explored associations between significant findings and severity of symptoms with the Spearman's correlation coefficient. RESULTS TBSS analysis revealed decreased axial diffusivity (AD) in the left posterior thalamic radiation in RLS/WED. In subjects with severe RLS/WED, AD was reduced in the left posterior corona radiata and this reduction was negatively correlated with severity of symptoms. ROI-based analysis showed that radial diffusivity (RD) was increased in the superior cerebellar peduncles of individuals with severe RLS/WED. Tractography did not show between-group or subgroup differences. CONCLUSIONS Our results are consistent with subtle white matter changes, prominently in RLS/WED subjects with more severe symptoms, in areas related to sensory or motor function, as well as to sensorimotor integration, compared to controls. These findings support the hypothesis, raised by prior pathophysiological studies, of defective integration within these networks.
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Affiliation(s)
- Joselisa Péres Queiroz de Paiva
- Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Imaging Research Center, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil.
| | - Samir Câmara Magalhães
- Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Universidade de Fortaleza (UNIFOR), Unifor, Fortaleza, CE, Brazil
| | - Luciana Monteiro Moura
- Imaging Research Center, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - João Ricardo Sato
- Center for Mathematics, Computing and Cognition, Universidade Federal do ABC (UFABC), São Bernardo do Campo, SP, Brazil
| | - Edson Amaro
- Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Imaging Research Center, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Annette Sterr
- School of Psychology, University of Surrey, Guildford, UK
| | - Lara Schlaffke
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Alan Luiz Eckeli
- Department of Neurosciences and Behavioral Sciences, Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Adriana Bastos Conforto
- Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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22
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Aldemir A, Yucel K, Güven H, Kamaşak B, Dilli A, Acer N, Çomoğlu S. Structural neuroimaging findings in migraine patients with restless legs syndrome. Neuroradiology 2020; 62:1301-1313. [PMID: 32488307 DOI: 10.1007/s00234-020-02451-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/28/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE One out of three migraine patients might have accompanying restless legs syndrome (RLS). In our study, we aimed to compare the volumes of the brain structures of migraineurs with and without RLS. METHODS We had 37 female patients with migraine and 17 females as the control group. Nineteen migraineurs had no RLS (RLS0) and 18 migraineurs had comorbidity of RLS (RLS1). The volumes of the brain structures were obtained by manual measurements, volBrain, and voxel-based morphometry (VBM). Manually, we measured caudate and putamen volumes. We used age, years of education, depression, anxiety scores, and total intracranial volume as covariates. RESULTS According to VBM analyses, the volumes of the left superior occipital gyrus and precuneus were increased, and the substantia nigra and cuneus were decreased in the RLS1 group compared with the RLS0 group. RLS1 patients had larger superior temporal gyrus, Brodmann area 38, and left insula, and RLS0 patients had larger Brodmann area 22, right superior temporal gyrus, and Heschl gyrus compared with controls. Migraine and RLS0 patients had a smaller corpus callosum anteriorly, whereas RLS1 patients had a smaller splenium. Caudate volumes were larger in migraine patients via the three techniques. There was a positive relation between the caudate and putamen volumes and attack frequency. CONCLUSIONS Comorbidity of RLS might be a confounding factor in structural neuroimaging studies in migraine. Deficits in the visual network seem to be related to accompanying RLS; deficits in the auditory network are particularly related to migraine.
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Affiliation(s)
- Arzu Aldemir
- Department of Neurology, Acıbadem Hospital, Eskişehir, Turkey
| | - Kaan Yucel
- Department of Anatomy, Aksaray University Medical School, Aksaray, Turkey.
| | - Hayat Güven
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Burcu Kamaşak
- Department of Anatomy, Ahi Evran University Medical School, Kırşehir, Turkey
| | - Alper Dilli
- Department of Radiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Niyazi Acer
- Department of Anatomy, Erciyes University Medical School, Kayseri, Turkey
| | - Selçuk Çomoğlu
- Department of Neurology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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23
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Wang J, Deng XP, Wu YY, Li XL, Feng ZJ, Wang HX, Jing Y, Zhao N, Zang YF, Zhang J. High-Frequency rTMS of the Motor Cortex Modulates Cerebellar and Widespread Activity as Revealed by SVM. Front Neurosci 2020; 14:186. [PMID: 32265624 PMCID: PMC7096733 DOI: 10.3389/fnins.2020.00186] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/20/2020] [Indexed: 11/15/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) studies have shown that the effect of repetitive transcranial magnetic stimulation (rTMS) can induce changes in remote brain regions. In the stimulated regions, low-frequency (≤1 Hz) rTMS induces inhibitory effects, while high-frequency (≥5 Hz) stimulation induces excitatory effects. However, these stereotypical effects arising from low- and high-frequency stimulation are based on measurements of motor evoked potentials (MEPs) induced by pulsed stimulation. To test the effects of rTMS on remote brain regions, the current study recruited 31 young healthy adults who participated in three rTMS sessions (10 Hz high frequency, 1 Hz low frequency, and sham) on three separate days. The stimulation target was based on individual fMRI activation in the motor cortex evoked by a finger movement task. Pre- and post-rTMS resting-state fMRI (RS-fMRI) were acquired. Regional homogeneity (ReHo) and degree centrality (DC) were calculated to measure the local and global connectivity, respectively. Compared with the sham session, high-frequency (10 Hz) rTMS significantly increased ReHo and DC in the right cerebellum, while low-frequency (1 Hz) stimulation did not significantly alter ReHo or DC. Then, using a newly developed PAIR support vector machine (SVM) method, we achieved accuracy of 93.18–97.24% by split-half validation for pairwise comparisons between conditions for ReHo or DC. While the univariate analyses suggest that high-frequency rTMS of the left motor cortex could affect distant brain activity in the right cerebellum, the multivariate SVM results suggest that both high- and low-frequency rTMS significantly modulated widespread brain activity. The current findings are useful for increasing the understanding of the mechanisms of rTMS, as well as guiding precise individualized rTMS treatment of movement disorders.
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Affiliation(s)
- Jue Wang
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Xin-Ping Deng
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yun-Ying Wu
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xiao-Long Li
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zi-Jian Feng
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Hong-Xiao Wang
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Ying Jing
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Na Zhao
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yu-Feng Zang
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China.,Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.,Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jian Zhang
- School of Psychology, Shanghai University of Sport, Shanghai, China
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Brain regions associated with periodic leg movements during sleep in restless legs syndrome. Sci Rep 2020; 10:1615. [PMID: 32005856 PMCID: PMC6994717 DOI: 10.1038/s41598-020-58365-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
The neural substrates related to periodic leg movements during sleep (PLMS) remain uncertain, and the specific brain regions involved in PLMS have not been evaluated. We investigated the brain regions associated with PLMS and their severity using the electroencephalographic (EEG) source localization method. Polysomnographic data, including electromyographic, electrocardiographic, and 19-channel EEG signals, of 15 patients with restless legs syndrome were analyzed. We first identified the source locations of delta-band (2–4 Hz) spectral power prior to the onset of PLMS using a standardized low-resolution brain electromagnetic tomography method. Next, correlation analysis was conducted between current densities and PLMS index. Delta power initially and most prominently increased before leg movement (LM) onset in the PLMS series. Sources of delta power at −4~−3 seconds were located in the right pericentral, bilateral dorsolateral prefrontal, and cingulate regions. PLMS index was correlated with current densities at the right inferior parietal, temporoparietal junction, and middle frontal regions. In conclusion, our results suggest that the brain regions activated before periodic LM onset or associated with their severity are the large-scale motor network and provide insight into the cortical contribution of PLMS pathomechanism.
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25
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Wang H, Han X, Jin M, Wang LY, Diao ZL, Guo W, Zhang P, Wang Z, Ding HY, Lv H, Zhang ZY, Zhao PF, Li J, Yang ZH, Liu WH, Wang ZC. Different iron deposition patterns in hemodialysis patients with and without restless legs syndrome: a quantitative susceptibility mapping study. Sleep Med 2020; 69:34-40. [PMID: 32045852 DOI: 10.1016/j.sleep.2019.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/13/2019] [Accepted: 12/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Brain iron deposition in hemodialysis (HD) patients increases over time. Iron deficiency in gray matter nuclei has been reported to lead to idiopathic restless legs syndrome (RLS) symptoms. Regardless of unpleasant RLS sensations, the patterns of iron deposition between hemodialysis patients with RLS (HD-RLS) and hemodialysis patients without RLS (HD-nRLS) are still unclear. To evaluate the differences in iron deposition patterns between HD-RLS and HD-nRLS patients, we utilized quantitative susceptibility mapping (QSM). METHODS In sum, 24 HD-RLS patients, 25 HD-nRLS patients and 30 age- and sex-matched healthy controls (HCs) were enrolled. The QSM was used to assess susceptibility values of the regions of interest (ROIs), including the caudate nucleus (CN), putamen (PUT), globus pallidus (GP), thalamus (THA), substantia nigra (SN), red nucleus (RN) and dentate nucleus (DN). RESULTS HD duration was significantly longer in HD-RLS patients than in HD-nRLS patients (P < 0.05). The susceptibility of HD-RLS and HD-nRLS patients in PUT was higher than that in HCs (P < 0.05), illustrating elevated iron content in the nucleus. Compared with HD-nRLS patients, HD-RLS patients demonstrated reduced susceptibility in CN and PUT (both P < 0.05). Compared with HCs, HD-RLS patients displayed decreased susceptibility in DN (P < 0.05). CONCLUSIONS Different iron deposition patterns between HD-RLS and HD-nRLS patients in PUT and DN, which further support disturbed sensory processing in RLS, may be involved in RLS pathogenesis in HD patients.
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Affiliation(s)
- Hao Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xue Han
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mei Jin
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li-Yan Wang
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zong-Li Diao
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Guo
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - He-Yu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng-Yu Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng-Fei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zheng-Han Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wen-Hu Liu
- Department of Nephrology, Faculty of Kidney Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Zhen-Chang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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26
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High-Frequency Repetitive Transcranial Magnetic Stimulation Could Improve Impaired Working Memory Induced by Sleep Deprivation. Neural Plast 2019; 2019:7030286. [PMID: 31915432 PMCID: PMC6930796 DOI: 10.1155/2019/7030286] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/11/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To investigate whether and how the working memory impairment induced by sleep deprivation (SD) could be recovered by using repetitive transcranial magnetic stimulation (rTMS), as well as to clarify the corresponding brain activity changes. Methods Seventeen healthy adults received one session of 5.0 Hz rTMS over the left dorsolateral prefrontal cortex (DLPFC) following 24 hours of SD. Resting state functional magnetic resonance imaging (fMRI) and working memory test were performed during a rested waking period, after SD and rTMS. The amplitude of low-frequency fluctuations (ALFF) was used to detect the spontaneous neural activity changes after both SD and rTMS. The relationship between ALFF and the performance of working memory was also assessed by using correlation analysis. Results After SD, the participants exhibited lower response accuracies and longer reaction times on the working memory tests of letters and numbers. The decreased response accuracy of numbers was significantly improved after rTMS similarly to the state of the rested waking period after a normal night of sleep. ALFF values decreased from the rested waking period state to the state of SD in the brain regions involving the frontal gyrus, precuneus, angular gyrus, and parietal lobe which showed significantly increased ALFF after rTMS. Furthermore, significantly positive correlations were observed between changes of response accuracy and the changes of ALFF value of the inferior frontal gyrus and supramarginal gyrus. Conclusion These results indicate that high-frequency rTMS applied over left DLPFC may contribute to the recovery of the impaired working memory after SD by modulating the neural activity of related brain regions.
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27
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Resting-state connectivity and the effects of treatment in restless legs syndrome. Sleep Med 2019; 67:33-38. [PMID: 31887606 DOI: 10.1016/j.sleep.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/05/2019] [Accepted: 10/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Resting-state brain connectivity has been shown to differ for Restless Legs Syndrome (RLS) compared to healthy control (CON) groups. This study evaluates the degree these RLS-CON differences are changed by concurrent treatment. METHODS Resting-state functional MRIs were obtained from 32 idiopathic RLS patients during the morning asymptomatic period and 16 age and gender-matched CON subjects. Of the 32 RLS patients, 16 were drug-naïve (DN-RLS), and 16 were regularly drug-treated using a dopamine agonist (DT-RLS). Various assessments of disease characteristics were also performed. The primary purpose was to assess the replicability of prior results and the effects of treatment on these differences between controls and untreated RLS patients. Resting-state connectivity was analyzed by a seed-based method using the bilateral ventral-posterolateral nuclei (VPLN) in the thalamus. RESULTS In the DN-RLS group, compared to the CON group, three areas (the bilateral lingual gyri and right middle temporal gyrus) were replicated. The three replicated areas did not significantly differ for DT-RLS compared to DN-RLS. DT-RLS compared to DN-RLS had significantly higher thalamic connectivity for the left uvula, right tuber, left anterior insula, and right declive. CONCLUSIONS Thalamic connectivity to the bilateral lingual gyri and right middle temporal gyrus is a replicable finding in DN-RLS that was not affected by dopamine agonist treatments. Other changes in thalamic connectivity were altered by dopamine agonist treatment. These treatment effects may be pertinent to the known treatment benefits of a dopamine agonist on RLS symptoms.
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28
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Li Z, Chen J, Lin Y, Zhou M, Cai Q, Li X, Wu Z, Chen X, Yang X, Zhu X, Lu J, Zhang L, Liu B, Luo X, Xu P. Reduced regional activity and functional connectivity within sensorimotor network in Parkinson's patients with restless legs syndrome. Mol Pain 2019; 15:1744806919882272. [PMID: 31554460 DOI: 10.1177/1744806919882272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Zhe Li
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuwan Lin
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Miaomiao Zhou
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiaodi Cai
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinchun Li
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhuohua Wu
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinjie Chen
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinling Yang
- Department of Neurology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoqin Zhu
- Department of Physiology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Jianjun Lu
- Department of Neurosurgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Li Zhang
- Department of Geriatrics, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaodong Luo
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pingyi Xu
- Department of Neurology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Physiology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
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29
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Adil SM, Han JL, Parente BA, Hickey P, Lad SP. Spinal Cord Stimulation for Restless Legs Syndrome: Case Series and Mechanistic Hypothesis. Stereotact Funct Neurosurg 2019; 97:31-36. [PMID: 30947223 DOI: 10.1159/000494737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/07/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal cord stimulation (SCS) is a well-established therapy for chronic pain syndromes, with growing applicability to other conditions. Restless legs syndrome (RLS) is a widespread, chronic movement disorder managed primarily and incompletely by medication, and its etiology can be classified as idiopathic or secondary. METHODS Three patients underwent SCS implantation for chronic back and/or leg pain with concomitant targeting of RLS: (1) a 34-year-old man with sporadic RLS symptoms that strongly intensified after military-related spinal fractures, (2) a 54-year-old man with RLS likely secondary to meralgia paresthetica, and (3) a 42-year-old man with low back and right lower extremity pain after a military motor vehicle accident. RESULTS Continuing through 40-month, 2-month, and 28-month follow-ups, respectively, the patients experienced exemplary relief of their RLS symptoms. Notably in the case of patient 1, this benefit appears separate from his pain relief, as during the 5-month period directly after surgery but before adjusted targeting, he only experienced pain alleviation. CONCLUSIONS To our knowledge, this is the first reported case of using SCS as a potentially long-lasting, safe, and highly effective therapy for RLS of mixed etiology. Additionally, 2 patients with RLS possibly secondary to chronic pain also benefited from the therapy. This success may be due to increased inhibition from hypothalamic cells controlling dopaminergic input to the spine.
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Affiliation(s)
- Syed M Adil
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jing L Han
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Beth A Parente
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Patrick Hickey
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shivanand P Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA,
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30
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Liu X, Meng F, Gao J, Zhang L, Zhou Z, Pan G, Luo B. Behavioral and Resting State Functional Connectivity Effects of High Frequency rTMS on Disorders of Consciousness: A Sham-Controlled Study. Front Neurol 2018; 9:982. [PMID: 30519211 PMCID: PMC6258881 DOI: 10.3389/fneur.2018.00982] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/31/2018] [Indexed: 12/20/2022] Open
Abstract
Objectives: A combined approach of behavioral characteristics and network properties was applied to explore the effect of repetitive transcranial magnetic stimulation (rTMS) on disorders of consciousness (DOC) and to observe changes in brain network connections before and after the stimulation. Methods: A total of 7 DOC patients and 11 healthy controls were enrolled. The study was designed as a randomized, sham-controlled study. All DOC patients were given 20 Hz rTMS real and sham stimuli to the left M1 region, with each stimulus lasting for 5 consecutive working days and the interval between two stimuli being 1 week. Coma Recovery Scale-Revised (CRS-R) and resting state functional MRI data before and after stimuli were collected. The functional connection (FC) of the default mode network and the frontoparietal network were chosen as the central target to compare differences in network connections between the DOC group and the normal control group. For DOC patients, changes in behavior and brain function before and after real and sham stimuli were also assessed as a group and individually. Results: (1). The overall analyses showed no significant changes of CRS-R scores or brain FC following real or sham rTMS stimuli in the DOC patients. However, real rTMS stimuli tended to enhance the FC of nodes in left lateral parietal cortex (LPC), left inferior temporal cortex (ITC) and right dorsolateral prefrontal cortex (DLPFC). (2). The individual analyses showed one minimally conscious state (MCS) patient presented with a obviously increased CRS-R score following real rTMS stimuli, and a visibly enhanced connectivity was observed in the nodes of left LPC, left ITC and right DLPFC of this patient. Conclusion: Our findings did not provide sufficient evidence of therapeutic effect of 20 Hz rTMS over the left M1 in DOC. However, MCS patients shortly after brain injury may possibly benefit from rTMS. Reconstruction of the left LPC, the left ITC and the right DLPFC may be the brain networking foundation of improvements in consciousness from rTMS.
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Affiliation(s)
- Xiaoyan Liu
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fanxia Meng
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, China
| | - Li Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Zhen Zhou
- Department of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Gang Pan
- Department of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Benyan Luo
- Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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31
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Anguelova GV, Vlak MHM, Kurvers AGY, Rijsman RM. Pharmacologic and Nonpharmacologic Treatment of Restless Legs Syndrome. Sleep Med Clin 2018; 13:219-230. [PMID: 29759272 DOI: 10.1016/j.jsmc.2018.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This article provides an updated practical guide for the treatment of primary restless legs syndrome (RLS). Articles that appeared after the American Academy of Neurology guideline search were reviewed according to the same evidence rating schedule. We found limited evidence for nonpharmacologic treatment options. In moderate to severe primary RLS, pharmacologic options may be considered, including iron suppletion, an α2δ ligand, a dopamine agonist, a combination of an α2δ ligand and a dopamine agonist, or oxycodone/naloxone. This article includes treatment options in case of augmentation.
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Affiliation(s)
- Galia V Anguelova
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands
| | - Monique H M Vlak
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands
| | - Arthur G Y Kurvers
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands
| | - Roselyne M Rijsman
- Center for Sleep and Wake Disorders, Haaglanden Medical Center, The Hague, The Netherlands.
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32
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Ferini-Strambi L, Carli G, Casoni F, Galbiati A. Restless Legs Syndrome and Parkinson Disease: A Causal Relationship Between the Two Disorders? Front Neurol 2018; 9:551. [PMID: 30087647 PMCID: PMC6066514 DOI: 10.3389/fneur.2018.00551] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/19/2018] [Indexed: 11/13/2022] Open
Abstract
Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is a common sleep related movement disorder that can be idiopathic or occurs in comorbidity with other medical conditions such as polyneuropathy, iron deficiency anemia, multiple sclerosis, hypertension and cardiovascular diseases. In recent years, a growing body of literature investigated the association between RLS/WED and Parkinson's Disease (PD). Several questions regarding the comorbidity between these two disorders are still unanswered. If the insurgence of RLS/WED may precede the onset of PD, or if RLS/WED could represent a secondary condition of PD and if impaired dopaminergic pathway may represent a bridge between these two conditions are still debatable issues. In this review, we critically discuss the relationship between RLS/WED and PD by reviewing cross sectional and longitudinal studies, as well as the role of dopamine in these disorders. A twofold interpretation have to be taken into account: dopaminergic therapy may have a crucial role in the development of RLS/WED in PD patients or RLS/WED can be conceived as an early manifestation of PD rather than a risk factor. Several studies showed a high prevalence of RLS/WED in PD patients and several findings related to dopaminergic and iron alterations in both disorders, however up to now it is difficult to find a point of agreement between studies. A greater number of systematic and strongly controlled longitudinal studies as well as basic pathophysiological investigations particularly in RLS/WED are needed to clarify this complex relationship.
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Affiliation(s)
- Luigi Ferini-Strambi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy.,Università Vita-Salute San Raffaele, Milan, Italy
| | - Giulia Carli
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy
| | - Francesca Casoni
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy
| | - Andrea Galbiati
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Center, Milan, Italy.,Università Vita-Salute San Raffaele, Milan, Italy
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33
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Lin Y, Wang Y, Zhan S, Ding Y, Hou Y, Wang L, Wang Y. Impaired Sensorimotor Integration in Restless Legs Syndrome. Front Neurol 2018; 9:568. [PMID: 30050496 PMCID: PMC6050383 DOI: 10.3389/fneur.2018.00568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/25/2018] [Indexed: 01/18/2023] Open
Abstract
Objective: Restless legs syndrome (RLS) is a complicated sensorimotor syndrome that may be linked to changes in sensorimotor integration. The mechanism of such changes is unclear. The aim of this study was to investigate sensorimotor integration in patients with RLS through transcranial magnetic stimulation-motor evoked potentials (TMS-MEPs) preceded by peripheral electric stimulation. Methods: Fourteen RLS patients and 12 healthy, age-matched controls were investigated. The clinical severity of RLS was evaluated based on the International Criteria of the International Restless Legs Syndrome Study Group (IRLSSG) severity scores. The tibial and median H-reflexes and the resting motor threshold (RMT) of the abductor pollicis brevis (APB) were tested in all 26 subjects. The RMT of the tibialis anterior (TA) was tested in 8 patients and 7 controls. All 26 subjects underwent measurement of unconditioned MEPs of the APB. Electric pulses were applied to the right median nerve, followed by TMS pulses over the left motor cortex at interstimulus intervals (ISIs) of 20, 25, 30, 50, 100, 150, and 200 ms. Unconditioned MEPs of the TA were measured in 8 patients and 7 controls. Electric pulses were applied to the right peroneal nerve, followed by TMS pulses over the left motor cortex at ISIs of 30, 35, 45, 60, 100, and 200 ms. The degree of modulation of MEPs by electric stimulation was expressed as the ratio of the conditioned MEP amplitude to the unconditioned MEP amplitude. Ratios <1 indicated inhibition, and ratios >1 indicated facilitation. Results: No significant differences in RMT or H-reflex latencies or amplitudes were found between RLS patients and controls. A significant increase in unconditioned MEP amplitudes of the TA was observed in patients compared to controls (p = 0.03). Long-latency afferent inhibition (LAI) of the median nerve in RLS patients was decreased significantly at ISIs of 150 (p = 0.000) and 200 ms (p = 0.004). Upon peroneal nerve stimulation, no significant difference was observed between the two groups at any ISI. Conclusions: Our results suggest increased motor cortical excitability of the legs and disturbed sensorimotor integration in RLS patients; this disturbance might originate at the cortical level.
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Affiliation(s)
- Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yijin Wang
- Department of Neurology, Beijing Renhe Hospital, Beijing, China
| | - Shuqin Zhan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Li Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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34
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Lanza G, Lanuzza B, Aricò D, Cantone M, Cosentino FII, Bella R, Pennisi G, Ferri R, Pennisi M. Impaired short-term plasticity in restless legs syndrome: a pilot rTMS study. Sleep Med 2018; 46:1-4. [PMID: 29773202 DOI: 10.1016/j.sleep.2018.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies showed an impairment of the LTP-like plasticity to TMS in restless legs syndrome (RLS). Clinically, repetitive TMS (rTMS) was effective in alleviating the sensory-motor complaints of patients, although the effects induced by low-frequency (inhibitory) rTMS have not yet been investigated. An impaired LTD-like mechanism of cortical plasticity has been hypothesized, which we have directly assessed in this pilot study. METHODS Motor evoked potentials (MEPs) from the right first dorsal interosseus muscle were recorded at the stimulus intensity of 110% of the resting motor threshold (rMT) from 13 right-handed patients and ten age-matched right-handed healthy controls. Median peak-to-peak amplitudes were calculated in all participants at baseline (T0), after the first train of a single evening session of low-frequency (1 Hz) rTMS over the left primary motor cortex (T1), and after the whole rTMS procedure (T2), which consists of 20 trains with 50 stimuli per train and intertrain interval of 30 s (1000 stimuli in total). RESULTS No differences were found for rMT and MEPs size between the two groups at T0. Smaller MEPs amplitudes at both T1 and T2 were observed in all subjects, although this was significantly more pronounced in controls than in patients. CONCLUSIONS Compared to normal individuals, patients exhibited an impairment of the LTD-like mechanisms induced by inhibitory rTMS, thus adding support to the involvement of GABA in RLS pathophysiology. Although future studies with a larger population are needed, TMS is confirmed to be effective in noninvasive probing of the neurophysiology and neurochemistry of RLS.
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Affiliation(s)
- Giuseppe Lanza
- Oasi Research Institute - IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy.
| | - Bartolo Lanuzza
- Oasi Research Institute - IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy.
| | - Debora Aricò
- Oasi Research Institute - IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy.
| | | | | | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Section of Neurosciences, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Via Santa Sofia, 78, 95125, Catania, Italy.
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, Azienda Ospedaliero Universitaria "Policlinico-Vittorio Emanuele", Via Santa Sofia, 78, 95125, Catania, Italy.
| | - Raffaele Ferri
- Oasi Research Institute - IRCCS, Via Conte Ruggero, 73, 94018, Troina, Italy.
| | - Manuela Pennisi
- Spinal Unit, Azienda Ospedaliera Cannizzaro, Via Messina, 829, 95126, Catania, Italy.
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Lanza G, Cantone M, Aricò D, Lanuzza B, Cosentino FII, Paci D, Papotto M, Pennisi M, Bella R, Pennisi G, Paulus W, Ferri R. Clinical and electrophysiological impact of repetitive low-frequency transcranial magnetic stimulation on the sensory-motor network in patients with restless legs syndrome. Ther Adv Neurol Disord 2018. [PMID: 29511386 DOI: 10.1177/1756285618759973.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Based on the hyperexcitability and disinhibition observed in patients with restless legs syndrome (RLS) following transcranial magnetic stimulation (TMS), we conducted a study with low-frequency repetitive TMS (rTMS) over the primary motor (M1) and somatosensory cortical areas (S1) in patients with RLS. Methods A total of 13 right-handed patients and 10 age-matched controls were studied using clinical scales and TMS. Measurements included resting motor threshold (rMT), motor-evoked potentials (MEPs), cortical silent period (CSP), and central motor conduction time (CMCT). A single evening session of rTMS (1 Hz, 20 trains, 50 stimuli each) was administered over the left M1, left S1, and sham stimulation over M1 in a random order. Clinical and TMS measures were repeated after each stimulation modality. Results Baseline CSP was shorter in patients than in controls and remained shorter in patients for both motor and somatosensory stimulation. The patients reported a subjective improvement of both initiating and maintaining sleep the night after the rTMS over S1. Patients exhibited a decrease in rMT after rTMS of S1 only, although the effect was smaller than in controls. MEP latency and CMCT changed only in controls after stimulation. Sham stimulation was without effect on the observed variables. Conclusions rTMS on S1-M1 connectivity alleviated the sensory-motor complaints of RLS patients. The TMS indexes of excitation and inhibition indicate an intracortical and corticospinal imbalance, mainly involving gamma-aminobutyric acid (GABA)ergic and glutamatergic circuitries, as well as an impairment of the short-term mechanisms of cortical plasticity. The rTMS-induced activation of the dorsal striatum with the consequent increase of dopamine release may have contributed to the clinical and neurophysiological outcome.
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Affiliation(s)
- Giuseppe Lanza
- Oasi Research Institute - IRCCS Via Conte Ruggero, 73 - 94018, Troina, Italy
| | | | | | | | | | | | | | | | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies 'GF Ingrassia', Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg August University Göttingen, Göttingen, Germany
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Liu C, Wang J, Hou Y, Qi Z, Wang L, Zhan S, Wang R, Wang Y. Mapping the changed hubs and corresponding functional connectivity in idiopathic restless legs syndrome. Sleep Med 2018; 45:132-139. [PMID: 29680421 DOI: 10.1016/j.sleep.2017.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/19/2017] [Accepted: 12/30/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The hubs of the brain network play a key role in integrating and transferring information between different functional modules. However, whether the changed pattern in functional network hubs contributes to the onset of leg discomfort symptoms in restless legs syndrome (RLS) patients remains unclear. Using resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory methods, we investigated whether alterations of hubs can be detected in RLS. METHODS First, we constructed the whole-brain voxelwise functional connectivity and calculated a functional connectivity strength (FCS) map in each of 16 drug-naive idiopathic RLS patients and 26 gender- and age-matched healthy control (HC) subjects. Next, a two-sample t test was applied to compare the FCS maps between HC and RLS patients, and to identify significant changes in FCS in RLS patients. To further elucidate the corresponding changes in the functional connectivity patterns of the aberrant hubs in RLS patients, whole-brain resting-state functional connectivity analyses for the hub areas were performed. RESULTS The hub analysis revealed decreased FCS in the cuneus, fusiform gyrus, paracentral lobe, and precuneus, and increased FCS in the superior frontal gyrus and thalamus in idiopathic drug-naive RLS patients. Subsequent functional connectivity analyses revealed decreased functional connectivity in sensorimotor and visual processing networks and increased functional connectivity in the affective cognitive network and cerebellar-thalamic circuit. Furthermore, the mean FCS value in the superior frontal gyrus was significantly correlated with Hamilton Anxiety Rating Scale scores in RLS patients, and the mean FCS value in the fusiform gyrus was significantly correlated with Hamilton Depression Rating Scale scores. CONCLUSIONS These findings may provide novel insight into the pathophysiology of RLS.
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Affiliation(s)
- Chunyan Liu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Jiaojian Wang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Yue Hou
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Zhigang Qi
- Department of Radiology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Shuqin Zhan
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Rong Wang
- Central Laboratory, Xuan Wu Hospital, Capital Medical University, Beijing Institute for Brain Disorders, Center of Alzheimer's Disease, Beijing, China; Beijing Geriatric Medical Research Center, Key Laboratory for Neurodegenerative Disease of Ministry of Education, Beijing, China.
| | - Yuping Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neuromodulation, Beijing, China.
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Yang FC, Chou KH, Hsu AL, Fuh JL, Lirng JF, Kao HW, Lin CP, Wang SJ. Altered Brain Functional Connectome in Migraine with and without Restless Legs Syndrome: A Resting-State Functional MRI Study. Front Neurol 2018; 9:25. [PMID: 29441041 PMCID: PMC5797592 DOI: 10.3389/fneur.2018.00025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/12/2018] [Indexed: 01/03/2023] Open
Abstract
Background Migraine is frequently comorbid with restless legs syndrome (RLS), both displaying functional connectivity (FC) alterations in multiple brain networks, although the neurological basis of this association is unknown. Methods We performed resting-state functional magnetic resonance imaging and network-wise analysis of FC in migraine patients with and without RLS and healthy controls (CRL). Network-based statistics (NBS) and composite FC matrix analyses were performed to identify the patterns of FC changes. Correlation analyses were performed to identify associations between alterations in FC and clinical profiles. Results NBS results revealed that both migraine patients with and without RLS exhibited lower FC than CRL in the dorsal attention, salience, default mode, cingulo-opercular, visual, frontoparietal, auditory, and sensory/somatomotor networks. Further composite FC matrix analyses revealed differences in FC of the salience, default mode to subcortical and frontoparietal, auditory to salience, and memory retrieval networks between migraine patients with and without RLS. There was a trend toward a negative association between RLS severity and cross-network abnormalities in the default mode to subcortical network. Discussion Migraine patients with and without RLS exhibit disruptions of brain FC. Such findings suggest that these disorders are associated with differential neuropathological mechanisms and may aid in the future development of neuroimaging-driven biomarkers for these conditions.
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Affiliation(s)
- Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Hsien Chou
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ai-Ling Hsu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hung-Wen Kao
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Po Lin
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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38
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Rizzo G, Plazzi G. Neuroimaging Applications in Restless Legs Syndrome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 143:31-64. [DOI: 10.1016/bs.irn.2018.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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39
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Lanza G, Cantone M, Aricò D, Lanuzza B, Cosentino FII, Paci D, Papotto M, Pennisi M, Bella R, Pennisi G, Paulus W, Ferri R. Clinical and electrophysiological impact of repetitive low-frequency transcranial magnetic stimulation on the sensory-motor network in patients with restless legs syndrome. Ther Adv Neurol Disord 2018; 11:1756286418759973. [PMID: 29511386 PMCID: PMC5833163 DOI: 10.1177/1756286418759973] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/22/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Based on the hyperexcitability and disinhibition observed in patients with restless legs syndrome (RLS) following transcranial magnetic stimulation (TMS), we conducted a study with low-frequency repetitive TMS (rTMS) over the primary motor (M1) and somatosensory cortical areas (S1) in patients with RLS. METHODS A total of 13 right-handed patients and 10 age-matched controls were studied using clinical scales and TMS. Measurements included resting motor threshold (rMT), motor-evoked potentials (MEPs), cortical silent period (CSP), and central motor conduction time (CMCT). A single evening session of rTMS (1 Hz, 20 trains, 50 stimuli each) was administered over the left M1, left S1, and sham stimulation over M1 in a random order. Clinical and TMS measures were repeated after each stimulation modality. RESULTS Baseline CSP was shorter in patients than in controls and remained shorter in patients for both motor and somatosensory stimulation. The patients reported a subjective improvement of both initiating and maintaining sleep the night after the rTMS over S1. Patients exhibited a decrease in rMT after rTMS of S1 only, although the effect was smaller than in controls. MEP latency and CMCT changed only in controls after stimulation. Sham stimulation was without effect on the observed variables. CONCLUSIONS rTMS on S1-M1 connectivity alleviated the sensory-motor complaints of RLS patients. The TMS indexes of excitation and inhibition indicate an intracortical and corticospinal imbalance, mainly involving gamma-aminobutyric acid (GABA)ergic and glutamatergic circuitries, as well as an impairment of the short-term mechanisms of cortical plasticity. The rTMS-induced activation of the dorsal striatum with the consequent increase of dopamine release may have contributed to the clinical and neurophysiological outcome.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies ‘GF Ingrassia’, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical–Surgical Specialties, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, Georg August University Göttingen, Göttingen, Germany
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Zhuo Y, Wu Y, Xu Y, Lu L, Li T, Wang X, Li K. Combined resting state functional magnetic resonance imaging and diffusion tensor imaging study in patients with idiopathic restless legs syndrome. Sleep Med 2017; 38:96-103. [DOI: 10.1016/j.sleep.2017.06.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
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41
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Ji GJ, Yu F, Liao W, Wang K. Dynamic aftereffects in supplementary motor network following inhibitory transcranial magnetic stimulation protocols. Neuroimage 2017; 149:285-294. [DOI: 10.1016/j.neuroimage.2017.01.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/24/2016] [Accepted: 01/15/2017] [Indexed: 12/20/2022] Open
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Lanza G, Bachmann CG, Ghorayeb I, Wang Y, Ferri R, Paulus W. Central and peripheral nervous system excitability in restless legs syndrome. Sleep Med 2017; 31:49-60. [PMID: 27745789 DOI: 10.1016/j.sleep.2016.05.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 02/07/2023]
Abstract
Neurophysiological techniques have been applied in restless legs syndrome (RLS) to obtain direct and indirect measures of central and peripheral nervous system excitability, as well as to probe different neurotransmission pathways. Data converge on the hypothesis that, from a pure electrophysiological perspective, RLS should be regarded as a complex sensorimotor disorder in which cortical, subcortical, spinal cord, and peripheral nerve generators are all involved in a network disorder, resulting in an enhanced excitability and/or decreased inhibition. Although the spinal component may have dominated in neurophysiological assessment, possibly because of better accessibility compared to the brainstem or cerebral components of a hypothetical dysfunction of the diencephalic A11 area, multiple mechanisms, such as reduced central inhibition and abnormal peripheral nerve function, contribute to the pathogenesis of RLS similarly to some chronic pain conditions. Dopamine transmission dysfunction, either primary or triggered by low iron and ferritin concentrations, may also bridge the gap between RLS and chronic pain entities. Further support of disturbed central and peripheral excitability in RLS is provided by the effectiveness of nonpharmacological tools, such as repetitive transcranial magnetic stimulation and transcutaneous spinal direct current stimulation, in transiently modulating neural excitability, thereby extending the therapeutic repertoire. Understanding the complex interaction of central and peripheral neuronal circuits in generating the symptoms of RLS is mandatory for a better refinement of its therapeutic support.
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Affiliation(s)
- Giuseppe Lanza
- Sleep Research Center, I.R.C.C.S. "Oasi Maria SS.", Troina, Italy.
| | | | - Imad Ghorayeb
- Department of Clinical Neurophysiology, CHU de Bordeaux, Bordeaux, France; CNRS, INCIA, CNRS UMR 5287, Université de Bordeaux, Bordeaux, France
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Raffale Ferri
- Sleep Research Center, I.R.C.C.S. "Oasi Maria SS.", Troina, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg August University Göttingen, Göttingen, Germany
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Bocquillon P, Charley-Monaca C, Houdayer E, Marques A, Kwiatkowski A, Derambure P, Devanne H. Reduced afferent-induced facilitation of primary motor cortex excitability in restless legs syndrome. Sleep Med 2017; 30:31-35. [DOI: 10.1016/j.sleep.2016.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/03/2016] [Accepted: 03/13/2016] [Indexed: 01/18/2023]
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44
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Rizzo G, Li X, Galantucci S, Filippi M, Cho YW. Brain imaging and networks in restless legs syndrome. Sleep Med 2016; 31:39-48. [PMID: 27838239 DOI: 10.1016/j.sleep.2016.07.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 01/18/2023]
Abstract
Several studies provide information useful to our understanding of restless legs syndrome (RLS), using various imaging techniques to investigate different aspects putatively involved in the pathophysiology of RLS, although there are discrepancies between these findings. The majority of magnetic resonance imaging (MRI) studies using iron-sensitive sequences supports the presence of a diffuse, but regionally variable low brain-iron content, mainly at the level of the substantia nigra, but there is increasing evidence of reduced iron levels in the thalamus. Positron emission tomography (PET) and single positron emission computed tomography (SPECT) findings mainly support dysfunction of dopaminergic pathways involving not only the nigrostriatal but also mesolimbic pathways. None or variable brain structural or microstructural abnormalities have been reported in RLS patients; reports are slightly more consistent concerning levels of white matter. Most of the reported changes were in regions belonging to sensorimotor and limbic/nociceptive networks. Functional MRI studies have demonstrated activation or connectivity changes in the same networks. The thalamus, which includes different sensorimotor and limbic/nociceptive networks, appears to have lower iron content, metabolic abnormalities, dopaminergic dysfunction, and changes in activation and functional connectivity. Summarizing these findings, the primary change could be the reduction of brain iron content, which leads to dysfunction of mesolimbic and nigrostriatal dopaminergic pathways, and in turn to a dysregulation of limbic and sensorimotor networks. Future studies in RLS should evaluate the actual causal relationship among these findings, better investigate the role of neurotransmitters other than dopamine, focus on brain networks by connectivity analysis, and test the reversibility of the different imaging findings following therapy.
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Affiliation(s)
- Giovanni Rizzo
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy; Unit of Neurology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Xu Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sebastiano Galantucci
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Yong Won Cho
- Department of Neurology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, South Korea.
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Ku J, Lee YS, Chang H, Earley CJ, Allen RP, Cho YW. Default mode network disturbances in restless legs syndrome/Willis-Ekbom disease. Sleep Med 2016; 23:6-11. [PMID: 27692278 DOI: 10.1016/j.sleep.2016.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 04/10/2016] [Accepted: 05/07/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The unusual sensations of restless legs syndrome/Willis-Ekbom disease (RLS/WED) are induced by rest or a low arousal state with a circadian variation in the threshold for induction. It has been suggested that the emergence of RLS/WED symptoms relates to abnormal brain functions dealing with internally generated stimuli. The purpose of this study was to investigate the changes in the default mode network (DMN) in RLS/WED subjects. METHODS Sixteen drug-naïve, idiopathic, RLS/WED subjects, and 16 age-matched and gender-matched healthy subjects were scanned in an asymptomatic resting state. A comparison of the DMN was conducted between the two groups. Resting state functional magnetic resonance imaging (MRI), Korean versions of the International RLS scale, and other sleep questionnaires were used. RESULTS The results showed reductions in the DMN connectivity in the left posterior cingulate cortex, the right orbito-frontal gyrus, the left precuneus, and the right subcallosal gyrus of the RLS/WED subjects. The DMN connectivity was increased in sensory-motor-associated circuits, which included the right superior parietal lobule, the right supplementary motor area, and the left thalamus. In addition, the connectivity between the DMN and thalamus was negatively correlated with that in the orbito-frontal gyrus and the subcallosal gyrus in the subjects. CONCLUSIONS The results showed disturbances of the DMN in RLS/WED subjects that influence the thalamic relay sensory-motor-associated circuit. These findings may underscore the fact that RLS/WED subjects have disturbances in default mode network functions involving internal stimuli in the resting state. This may be related to compensatory changes to maintain resting.
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Affiliation(s)
- Jeonghun Ku
- Department of Biomedical Engineering, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Yeong Seon Lee
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - HyukWon Chang
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Richard P Allen
- Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.
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Gorges M, Rosskopf J, Müller HP, Lindemann K, Hornyak M, Kassubek J. Patterns of increased intrinsic functional connectivity in patients with restless legs syndrome are associated with attentional control of sensory inputs. Neurosci Lett 2016; 617:264-9. [PMID: 26921454 DOI: 10.1016/j.neulet.2016.02.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Potential alterations of intrinsic functional connectivity in idiopathic restless legs syndrome (RLS) are to be assumed since RLS is considered a network disorder. Whole-brain-based investigation of intrinsic functional connectivity networks including the sensorimotor systems in patients with RLS was compared with matched healthy controls. METHODS 'Resting-state' functional MRI (1.5 T) from 26 patients with RLS and 26 matched controls were analyzed using standardized seed-based analysis procedures. The motor/sensorimotor, sensory thalamic, ventral and dorsal attention, basal ganglia-thalamic, cingulate, and brainstem networks were used for voxel-based group comparisons between RLS patients and controls. RESULTS Significantly increased connectivities were observed in the sensory thalamic, ventral and dorsal attention, basal ganglia-thalamic, and cingulate networks in RLS patients, whereas no differences could be demonstrated for the motor/sensorimotor and the brainstem system. The pattern of functional connectivity alterations was positively correlated with increasing symptom severity. CONCLUSIONS Abnormally increased regional BOLD synchronization appears to be a key feature of intrinsic brain architecture in RLS. Alterations in cortical and sub-cortical functional networks support the notion that the underlying pathophysiology of RLS is beyond the sensorimotor and the brainstem system and may be also associated with altered attentional control of sensory inputs.
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Affiliation(s)
- Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | | | - Magdolna Hornyak
- Department of Neurology, University of Ulm, Ulm, Germany; Neuropsychiatry Centre Erding/München, Erding, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany.
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