Restless legs syndrome and cerebrovascular disease

A patient with insomnia due to restless leg and periodic limb movement syndrome after stroke–A clinical case

Restless legs syndrome (or Willis-Ekbom) presents with an overwhelming need for movement of the lower limbs in order to eliminate the unpleasant sensations in them, which appear during rest and sleep. The unpleasant sensations are described as “tingling, pulling or pain” in the knees, ankles, or through the entire lower limbs. Periodic limb movement syndrome presents with involuntary movements of the lower limbs or the body during sleep, for which the patient has no recollection, unlike in those in restless leg syndrome. In most cases they present with four or more successive movements of dorsal flection of the toes and ancles with partial flection of the knees and hips divided into five to 90 second intervals.<br /> A 44-year-old man, a taxi driver, is admitted in a neurological clinic with complaints of a headache, dizziness, exhaustion, which he associates with difficulty falling asleep and maintaining a sleeping state after an ischemic stroke in the right middle cerebral artery four months earlier. The conducted polysomnography reveals an increased sleep latency, periodic limb movement syndrome and multiple arousals before entering REM sleep.

Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management

Restless legs syndrome (RLS), a common neurological sensorimotor disorder in western countries, has gained more and more attention in Asian countries. The prevalence of RLS is higher in older people and females. RLS is most commonly related to iron deficiency, pregnancy and uremia. The RLS symptoms show a significant circadian rhythm and a close relationship to periodic limb movements (PLMs) in clinical observations, while the pathophysiological pathways are still unknown. The diagnostic criteria have been revised in 2012 to improve the validity of RLS diagnosis. Recent studies have suggested an important role of iron decrease of brain in RLS pathophysiology. Dopaminergic (DA) system dysfunction in A11 cell groups has been recognized long ago from clinical treatment and autopsy. Nowadays, it is believed that iron dysfunction can affect DA system from different pathways and opioids have a protective effect on DA system. Several susceptible single nucleotide polymorphisms such as BTBD9 and MEIS1, which are thought to be involved in embryonic neuronal development, have been reported to be associated with RLS. Several pharmacological and non-pharmacological treatment are discussed in this review. First-line treatments of RLS include DA agents and α2δ agonists. Augmentation is very common in long-term treatment of RLS which makes prevention and management of augmentation very important for RLS patients. A combination of different types of medication is effective in preventing and treating augmentation. The knowledge on RLS is still limited, the pathophysiology and better management of RLS remain to be discovered.