Painful Restless Legs Syndrome

Karroum, Elias G.; Golmard, Jean‐Louis; Leu‐Semenescu, Smaranda; Arnulf, Isabelle

doi:10.1097/ajp.0000000000000133

Cited by 28 publications

(3 citation statements)

References 42 publications

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“…25 Unpleasant sensations were perceived as painful by 47% to 61% of iRLS patients in large clinical studies, and 59% of individuals with RLS reported pain in a general population survey. 26 In our study, 50% PD-RLS + patients reported painful sensations. The pain experience includes sensory and affective motivational components, which are controlled by the lateral and medial pain system, respectively.…”

Section: Discussionsupporting

confidence: 46%

Reduced regional activity and functional connectivity within sensorimotor network in Parkinson’s patients with restless legs syndrome

Lin

Zhou

et al. 2019

Mol Pain

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Background: Restless legs syndrome is an important sleep disturbance in Parkinson's disease. Restless legs syndrome causes an urge to move the legs accompanying sensations which can be difficult to describe but include aching, burning, tingling, or crawling. However, the underlying pathophysiology of restless legs syndrome in Parkinson's disease remains unknown and no imaging investigation has been conducted to explore its mechanism to date. Objective: This study is to investigate the brain functional changes in Parkinson's disease with restless legs syndrome (PD-RLS þ) patients using functional magnetic resonance imaging. Methods: Data of functional magnetic resonance imaging were collected from 14 PD-RLS þ patients, 20 Parkinson's disease without restless legs syndrome (PD-RLS À) patients, as well as 19 normal controls during restless legs syndrome-free periods. Intraregional brain activity was evaluated by regional homogeneity method and compared between each pair of the three groups. Area with significantly altered regional homogeneity between two patient groups was further selected as seed in subsequent functional connectivity analysis. Correlations between clinical variables and the altered regional homogeneity and functional connectivity were then assessed in patient groups. Results: Compared with PD-RLS À , PD-RLS þ had much reduced brain activity in the right precentral gyrus, which was negatively associated with restless legs scores in Parkinson's disease patients. Comparison between PD-RLS þ and normal controls revealed that brain activities were increased in the left brainstem and reduced in the left lingual, fusiform and inferior occipital gyri, middle cingulate and paracingulate gyri, and supplement motor area. Further functional connectivity analysis between right precentral gyrus and left postcentral/precentral gyri decreased dramatically within PD-RLS þ patients, which were also negatively correlated with restless legs symptoms in patient groups. Conclusion: PD-RLS þ patients showed diminished regional homogeneity and functional connectivity within the precentral and postcentral gyri, which implies that the functional abnormalities in sensorimotor network may disrupt the lateral pain pathway, contributing to restless legs syndrome symptoms in Parkinson's disease patients. This may provide imaging evidence to explore the pathophysiology of Parkinson's disease-related restless legs syndrome.

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Section: Discussionsupporting

confidence: 46%

Reduced regional activity and functional connectivity within sensorimotor network in Parkinson’s patients with restless legs syndrome

Lin

Zhou

et al. 2019

Mol Pain

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“…The urge to move was accompanied in some patients by more atypical symptoms such as “burning and itching” or painful “electric shock sensations” 22,27. These symptoms could be misleading, but have also been described in a large cohort of RLS patients 36,37. In some patients periodic movements of the upper limbs were present during wakefulness at rest, similarly to PLMs during wakefulness observed in RLS patients 2.…”

Section: Discussionmentioning

confidence: 92%

<p>Restless arms syndrome: prevalence, impact, and management strategies</p>

Ruppert

2019

NDT

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This literature review focuses on restless arms syndrome (RAS), an upper limb variant of restless legs syndrome (RLS). RLS, also known as Willis-Ekbom disease, is a frequently occurring neurological disorder characterized by an irresistible urge to move the lower limbs often accompanied by unpleasant sensations in the legs, worsened at rest and in the evening, improved by movement. Extension of leg restlessness to the upper limbs is frequently reported in typical patients who had RLS only in the legs and usually occurs later in the course of RLS, restlessness remaining most invalidating in the lower limbs. In RAS, the arms are predominantly affected with little or no involvement of the legs. Cases of restless shoulders syndrome or periodic arm movements without arm restlessness were not considered. A total of 9 articles with 10 cases were included and analyzed for the adherence to the five essential diagnostic criteria of the International RLS Study Group (IRLSSG) classification, as well as for the additional supportive features. All of the reported cases were classified as having definite RAS. The clinical history and disease evolution of two previously reported patients were completed and updated. Overall, the clinical picture of RAS does not differ from that of RLS, except for the symptoms localization on the upper limbs. Underlying mechanisms of the spread of RLS to upper limb restlessness and of RAS remain unknown. Whether RAS is a phenotypic variant of RLS or a separate entity needs further investigations. RAS likely remains underdiagnosed and according to IRLSSG diagnostic criteria RAS should be considered when RLS-like symptoms are present in one or both arms, especially when they have a circadian pattern and are improved by movement and dopaminergic therapy. Clinicians should be aware of this rare condition, especially as treatment using dopaminergic agonists proves to be very efficient.

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“…In our patient, the leg cramping mainly occurred only at night, suggesting that the symptom was caused by carnitine deficiency rather than iron deficiency. Restless legs syndrome (RLS) is an important differential diagnosis in this case because it occurs mainly in the evening or at night when the patient is at rest and is sometimes accompanied by pain [14]. Additionally, iron deficiency is involved in exacerbating RLS symptoms [15].…”

Section: Discussionmentioning

confidence: 96%

Nocturnal Leg Cramping Caused by Carnitine Deficiency Due to Long-Term Pivalate Antibiotics Administration in a Patient With Chronic Kidney Disease

Tanizaki,

Miyamatsu

2023

Cureus

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Carnitine deficiency is a known cause of leg cramps and is sometimes observed in patients taking certain medications such as pivalate-containing antibiotics. A 69-year-old Japanese woman presented with a progression of painful involuntary nocturnal leg cramping. She had been taking cefcapene-pivoxil for six months. Serum-free carnitine (FC) and acylcarnitine levels were decreased. Then, carnitine deficiency due to long-term pivalate-containing antibiotics administration was diagnosed. After initiating oral L-carnitine treatment, her symptoms improved. It should be aware of carnitine deficiency if a patient taking pivalate-containing antibiotics presents with leg cramping.

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Painful Restless Legs Syndrome

Abstract: Painful RLS appears to be a severe, "burning" subtype of RLS, and could be a distinct disease or a clinical variant in a sensations continuum.

Cited by 28 publications

References 42 publications

Reduced regional activity and functional connectivity within sensorimotor network in Parkinson’s patients with restless legs syndrome

Reduced regional activity and functional connectivity within sensorimotor network in Parkinson’s patients with restless legs syndrome

<p>Restless arms syndrome: prevalence, impact, and management strategies</p>

Nocturnal Leg Cramping Caused by Carnitine Deficiency Due to Long-Term Pivalate Antibiotics Administration in a Patient With Chronic Kidney Disease

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