The Impact of Subthalamic Deep Brain Stimulation on Restless Legs Syndrome in Parkinson's Disease

Dulski, Jarosław; Wąż, Piotr; Konkel, Agnieszka; Grabowski, Karol; Libionka, Witold; Schinwelski, Michał; Sitek, Emilia J.; Sławek, Jarosław

doi:10.1111/ner.13462

Cited by 11 publications

(13 citation statements)

References 30 publications

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“…We found that the incidence of PD patients with RLS was 9.1%, which is similar to the results of previous reports in China [ 21 , 22 ], but is lower than the results of previous reports outside of China [ 11 ]. This finding may be related to the sample size and ethnic differences of the population that we investigated.…”

Section: Discussionsupporting

confidence: 87%

“…The efficacy of DBS in relieving motor symptoms and increasing quality of life in PD patients is well established [ 7 ]. Deep brain stimulation of the subthalamic nucleus (STN-DBS) can remarkably reduce the symptoms of restless legs syndrome and relieve motor symptoms, and some patients even experience complete symptom relief [ 8 , 9 , 10 , 11 ]. However, other studies have found that patients’ RLS symptoms worsened after STN-DBS [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Optimal Contact Position of Subthalamic Nucleus Deep Brain Stimulation for Reducing Restless Legs Syndrome in Parkinson’s Disease Patients: One-Year Follow-Up with 33 Patients

Lei¹,

Yang²,

Zhang

et al. 2022

Brain Sciences

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Objectives: To determine the short- and medium-term therapeutic effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on restless legs syndrome (RLS) in patients with Parkinson’s disease (PD) and to study the optimal position of activated contacts for RLS symptoms. Methods: We preoperatively and postoperatively assessed PD Patients with RLS undergoing STN-DBS. Additionally, we recorded the stimulation parameters that induced RLS or relieved RLS symptoms during a follow-up. Finally, we reconstructed the activated contacts’ position that reduced or induced RLS symptoms. Results: 363 PD patients were enrolled. At the 1-year follow-up, we found that the IRLS sum significantly decreased in the RLS group (preoperative 18.758 ± 7.706, postoperative 8.121 ± 7.083, p < 0.05). The results of the CGI score, MOS sleep, and RLS QLQ all showed that the STN-DBS improved RLS symptoms after one year. Furthermore, the activated contacts that relieved RLS were mainly located in the central sensorimotor region of the STN. Activated contacts in the inferior sensorimotor part of the STN or in the substantia nigra might have induced RLS symptoms. Conclusions: STN-DBS improved RLS in patients with PD in one year, which reduced their sleep disorders and increased their quality of life. Furthermore, the central sensorimotor region part of the STN is the optimal stimulation site.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Optimal Contact Position of Subthalamic Nucleus Deep Brain Stimulation for Reducing Restless Legs Syndrome in Parkinson’s Disease Patients: One-Year Follow-Up with 33 Patients

Lei¹,

Yang²,

Zhang

et al. 2022

Brain Sciences

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“…In mice, bilateral damage to the A11 nucleus results in hyperactivity. [41] However, this hypothetical basis for RLS has not been shown to exist directly in humans, as anatomical studies of patients with RLS have shown no abnormalities in the A11 dopaminergic system. [42] Although treatment with an evidential dopaminergic agonist may initially alleviate RLS symptoms, given the frequency of potentiating syndromes, these agents may not be a long-term solution.…”

Section: Neurotransmitter Dysfunctionmentioning

confidence: 99%

“…Alterations in the dopaminergic system, that is, the presynaptic hyperdopaminergic state, appear to be involved in causing PLMS, and alterations in the glutamate neurotransmitter, that is, the presynaptic hyperglutamate state, are involved in causing excessive anxiety and PLMS. [ 41 , 44 , 45 ]…”

Section: Pathophysiologymentioning

confidence: 99%

Exploration of restless legs syndrome under the new concept: A review

2022

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Restless leg syndrome (Restless legs syndrome, RLS) is a common neurological disorder. The pathogenesis of RLS remains unknown, and recent pathophysiological developments have shown the contribution of various genetic markers, neurotransmitter dysfunction, and iron deficiency to the disease, as well as other unidentified contributing mechanisms, particularly chronic renal dysfunction. RLS enhancement syndrome is frequently observed in patients with RLS who have received long-term dopamine agonist therapy, manifesting as a worsening of RLS symptoms, usually associated with an increase in the dose of dopamine agonist. Some patients with RLS can adequately control their symptoms with non-pharmacological measures such as massage and warm baths. First-line treatment options include iron supplementation for those with evidence of reduced iron stores, or gabapentin or pregabalin, as well as dopamine agonists, such as pramipexole. Second-line therapies include opioids such as tramadol. RLS seriously affects the quality of life of patients, and because its pathogenesis is unclear, more biological evidence and treatment methods need to be explored.Abbreviations: BID = brain iron deficiency, CNS = central nervous system, GABA = gamma-aminobutyric acid, IRLSSG = International restless leg syndrome research group, PLMD = periodic limb movement disorder, PLMS = periodic leg movement in sleep, RLS = restless legs syndrome, WED = Willis-Ekbom disease.

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“…In contrast, the latter (novel) approach is more advantageous in the research setting, as it allows hypothesis-free analysis of multiple domains; but it is rarely translated into an algorithm applicable in clinical practice ( Fereshtehnejad et al, 2017 ; Lawton et al, 2018 ; Zhang et al, 2019 ; Mestre et al, 2021 ). To further confound the picture, non-motor symptoms have been recognized, including behavioral and mood disturbances, cognitive impairment, sensory symptoms, autonomic dysfunction, and sleep and wakefulness disorders ( Dulski et al, 2015 , 2018 , 2019 , 2022 , forthcoming ; Balestrino and Schapira, 2020 ; Siuda, 2021 ; Tipton, 2021 ). Table 1 presents the various PD subtypes investigated in the previous studies.…”

Section: Introductionmentioning

confidence: 99%

Genetic architecture of Parkinson’s disease subtypes – Review of the literature

Dulski

Uitti²,

Ross³

et al. 2022

Front. Aging Neurosci.

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The heterogeneity of Parkinson’s disease (PD) has been recognized since its description by James Parkinson over 200 years ago. The complexity of motor and non-motor PD manifestations has led to many attempts of PD subtyping with different prognostic outcomes; however, the pathophysiological foundations of PD heterogeneity remain elusive. Genetic contributions to PD may be informative in understanding the underpinnings of PD subtypes. As such, recognizing genotype-phenotype associations may be crucial for successful gene therapy. We review the state of knowledge on the genetic architecture underlying PD subtypes, discussing the monogenic forms, as well as oligo- and polygenic risk factors associated with various PD subtypes. Based on our review, we argue for the unification of PD subtyping classifications, the dichotomy of studies on genetic factors and genetic modifiers of PD, and replication of results from previous studies.

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The Impact of Subthalamic Deep Brain Stimulation on Restless Legs Syndrome in Parkinson's Disease

Cited by 11 publications

References 30 publications

Optimal Contact Position of Subthalamic Nucleus Deep Brain Stimulation for Reducing Restless Legs Syndrome in Parkinson’s Disease Patients: One-Year Follow-Up with 33 Patients

Optimal Contact Position of Subthalamic Nucleus Deep Brain Stimulation for Reducing Restless Legs Syndrome in Parkinson’s Disease Patients: One-Year Follow-Up with 33 Patients

Exploration of restless legs syndrome under the new concept: A review

Genetic architecture of Parkinson’s disease subtypes – Review of the literature

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