Introduction: Restless legs syndrome (RLS) is a very common sensorimotor neurologic disorder. The impact of RLS on patients' quality of life cannot be underestimated. Although there are multiple effective treatment options for RLS, in some cases RLS symptoms remain refractory to all known therapeutic modalities. In this study we aimed to study the effect of STN DBS in the largest cohort of patients with Parkinson's disease and moderate to severe RLS, reported in the literature to-date, on their RLS symptoms.
Methods: Patients, undergoing STN DBS surgery for PD, completed the International RLS Study Group rating scale (IRLS) and the RLS Quality of Life (QoL) questionnaires pre-operatively and post-operatively at 6 months, 1 and 2 years. Primary outcome measure was IRLS sum score and subscales (severity and impact) and the secondary were RLS QoL scores, and rate of responders, remitters, and complete remitters. Differences among the mean scores over time were analyzed using mixed model regression.
Results: 22 patients were enrolled. The preoperative IRLS sum scores were 19.59±6.95, severity subscale 12.91±4.33, impact subscale 4.45±2.72, and transformed RLS QoL score 68.30±20.26. The differences between pre- and averaged post-operative scores were: IRLS sum score -7.80, severity subscale -5.50, impact subscale -1.20, and RLS QoL 4.73. The overall F tests demonstrated differences among the times for the means of the IRLS sum and subscales: p<0.05. There was no significant correlations between RLS symptoms improvement and PD motor symptoms improvement or reduction in PD medications. Rate of responders was 50%, remitters 50%, and complete remitters 27.3%.
Conclusions: STN DBS significantly decreased RLS symptoms in PD patients despite a decrease in dopaminergic treatment. This improvement was sustained over a two-year period. These data suggest that STN DBS could be effective for treatment for medications refractory RLS.
Patient Care: Restless legs syndrome (RLS) is a very common sensorimotor neurologic disorder. The impact of RLS on patients’ Quality of Life (QoL) cannot be underestimated. Although, there are multiple effective treatment options for RLS, in some cases RLS symptoms remain refractory to all known therapeutic modalities. This study demonstrated a significant improvement of the IRLS sum score, and severity and impact subscales, in 22 patients with PD and moderate to severe RLS after STN DBS. These improvements lasted for up to two years after surgery despite a significant reduction in dopaminergic therapy (34.5% - 69.2%). Half of the patients improved to only mild degree of RLS symptoms (<10 on IRLS score), and almost one-third (27.3%) had complete resolution of symptoms. RLS QoL scale also improved postoperatively, although, not statistically significantly. This study is the largest study thus far to find a beneficial effect of STN DBS on RLS symptoms in PD patients.
Learning Objectives: By the conclusion of this session, participants should be able to understand the effect of the STN DBS in patients with Parkinson disease (PD) and moderate to severe Restless Legs Syndrome (RLS) on their RLS symptoms.