Objective: To investigate the relationship between RLS and the lesion topography and clinical features of stroke.

Background: Restless legs syndrome (RLS) is a sleep-related sensorimotor disorder. The pathophysiology of RLS remains unclear. The relationship between RLS and stroke is to be clarified. We hypothesis that RLS can be associated with stroke.

Methods: We screened consecutive stroke patients admitted to a tertiary hospital. Using a standardized cerebral stroke, restless legs syndrome clinical pathway, all hospitalized patients underwent standard screening, diagnosis, treatment, evaluation and follow-up procedures. Stroke patients who complained of RLS symptoms as part of stroke presentation were assessed by 2 movement disorder specialists. Diagnosis of RLS was made according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG). All ischemic patients enrolled underwent MRI within 14 days of the onset and hemorrhagic patients underwent CT within 1 day. The onset time of RLS was limited within 2 weeks before stroke. Unconscious, dementia, aphasia, primary RLS and other causes of secondary RLS were excluded.

Results: Out of 4000 stroke patients, 7 patients who first presented with RLS symptoms were included. The symptoms appeared bilaterally in 4 cases (57.1%) and unilaterally in 3 cases (42.9%) which were contralateral to the hemisphere involved in the stroke. The mean age of onset was 60.57(44~69) years old. International restless legs syndrome group score (IRLSG) was 11.25 ± 4.51. NIHSS score was 4.17 ± 3.82. Imaging evidence confirmed that 5 out of 7 patients (71.4%) had pontine infarct, 1 had internal capsule infarct and 1 had basal ganglia hemorrhage. RLS symptoms in 2 patients resolved within 15 days, 4 cases showed poor response to pramipexole while good response to gabapentin, 1 patient can’t tolerate pramipexole and had moderate response to gabapentin. RLS Symptoms in 6 patients significantly improved or disappeared within 3 months, in 1 case the symptoms persisted, requiring medications.

Conclusions: Sudden onset RLS can be an early clinical presentation of strokes, especially those with pontine infarcts. Disruption of the pyramidal tract could be a predisposing factor for RLS symptoms. Our findings provide new pathophysiologic clues linking RLS with strokes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/restless-legs-syndrome-as-a-first-manifestation-of-cerebral-stroke-clinical-analysis-of-7-cases/