Objective: To describe a case of acute onset, unilateral restless leg syndrome (RLS) after  subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson’s disease.

Background: Parkinson’s disease is a neurodegenerative condition associated with profound sleep disruption. RLS is a common but poorly understood nocturnal symptom that may be associated with Parkinson’s disease. DBS is now widely used for the treatment of Parkinson’s disease, but little is known about how it affects the presence or severity of RLS.

Method: We report here a patient with tremor-predominant Parkinson’s disease who developed new onset, unilateral RLS after STN DBS.

Results: A 79 year-old right-handed man with a history of Parkinson’s disease underwent the implantation of right STN DBS to treat left upper extremity rest and postural tremor and enable medication reduction. Ten years prior to presentation, he developed left upper extremity rest tremor and bradykinesia. He underwent a DaT scan, which showed decreased dopamine uptake in the right putamen. He initiated therapy with carbidopa/levodopa and experienced an initial improvement in his symptoms. His tremor progressively worsened over time despite escalating doses of carbidopa/levodopa, so he pursued a staged approach of bilateral DBS starting with the right STN. When stimulation was turned on for programming, he reported acute onset of an uncomfortable “numbness” and “jitteriness” that created an urge to move his left leg and, to a lesser degree, his left arm. This occurred primarily at night and worsened when he lied in bed, significantly interfering with his ability to fall asleep. Ambulation improved the symptom. After several weeks of disrupted sleep, he reduced his dopaminergic therapy and these sensations fully resolved. He had no prior history of restless leg syndrome.

Conclusion: To our knowledge, this is the first case report of the acute development of symptoms meeting diagnostic criteria for RLS during initial stimulation with STN DBS. Existing evidence suggests that STN DBS may improve RLS in the long term, likely due to the modulation of basal ganglia outflow and downstream effects on diencephalospinal dopaminergic pathways. Our case illustrates that stimulation may also cause the emergence of RLS. Further understanding the effect of STN DBS on RLS through individual cases can illuminate relevant neural networks.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-onset-unilateral-restless-leg-syndrome-after-subthalamic-nucleus-deep-brain-stimulation/