Objective: To determine whether there could be a semiological overlap between Restless Legs Syndrome (RLS) and Impulse Control Disorders (ICDs) in Parkinson’s Disease (PD), using the Suggested Immobilization Test (SIT)

Background: ICDs in PD are defined by the failure to resist an “urge to drive a conduct” that may harmful to patients themselves or others. We recently showed that RLS is associated with the presence of ICDs in PD. Yet, it remains unclear whether RLS could be a risk factor for ICD or part of its clinical spectrum. Actually, RLS is defined by an “urge to move” the legs occurring during rest, relieved by movement, worsening in the evening or night. The suggested immobilization test (SIT) has been developed to assess the “urge to move” and support the diagnosis of RLS in general population but also in Parkinson’s disease.

Method: Fifty-six consecutive non-demented patients fulfilling the diagnostic criteria for PD (Male/Female: 32/24; mean age: 64.1±8 yrs; mean Hoen and Yahr stage: 2.1±0.6; mean duration of disease: 7.7±4.5 yrs) participated to this cross-sectional study. Among them, patients with RLS (n=20) and with one or more ICDs (n=23) were identified using standard clinical criteria. All the patients underwent a SIT and a one-night videopolysomnography. Demographical, treatment, motor, psycho-behavioral and sleep characteristics were recorded.

Results: PD patients with RLS had a longer PD duration but similar dopaminergic treatment doses and duration compared to PD without RLS. PD patients with ICDs had a longer PD duration, longer dopaminergic treatment duration and dose, and a higher severity of non-motor signs, daily life functioning and motor complications compared to those without ICDs. Subjective discomfort (SD) during SIT did not differ between patients with and without RLS (p=0.24), however PD patients with ICD reported an increased SD during SIT compared to PD patients without ICDs (p=0.015). Periodic limb movements during SIT did not differ between patients with and without RLS (p=0.83), neither between patients with and without ICDs (p=0.28).

Conclusion: SD during SIT appears to be more sensitive to discriminate patients with ICDs rather than those with RLS in PD. SD during SIT could reflect the “urge” to move in these patients, and more generally a motor component of impulsivity. Thus it may be discussed whether RLS could be part of the ICDs spectrum, as a motor ICD.

References: Marques, A., Figorilli, M., Pereira, B., Derost, P., Debilly, B., Beudin, P., Vidal, T., Durif, F., and Fantini, M.L. (2018). Impulse control disorders in Parkinson’s disease patients with RLS: a cross sectional-study. Sleep Med. 48, 148–154. Voon, V., Fernagut, P.-O., Wickens, J., Baunez, C., Rodriguez, M., Pavon, N., Juncos, J.L., Obeso, J.A., and Bezard, E. (2009). Chronic dopaminergic stimulation in Parkinson’s disease: from dyskinesias to impulse control disorders. Lancet Neurol. 8, 1140–1149.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-urge-to-move-in-restless-legs-syndrome-associated-with-parkinsons-disease-a-motor-impulse-control-disorder/