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Zhang J, Zhang J, Sun H, Yang J, Ma Y, Chen K, Su J, Yu X, Yang F, Zhang Z, Zhao T, Hu X, Zhai Y, Liu Q, Wang J, Liu C, Wang Z. Cerebellum drives functional dysfunctions in restless leg syndrome. Sleep Med 2023; 110:172-178. [PMID: 37595434 DOI: 10.1016/j.sleep.2023.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/04/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE Restless legs syndrome (RLS) has serious effects on patients' sleep quality, physical and mental health. However, the pathophysiological mechanisms of RLS remain unclear. This study utilized both static and dynamic functional activity and connectivity analyses approaches as well as effective connectivity analysis to reveal the neurophysiological basis of RLS. METHODS The resting-state functional MRI (rs-fMRI) data from 32 patients with RLS and 33 age-, and gender-matched healthy control (HC) were collected. Dynamic and static amplitude of low frequency fluctuation (ALFF), functional connectivity (FC), and Granger causality analysis (GCA) were employed to reveal the abnormal functional activities and couplings in patients with RLS. RESULTS RLS patients showed over-activities in left parahippocampus and right cerebellum, hyper-connectivities of right cerebellum with left basal ganglia, left postcentral gyrus and right precentral gyrus, and enhanced effective connectivity from right cerebellum to left postcentral gyrus compared to HC. CONCLUSIONS Abnormal cerebellum-basal ganglia-sensorimotor cortex circuit may be the underlying neuropathological basis of RLS. Our findings highlight the important role of right cerebellum in the onset of RLS and suggest right cerebellum may be a potential target for precision therapy.
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Affiliation(s)
- Jiang Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jingyue Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Hui Sun
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Jia Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Yingzi Ma
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Kexuan Chen
- Medical School, Kunming University of Science and Technology, Kunming, China
| | - Jing Su
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Xiaohui Yu
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Futing Yang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China
| | - Zhiwei Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Tianyu Zhao
- College of Electrical Engineering, Sichuan University, Chengdu, China
| | - Xiuying Hu
- Med-X Center for Informatics, Sichuan University, Chengdu, China; Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yiran Zhai
- College of Electrical Engineering, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Qihong Liu
- College of Biomedical Engineering, Sichuan University, Chengdu, China
| | - Jiaojian Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China.
| | - Chunyan Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neuromodulation, Beijing, China.
| | - Zhengbo Wang
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China; Yunnan Key Laboratory of Primate Biomedical Research, Kunming, Yunnan, China.
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Xue Y, Xie S, Wang X, Xi X, Liu C. White matter microstructure alterations in idiopathic restless legs syndrome: a study combining crossing fiber-based and tensor-based approaches. Front Neurosci 2023; 17:1240929. [PMID: 37811323 PMCID: PMC10551141 DOI: 10.3389/fnins.2023.1240929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Restless legs syndrome (RLS) is a common sensorimotor disorder characterized by an irrepressible urge to move the legs and frequently accompanied by unpleasant sensations in the legs. The pathophysiological mechanisms underlying RLS remain unclear, and RLS is hypothesized to be associated with alterations in white matter tracts. Methods Diffusion MRI is a unique noninvasive method widely used to study white matter tracts in the human brain. Thus, diffusion-weighted images were acquired from 18 idiopathic RLS patients and 31 age- and sex-matched healthy controls (HCs). Whole brain tract-based spatial statistics (TBSS) and atlas-based analyzes combining crossing fiber-based metrics and tensor-based metrics were performed to investigate the white matter patterns in individuals with RLS. Results TBSS analysis revealed significantly higher fractional anisotropy (FA) and partial volume fraction of primary (F1) fiber populations in multiple tracts associated with the sensorimotor network in patients with RLS than in HCs. In the atlas based analysis, the bilateral anterior thalamus radiation, bilateral corticospinal tract, bilateral inferior fronto-occipital fasciculus, left hippocampal cingulum, left inferior longitudinal fasciculus, and left uncinate fasciculus showed significantl increased F1, but only the left hippocampal cingulum showed significantly higher FA. Discussion The results demonstrated that F1 identified extensive alterations in white matter tracts compared with FA and confirmed the hypothesis that crossing fiber-based metrics are more sensitive than tensor-based metrics in detecting white matter abnormalities in RLS. The present findings provide evidence that the increased F1 metric observed in sensorimotor tracts may be a critical neural substrate of RLS, enhancing our understanding of the underlying pathological changes.
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Affiliation(s)
- Yibo Xue
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | - Sangma Xie
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | - Xunheng Wang
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | - Xugang Xi
- School of Automation, Hangzhou Dianzi University, Hangzhou, China
| | - Chunyan Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neuromodulation, Beijing, China
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Szentkirályi A, Hermesdorf M, Sundermann B, Czira M, Teismann H, Wulms N, Minnerup H, Young P, Berger K. Periodic limb movements in sleep are linked to decreased hippocampus and amygdala volumes in the population-based BiDirect Study. Sleep 2023; 46:6795532. [PMID: 36330698 DOI: 10.1093/sleep/zsac263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
STUDY OBJECTIVES Even though numerous studies indicate that sleep disorders are associated with altered brain morphology, MRI studies focusing on periodic limb movements in sleep (PLMS) are scarce. Our aim was to investigate the association of PLMS with global and regional gray matter volumes as well as white matter hyperintensity (WMH) volume. METHODS One hundred and eighty-nine subjects (57.0 ± 7.8 years, women: 50.5%) of the population-based BiDirect Study underwent a single-night polysomnography (PSG). Standard criteria of the American Academy of Sleep Medicine were applied to evaluate sleep characteristics and calculate the PLMS index (PLMSI). T1w and FLAIR images were acquired with cerebral MRI at 3 Tesla. Voxel-based morphometry was performed to determine the total gray matter volume as well as the volume of cortical segments and subcortical gray matter areas using SPM12 and CAT12. The WMH volume was quantified with the Brain Intensity AbNormality Classification Algorithm. The independent relationship between MRI markers and PLMSI was analyzed using multivariable linear regression with adjustment for age, sex, body mass index, intracranial volume, PSG scorer, PSG device, sleep apnea, and the use of antidepressants. RESULTS PLMSI was not significantly related to global gray matter volume and WMH volume. However, significant inverse associations of the PLMSI with the volume of the hippocampus (left and right hemisphere) and left amygdala were observed. CONCLUSIONS A significant relationship between a higher PLMSI and lower volumes of the hippocampus and amygdala was found among the participants of the BiDirect Study. Since these associations are based on exploratory analyses, further replications are required before drawing firm conclusions.
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Affiliation(s)
- András Szentkirályi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Marco Hermesdorf
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Benedikt Sundermann
- Clinic of Radiology, University Hospital Münster, Münster, Germany.,Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Maria Czira
- Johannes Keller General Practice, Greven, Germany
| | - Henning Teismann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Niklas Wulms
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Heike Minnerup
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Peter Young
- Medical Park/Neurological Clinic Reithofpark, Bad Feilnbach, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Zang QL, Zheng JH, Ma JJ, Zhang Q, Huang PP, Shen NN, Miao W. Neuroanatomy and Functional Connectivity in Patients with Parkinson's Disease with or without Restless Legs Syndrome. Neurol Ther 2022; 11:1625-1636. [PMID: 35999489 DOI: 10.1007/s40120-022-00397-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Restless legs syndrome (RLS) is a common non-motor symptom in Parkinson's disease (PD), but its pathogenesis remains unclear. This study aimed to explore the potential neural substrates of RLS in a large sample of patients with PD. METHODS A total of 42 patients with PD with RLS and 124 patients with PD without RLS were prospectively recruited at our hospital between February 2019 and October 2020 and underwent structural and resting-state functional magnetic resonance imaging. Differences between the two patient groups were assessed using voxel-based morphometry and functional connectivity analysis. PD duration, Part III of the Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III) score, and levodopa equivalent daily dose were treated as covariates. RESULTS Patients with PD with RLS had significantly larger gray matter volume in the bilateral posterior cingulate cortex than patients with PD without RLS (FDR-adjusted P < 0.05). Compared to patients without RLS, those with RLS had significantly lower functional connectivity between the left central opercular cortex and the bilateral precentral gyri and postcentral gyri (FDR-adjusted P < 0.001). CONCLUSION Our study provides the first evidence that in patients with PD, RLS is associated with significantly larger gray matter volume in the posterior cingulate cortex and lower resting-state functional connectivity within the sensorimotor network. Our results may help clarify the pathophysiology of RLS in PD and identify possible therapeutic targets.
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Affiliation(s)
- Qiu Ling Zang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 1 Jian She East Road, Zhengzhou, 450007, Henan Province, People's Republic of China
| | - Jin Hua Zheng
- Department of Neurology, Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China
| | - Jian Jun Ma
- Department of Neurology, Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou, 450003, Henan Province, People's Republic of China.
| | - Qi Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 1 Jian She East Road, Zhengzhou, 450007, Henan Province, People's Republic of China
| | - Pei Pei Huang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 1 Jian She East Road, Zhengzhou, 450007, Henan Province, People's Republic of China
| | - Nan Nan Shen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 1 Jian She East Road, Zhengzhou, 450007, Henan Province, People's Republic of China
| | - Wang Miao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, 1 Jian She East Road, Zhengzhou, 450007, Henan Province, People's Republic of China.
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5
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Park KM, Kim KT, Lee DA, Cho YW. Structural brain connectivity in patients with restless legs syndrome: a diffusion tensor imaging study. Sleep 2022; 45:6575835. [PMID: 35485481 DOI: 10.1093/sleep/zsac099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To evaluate alterations of global and local structural brain connectivity in patients with restless legs syndrome (RLS). METHODS Patients with primary RLS and healthy controls were recruited at a sleep center where they underwent diffusion tensor imaging (DTI) of the brain. We calculated the network measures of global and local structural brain connectivity based on the DTI in both groups using DSI studio program and a graph theory. RESULTS A total of 69 patients with primary RLS and 51 healthy controls were included in the study. We found a significant difference in the global structural connectivity between the groups. The transitivity in the patients with RLS was lower than that in healthy controls (0.031 vs. 0.033, p = 0.035). Additionally, there were significant differences in the local structural connectivity between the groups. The characteristic path length (r = 0.283, p = 0.018), radius of graph (r = 0.260, p = 0.030), and diameter of graph (r = 0.280, p = 0.019) were all positively correlated with RLS severity, whereas the mean clustering coefficient (r = -0.327, p = 0.006), global efficiency (r = -0.272, p = 0.023), small-worldness index (r = -0.325, p = 0.006), and transitivity (r = -0.351, p = 0.003) were negatively correlated with RLS severity. CONCLUSION We identified changes in the global structural connectivity of patients with RLS using graph theory based on DTI, which showed decreased segregation in the brain network compared to healthy controls. These changes are well correlated with RLS severity. We also found changes in local structural connectivity, especially in regions involved in sensorimotor function, which suggests that these areas play a pivotal role in RLS. These findings contribute to a better understanding of the pathophysiology of RLS symptoms.
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Affiliation(s)
- Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
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6
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Richards K, Britt KC, Cuellar N, Wang Y, Morrison J. Clinical Decision-Making: Restless Legs Syndrome and Dementia in Older Adults. Nurs Clin North Am 2021; 56:265-274. [PMID: 34023120 DOI: 10.1016/j.cnur.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Restless legs syndrome (RLS), one of the more prevalent sleep disturbances among older adults, impacts quality of life. Patients with dementia are at high risk for developing RLS and may be unable to describe their symptoms. Often underdiagnosed, RLS can contribute to discomfort, pain, nighttime agitation, disturbed sleep, and falls. Clinical assessment is crucial and should include a thorough evaluation with input from the patient and family, deprescribing medication if possible, and consideration of common sleep-disturbing factors. Evidence-based treatment in this population is limited; overall focus should center on relieving discomfort while identifying and treating bothersome sleep symptoms.
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Affiliation(s)
- Kathy Richards
- The University of Texas at Austin, School of Nursing, 1710 Red River Street, Austin, TX 78712, USA. https://twitter.com/kathyrichards2
| | - Katherine Carroll Britt
- The University of Texas at Austin, School of Nursing, 1712 Red River Street, Austin, TX 78712, USA. https://twitter.com/KatherineCBritt1
| | - Norma Cuellar
- The University of Alabama, University Boulevard, 650 University Boulevard East, Tuscaloosa, AL 35401, USA.
| | - Yanyan Wang
- The University of Texas at Austin, School of Nursing, 1712 Red River Street, Austin, TX 78712, USA. https://twitter.com/yanw06689982
| | - Janet Morrison
- The University of Texas at Austin, School of Nursing, 1712 Red River Street, Austin, TX 78712, USA. https://twitter.com/phdb4ss
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White matter tract-specific alterations in patients with primary restless legs syndrome. Sci Rep 2021; 11:16116. [PMID: 34373482 PMCID: PMC8352949 DOI: 10.1038/s41598-021-95238-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/22/2021] [Indexed: 01/18/2023] Open
Abstract
Prior diffusion tensor imaging (DTI) studies have investigated white matter (WM) changes in patients with primary restless legs syndrome (RLS), but the results were inconsistent. Here, we proposed using tract-specific statistical analysis (TSSA) to find alterations in specific WM tracts to clarify the pathophysiological mechanisms of RLS. We enrolled 30 patients with RLS and 31 age- and sex- matched controls who underwent brain magnetic resonance imaging, neuropsychological tests, and polysomnography. Fractional anisotropy (FA) maps obtained from whole-brain diffusion tensor imaging and TSSA were used to localize WM changes in patients with RLS. Subsequently, a comparison of FA values for each tract between patients and controls was performed. The associations between FA values and clinical, polysomnographic, and neuropsychological parameters in RLS patients were assessed. RLS patients demonstrated decreased FA values in the left corticospinal tract (CST) and cingulum, and in the right anterior thalamic radiation (ATR) and inferior fronto-occipital fasciculus (IFO). Patients’ attention/executive function and visual memory scores positively correlated with FA values in the right ATR, and anxiety levels negatively correlated with FA values in the right IFO. Additionally, the number of periodic leg movements and movement arousal index were negatively correlated with FA values in the left CST. The TSSA method identified previously unknown tract-specific alterations in patients with RLS and significant associations with distinct clinical manifestations of RLS.
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Sheng L, Zhao P, Ma H, Qi L, Yi Z, Shi Y, Zhong J, Shi H, Dai Z, Pan P. Grey matter alterations in restless legs syndrome: A coordinate-based meta-analysis. J Sleep Res 2021; 30:e13298. [PMID: 33554365 DOI: 10.1111/jsr.13298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/18/2023]
Abstract
Brain structural abnormalities in idiopathic restless legs syndrome have long been debated. Voxel-based morphometry is an objective structural magnetic resonance imaging technique to investigate regional grey matter volume or density differences between groups. In the last decade, voxel-based morphometry studies have exhibited inconsistent and conflicting findings regarding the presence and localization of brain grey matter alterations in restless legs syndrome. We therefore conducted a coordinate-based meta-analysis to quantitatively examine whether there were consistent grey matter findings in restless legs syndrome using the latest algorithms, seed-based d mapping with permutation of subject images. We included 12 voxel-based morphometry studies (13 datasets, 375 patients and 385 healthy controls). Our coordinate-based meta-analysis did not identify evidence of consistent grey matter alterations in restless legs syndrome. Grey matter alterations via voxel-based morphometry analysis are not therefore recommended to be used as a reliable surrogate neuroimaging marker for restless legs syndrome. This lack of consistency may be attributed to differences in sample size, genetics, gender distribution and age at onset, clinical heterogeneity (clinical course, anatomical distribution of symptoms, disease severity, disease duration, abnormal sensory profiles and comorbidity), and variations in imaging acquisition, data processing and statistical strategies. Longitudinal studies with multimodal neuroimaging techniques are needed to determine whether structural changes are dynamic and secondary to functional abnormalities.
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Affiliation(s)
- LiQin Sheng
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - PanWen Zhao
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - HaiRong Ma
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Liang Qi
- Second People's Hospital of Huai'an City, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, China
| | - ZhongQuan Yi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - YuanYuan Shi
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - HaiCun Shi
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - ZhenYu Dai
- Department of Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China.,Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
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9
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Shi GM, Wang XR, Xu W, Guo MW, Ding CQ, Zhou RJ. Pontine warning syndrome and restless legs syndrome secondary to paramedian pontine infarction: a case report. Int J Neurosci 2020; 132:881-884. [PMID: 33175613 DOI: 10.1080/00207454.2020.1849187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pontine warning syndrome (PWS) occurs rarely and is characterized by recurrent, stereotyped episodes of motor or sensory dysfunction, dysarthria, or ophthalmoplegia leading to pontine infarction. Restless legs syndrome (RLS) is a distinct neurological sensorimotor disorder. Pontine infarction is a rare but possible cause of RLS. Here, we report the case of a 58-year-old woman who experienced unilateral RLS in concomitance with stereotyped episodes of left-sided weakness and dysarthria, and developed an acute paramedian pontine infarction eventually. To the best of our knowledge, no other cases of PWS coinciding with RLS in the progression of pontine infarction have been reported in the literature. Furthermore, we discussed the potential mechanisms of PWS and RLS secondary to pontine infarction, which may be helpful for managing such patients.
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Affiliation(s)
- Guo-Mei Shi
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, China
| | - Xiao-Rong Wang
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, China
| | - Wu Xu
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, China
| | - Min-Wang Guo
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, China
| | - Chun-Qin Ding
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, China
| | - Ru-Juan Zhou
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, China.,Department of Geriatrics Stroke Center, The Taixing People's Hospital, Taixing, Jiangsu, China
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10
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Altered cortical gray matter volume and functional connectivity after transcutaneous spinal cord direct current stimulation in idiopathic restless legs syndrome. Sleep Med 2020; 74:254-261. [DOI: 10.1016/j.sleep.2020.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 01/18/2023]
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11
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de Paiva JPQ, Magalhães SC, Moura LM, Sato JR, Amaro E, Sterr A, Schlaffke L, Eckeli AL, do Prado GF, Conforto AB. Sensorimotor white matter projections and disease severity in primary Restless Legs Syndrome/Willis-Ekbom disease: a multimodal DTI analysis. Sleep Med 2020; 73:106-116. [PMID: 32805477 DOI: 10.1016/j.sleep.2020.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Restless Legs Syndrome, a potentially disabling sleep disorder, also known as Willis-Ekbom disease (RLS/WED), may be caused by loss of inhibitory modulation of descending central motor pathways, structural changes in the somatosensory cortex, abnormal connectivity between motor and sensory areas, as well as by subtle abnormalities in white matter micro-organization. OBJECTIVE To compare diffusion-tensor imaging (DTI) metrics in areas associated with sensory or motor function, as well as sensorimotor integration, between subjects with primary mild-to-severe RLS/WED and controls. METHODS DTI metrics were assessed in 38 subjects with RLS/WED (14 mild to moderate, 24 severe to very severe) and 24 healthy age-matched controls with whole-brain Tract Based Spatial Statistics (TBSS), Region-of-interest (ROI) and probabilistic tractography based analyses. The ROIs corresponded to the corticospinal tract (CST) at the level of the cerebral peduncle; the superior, middle and inferior cerebellar peduncles. Subgroup analyses were made according to the severity of RLS/WED symptoms. The corticospinal tract was evaluated with probabilistic tractography. We also explored associations between significant findings and severity of symptoms with the Spearman's correlation coefficient. RESULTS TBSS analysis revealed decreased axial diffusivity (AD) in the left posterior thalamic radiation in RLS/WED. In subjects with severe RLS/WED, AD was reduced in the left posterior corona radiata and this reduction was negatively correlated with severity of symptoms. ROI-based analysis showed that radial diffusivity (RD) was increased in the superior cerebellar peduncles of individuals with severe RLS/WED. Tractography did not show between-group or subgroup differences. CONCLUSIONS Our results are consistent with subtle white matter changes, prominently in RLS/WED subjects with more severe symptoms, in areas related to sensory or motor function, as well as to sensorimotor integration, compared to controls. These findings support the hypothesis, raised by prior pathophysiological studies, of defective integration within these networks.
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Affiliation(s)
- Joselisa Péres Queiroz de Paiva
- Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Imaging Research Center, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil.
| | - Samir Câmara Magalhães
- Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Universidade de Fortaleza (UNIFOR), Unifor, Fortaleza, CE, Brazil
| | - Luciana Monteiro Moura
- Imaging Research Center, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - João Ricardo Sato
- Center for Mathematics, Computing and Cognition, Universidade Federal do ABC (UFABC), São Bernardo do Campo, SP, Brazil
| | - Edson Amaro
- Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Imaging Research Center, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Annette Sterr
- School of Psychology, University of Surrey, Guildford, UK
| | - Lara Schlaffke
- Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Alan Luiz Eckeli
- Department of Neurosciences and Behavioral Sciences, Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Adriana Bastos Conforto
- Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Sigirli D, Gunes A, Turan Ozdemir S, Ercan I, Durmus Y, Erdemli Gursel B. Statistical shape analysis of corpus callosum in restless leg syndrome. Neurol Res 2020; 42:760-766. [PMID: 32496941 DOI: 10.1080/01616412.2020.1773631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES In this study we aimed to investigate corpus callosum shape differences between restless leg syndrome patients and healthy controls, and to determine whether disease severity and duration are indicators for corpus callosum deformation in RLS patients. METHODS This study was conducted using the magnetic resonance imaging scans of 33 restless leg syndrome patients and 33 control subjects. Landmarks were marked on the digital images and callosal landmark coordinate data were used to assess shape difference by performing Generalized Procrustes analysis. The shape deformation from controls to the patients was evaluated performing the Thin Plate Spline approach. RESULTS There was a statistically significant shape difference between the groups. Highest deformation was determined at the posterior midbody of the corpus callosum. Growth curve analyses showed that with the increase in disease duration and severity, the CC size decreased. DISCUSSION The present study demonstrated callosal shape differences in restless leg syndrome using a landmark-based geometric morphometric approach, considering the topographic distribution of corpus callosum for the first time.
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Affiliation(s)
- Deniz Sigirli
- Department of Biostatistics, Medicine, Bursa Uludag University , Bursa, Turkey
| | - Aygul Gunes
- Department of Neurology, Bursa Yuksek Ihtisas Education and Training Hospital, University of Health Sciences , Bursa, Turkey
| | | | - Ilker Ercan
- Department of Biostatistics, Medicine, Bursa Uludag University , Bursa, Turkey
| | - Yavuz Durmus
- Department of Radiology, Bursa Yuksek Ihtisas Education and Training Hospital, University of Health Sciences , Bursa, Turkey
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13
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Xu Z, Han T, Li T, Zhang X, Huang Z, Zhan S, Liu C, Xu J, Wang Y. Increased Gray Matter Density and Functional Connectivity of the Pons in Restless Legs Syndrome. Nat Sci Sleep 2020; 12:221-230. [PMID: 32273784 PMCID: PMC7102916 DOI: 10.2147/nss.s239852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/07/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Neurophysiological and radiological studies provide accumulating evidence for the involvement of the brainstem in the pathogenesis of restless legs syndrome (RLS). The analysis of the various subregions of the brainstem may help us better understand the pathophysiological mechanisms underlying the disorder. In this study, we investigated the structural and functional changes in the various subregions of the brainstem in RLS patients. METHODS The subregional changes in gray matter density and functional connectivity in the brainstem were analyzed in 20 drug-naive idiopathic RLS patients, as well as 18 normal control (NC) subjects for comparison. Correlation analyses and multivariate pattern analyses using linear support vector machine (SVM) were conducted. RESULTS We found significantly increased gray matter density in two clusters in the pons (designated pons_1 and pons_2) and in one cluster in the midbrain in RLS patients compared with NC subjects. Further functional connectivity analyses revealed significantly decreased functional connectivity between the midbrain and the right middle occipital gyrus, between pons_1 and the right orbital part of the superior frontal gyrus, and between pons_2 and the right parahippocampus in RLS compared with NC. Moreover, the functional connectivity between pons_2 and the right supplementary motor area (SMA) was significantly increased in RLS compared with NC. This change in RLS was marginally correlated with RS_RLS scores in the RLS patients. SVM-based classification showed an AUC of 0.955 using gray matter density of pons_2, and functional connectivity between pons_2 and SMA as features. CONCLUSION Collectively, our findings suggest that changes in gray matter density and functional connectivity in the pons may play a pathologic role in RLS. Furthermore, these abnormal changes in the pons might help to discriminate RLS from healthy subjects.
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Affiliation(s)
- Zhexue Xu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation, Beijing 100053, People's Republic of China
| | - Tao Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation, Beijing 100053, People's Republic of China
| | - Tian Li
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Xiaodong Zhang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation, Beijing 100053, People's Republic of China
| | - Shuqin Zhan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation, Beijing 100053, People's Republic of China
| | - Chunyan Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation, Beijing 100053, People's Republic of China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, People's Republic of China.,Beijing Key Laboratory of Neuromodulation, Beijing 100053, People's Republic of China
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14
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Magalhães SC, Queiroz de Paiva JP, Kaelin-Lang A, Sterr A, Eckeli AL, Winkler AM, Fernandes do Prado G, Amaro E, Conforto AB. Short-interval intracortical inhibition is decreased in restless legs syndrome across a range of severity. Sleep Med 2019; 62:34-42. [PMID: 31539846 DOI: 10.1016/j.sleep.2019.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Decreased short-interval intracortical inhibition (SICI) to transcranial magnetic stimulation (TMS) of the primary motor cortex was described in subjects with restless legs syndrome/Willis-Ekbom disease (RLS/WED). It remained to be determined whether the magnitude of SICI decrease would be similar across levels of RLS/WED severity. Moreover, it was unknown whether, in addition to decreases in SICI, changes in cortical thickness or area could be detected in subjects with RLS/WED compared to controls. The objective of this study was to compare SICI, cortical thickness, and cortical area in subjects with idiopathic mild to moderate RLS/WED, severe to very severe RLS/WED, and controls. METHODS The severity of RLS/WED was assessed by the International Restless Legs Syndrome Severity Scale (IRLSS). SICI and 3T magnetic resonance imaging (MRI) data of subjects with RLS/WED and controls were compared. A receiver operating characteristic curve for SICI was designed for discrimination of participants with RLS/WED from controls. Cortical thickness and area were assessed by automated surface-based analysis. RESULTS SICI was significantly reduced in patients with mild to moderate and severe to very severe RLS/WED, compared to controls (one-way analysis of variance: F = 9.62, p < 0.001). Receiver operating characteristic curve analysis predicted RLS/WED when SICI was above 35% (area under the curve = 0.79, 95% CI 0.67-0.91, p < 0.001). Analyses of the whole brain and of regions of interest did not reveal differences in gray matter thickness or area between controls and subjects with RLS/WED. CONCLUSION SICI is an accurate cortical biomarker that can support the diagnosis of RLS/WED even in subjects with mild symptoms, but cortical thickness and area were not useful for discriminating subjects with this condition from controls.
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Affiliation(s)
- Samir Câmara Magalhães
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Universidade de Fortaleza, Unifor, Fortaleza, CE, Brazil.
| | | | | | - Annette Sterr
- Department of Psychology, University of Surrey, Guildford, Surrey, UK
| | - Alan Luiz Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Divisão de Neurologia, Hospital das Clínicas da Faculdade de Medicina da USP-Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | | | - Edson Amaro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Departamento de Radiologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana Bastos Conforto
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Departamento de Neurologia, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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Li T, Liu C, Lyu H, Xu Z, Hu Q, Xu B, Wang Y, Xu J. Alterations of Sub-cortical Gray Matter Volume and Their Associations With Disease Duration in Patients With Restless Legs Syndrome. Front Neurol 2018; 9:1098. [PMID: 30619055 PMCID: PMC6304426 DOI: 10.3389/fneur.2018.01098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023] Open
Abstract
Object: The purpose of this study was to uncover the pathology of restless legs syndrome (RLS) by exploring brain structural alterations and their corresponding functional abnormality. Method: Surface-based morphometry (SBM) and voxel-based morphometry (VBM) were performed to explore the alterations in cortical and sub-cortical gray matter volume (GMV) in a cohort of 20 RLS and 18 normal controls (NC). Furthermore, resting-state functional connectivity (RSFC) was also performed to identify the functional alterations in patients with RLS. Results: We found significant alterations of sub-cortical GMV, especially the bilateral putamen (PUT), rather than alterations of cortical GMV in patients with RLS compared to NC using both SBM and VBM. Further sub-regional analysis revealed that GMV alterations of PUT was mostly located in the left dorsal caudal PUT in patients with RLS. In addition, altered RSFC patterns of PUT were identified in patients with RLS compared to NC. Moreover, correlation analyses showed that the GMV of the left caudate and the left ventral rostral PUT were positively correlated with disease duration in patients with RLS. Conclusions: The alterations of subcortical GMV might imply that the primarily affected areas are located in sub-cortical areas especially in the sub-region of PUT by the pathologic process of RLS, which might be used as potential biomarkers for the early diagnosis of RLS.
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Affiliation(s)
- Tian Li
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China.,Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Chunyan Liu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Hanqing Lyu
- Radiology Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhexue Xu
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bibo Xu
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
| | - Yuping Wang
- Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neuromodulation, Beijing, China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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16
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Yang H, Wang L, Li X, Wang K, Hou Y, Zhang X, Chen Z, Liu C, Yin C, Wu S, Huang Q, Lin Y, Bao Y, Chen Y, Wang Y. A study for the mechanism of sensory disorder in restless legs syndrome based on magnetoencephalography. Sleep Med 2018; 53:35-44. [PMID: 30414507 DOI: 10.1016/j.sleep.2018.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
In spite of the relatively high incidence rate, the etiology and pathogenesis of restless legs syndrome (RLS) are still unclear. Long-term drug treatments fail to achieve satisfying curative effects, which is reflected by rebound and augmentation of related symptoms. An electrophysiological endophenotype experiment was done to investigate the mechanism of somatosensory disorder among RLS patients. Together with 15 normal subjects as the control group, with comparable ages and genders to the RLS patients, 15 primitive RLS patients were scanned by Magnetoencephalography (MEG) under natural conditions; furthermore, the somatosensory evoked magnetic field (SEF) with single and paired stimuli, was also measured. Compared to the control group, the SEF intensities of RLS patients' lower limbs were higher, and the paired-pulse depression (PPD) for SEF in RLS patients was attenuated. It was also revealed by time-frequency analysis of somatosensory induced oscillation (SIO) in RLS patients, that 93.3% of somatosensory induced Alpha (8-12 Hz) oscillations were successfully elicited, while 0% somatosensory induced Gamma (30-55 Hz) oscillations were elicited; which was significantly different from the control group. Additionally, in RLS patients exhibit increased excitability of the sensorimotor cortex, a remarkable abnormality existing in early somatosensory gating control (GC) and an attenuated inhibitory interneuron network, which consequently results in a compensatory mechanism through which RLS patients increase their attention-driven lower limb sensory gating control via somatosensory-induced Alpha (8-12 Hz) oscillation. This hyperexcitability, partially due to an electrocortical disinhibition, may have an important therapeutical implication, and become an important target of neuromodulatory interventions.
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Affiliation(s)
- Haoxiang Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Li Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Xin Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Kun Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Xiating Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Zheng Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Chunyan Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Chunli Yin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Siqi Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Qian Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Yicong Lin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Yan Bao
- Department of Nuclear Magnetic Resonance, Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yuanyuan Chen
- Department of Nuclear Magnetic Resonance, Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; The Beijing Key Laboratory of Neuromodulation, Beijing, 100053, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China.
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Yousaf T, Pagano G, Wilson H, Politis M. Neuroimaging of Sleep Disturbances in Movement Disorders. Front Neurol 2018; 9:767. [PMID: 30323786 PMCID: PMC6141751 DOI: 10.3389/fneur.2018.00767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 08/23/2018] [Indexed: 01/18/2023] Open
Abstract
Sleep dysfunction is recognized as a distinct clinical manifestation in movement disorders, often reported early on in the disease course. Excessive daytime sleepiness, rapid eye movement sleep behavior disorder and restless leg syndrome, amidst several others, are common sleep disturbances that often result in significant morbidity. In this article, we review the spectrum of sleep abnormalities across atypical Parkinsonian disorders including multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS), as well as Parkinson's disease (PD) and Huntington's disease (HD). We also explore the current concepts on the neurobiological underpinnings of sleep disorders, including the role of dopaminergic and non-dopaminergic pathways, by evaluating the molecular, structural and functional neuroimaging evidence based on several novel techniques including magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), single-photon emission computed tomography (SPECT) and positron emission tomography (PET). Based on the current state of research, we suggest that neuroimaging is an invaluable tool for assessing structural and functional correlates of sleep disturbances, harboring the ability to shed light on the sleep problems attached to the limited treatment options available today. As our understanding of the pathophysiology of sleep and wake disruption heightens, novel therapeutic approaches are certain to transpire.
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Affiliation(s)
- Tayyabah Yousaf
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gennaro Pagano
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Heather Wilson
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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18
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Pandey AK, Ardekani BA, Kamarajan C, Zhang J, Chorlian DB, Byrne KNH, Pandey G, Meyers JL, Kinreich S, Stimus A, Porjesz B. Lower Prefrontal and Hippocampal Volume and Diffusion Tensor Imaging Differences Reflect Structural and Functional Abnormalities in Abstinent Individuals with Alcohol Use Disorder. Alcohol Clin Exp Res 2018; 42:1883-1896. [PMID: 30118142 DOI: 10.1111/acer.13854] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 07/25/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) is known to have adverse effects on brain structure and function. Multimodal assessments investigating volumetric, diffusion, and cognitive characteristics may facilitate understanding of the consequences of long-term alcohol use on brain circuitry, their structural impairment patterns, and their impact on cognitive function in AUD. METHODS Voxel- and surface-based volumetric estimations, diffusion tensor imaging (DTI), and neuropsychological tests were performed on 60 individuals: 30 abstinent individuals with AUD (DSM-IV) and 30 healthy controls. Group differences in the volumes of cortical and subcortical regions, fractional anisotropy (FA), axial and radial diffusivities (AD and RD, respectively), and performance on neuropsychological tests were analyzed, and the relationship among significantly different measures was assessed using canonical correlation. RESULTS AUD participants had significantly smaller volumes in left pars orbitalis, right medial orbitofrontal, right caudal middle frontal, and bilateral hippocampal regions, lower FA in 9 white matter (WM) regions, and higher FA in left thalamus, compared to controls. In AUD, lower FA in 6 of 9 WM regions was due to higher RD and due to lower AD in the left external capsule. AUD participants scored lower on problem-solving ability, visuospatial memory span, and working memory. Positive correlations of prefrontal cortical, left hippocampal volumes, and FA in 4 WM regions with visuospatial memory performance and negative correlation with lower problem-solving ability were observed. Significant positive correlation between age and FA was observed in bilateral putamen. CONCLUSIONS Findings showed specific structural brain abnormalities to be associated with visuospatial memory and problem-solving ability-related impairments observed in AUD. Higher RD in 6 WM regions suggests demyelination, and lower AD in left external capsule suggests axonal loss in AUD. The positive correlation between FA and age in bilateral putamen may reflect accumulation of iron depositions with increasing age.
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Affiliation(s)
- Ashwini Kumar Pandey
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Babak Assai Ardekani
- Computational Neuroimaging Laboratories of the Center for Biomedical Imaging and Neuromodulation (C-BIN), The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Chella Kamarajan
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Jian Zhang
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - David Balin Chorlian
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Kelly Nicole-Helen Byrne
- Computational Neuroimaging Laboratories of the Center for Biomedical Imaging and Neuromodulation (C-BIN), The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Gayathri Pandey
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Jacquelyn Leigh Meyers
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Sivan Kinreich
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Arthur Stimus
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
| | - Bernice Porjesz
- Henri Begleiter Neurodynamics Laboratory, Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York
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Hermesdorf M, Sundermann B, Rawal R, Szentkirályi A, Dannlowski U, Berger K. Lack of Association Between Shape and Volume of Subcortical Brain Structures and Restless Legs Syndrome. Front Neurol 2018; 9:355. [PMID: 29867753 PMCID: PMC5968110 DOI: 10.3389/fneur.2018.00355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/01/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Previous studies on patients with restless legs syndrome (RLS) yielded inconclusive results in the magnetic resonance imaging (MRI)-based analyses of alterations of subcortical structures in the brain. The aim of this study was to compare volumes as well as shapes of subcortical structures and the hippocampus between RLS cases and controls. Additionally, the associations between the genetic risks for RLS and subcortical volumes were investigated. Methods We compared volumetric as well as shape differences assessed by 3 T MRI in the caudate nucleus, hippocampus, globus pallidus, putamen, and thalamus in 39 RLS cases versus 117 controls, nested within a population-based sample. In a subsample, we explored associations between known genetic risk markers for RLS and the volumes of the subcortical structures and the hippocampus. Results No significant differences between RLS cases and controls in subcortical and hippocampal shapes and volumes were observed. Furthermore, the genetic risk for RLS was unrelated to any alterations of subcortical and hippocampal gray matter volume. Interpretation We conclude that neither RLS nor the genetic risk for the disease give rise to changes in hippocampal and subcortical shapes and gray matter volumes.
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Affiliation(s)
- Marco Hermesdorf
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Benedikt Sundermann
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Rajesh Rawal
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - András Szentkirályi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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20
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Lee BY, Kim J, Connor JR, Podskalny GD, Ryu Y, Yang QX. Involvement of the central somatosensory system in restless legs syndrome. Neurology 2018; 90:e1834-e1841. [DOI: 10.1212/wnl.0000000000005562] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/23/2018] [Indexed: 01/18/2023] Open
Abstract
ObjectiveTo investigate morphologic changes in the somatosensory cortex and the thickness of the corpus callosum subdivisions that provide interhemispheric connections between the 2 somatosensory cortical areas.MethodsTwenty-eight patients with severe restless legs syndrome (RLS) symptoms and 51 age-matched healthy controls were examined with high-resolution MRI at 3.0 tesla. The vertex-wise analysis in conjunction with a novel cortical surface classification method was performed to assess the cortical thickness across the whole-brain structures. In addition, the thickness of the midbody of the corpus callosum that links postcentral gyri in the 2 hemispheres was measured.ResultsWe demonstrated that a morphologic change occurred in the brain somatosensory system in patients with RLS compared to controls. Patients with RLS exhibited a 7.5% decrease in average cortical thickness in the bilateral postcentral gyrus (p < 0.0001). Accordingly, there was a substantial decrease in the corpus callosum posterior midbody (p < 0.008) wherein the callosal fibers are connected to the postcentral gyrus, suggesting altered white matter properties in the somatosensory pathway.ConclusionOur results provide in vivo evidence of morphologic changes in the primary somatosensory system, which could be responsible for the sensory functional symptoms of RLS. These results provide a better understanding of the pathophysiology underlying the RLS sensory symptoms and could lead to a potential imaging marker for RLS.
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21
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Rizzo G, Plazzi G. Neuroimaging Applications in Restless Legs Syndrome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 143:31-64. [DOI: 10.1016/bs.irn.2018.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Zhuo Y, Wu Y, Xu Y, Lu L, Li T, Wang X, Li K. Combined resting state functional magnetic resonance imaging and diffusion tensor imaging study in patients with idiopathic restless legs syndrome. Sleep Med 2017; 38:96-103. [DOI: 10.1016/j.sleep.2017.06.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
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Yousaf T, Wilson H, Politis M. Imaging the Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:179-257. [PMID: 28802921 DOI: 10.1016/bs.irn.2017.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is acknowledged to be a multisystem syndrome, manifesting as a result of multineuropeptide dysfunction, including dopaminergic, cholinergic, serotonergic, and noradrenergic deficits. This multisystem disorder ultimately leads to the presentation of a range of nonmotor symptoms, now appreciated to be an integral part of the disease-specific spectrum of symptoms, often preceding the diagnosis of motor Parkinson's disease. In this chapter, we review the dopaminergic and nondopaminergic basis of these symptoms by exploring the neuroimaging evidence based on several techniques including positron emission tomography, single-photon emission computed tomography molecular imaging, magnetic resonance imaging, functional magnetic resonance imaging, and diffusion tensor imaging. We discuss the role of these neuroimaging techniques in elucidating the underlying pathophysiology of NMS in Parkinson's disease.
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Affiliation(s)
- Tayyabah Yousaf
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Heather Wilson
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Marios Politis
- Neurodegeneration Imaging Group, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
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Rizzo G, Li X, Galantucci S, Filippi M, Cho YW. Brain imaging and networks in restless legs syndrome. Sleep Med 2016; 31:39-48. [PMID: 27838239 DOI: 10.1016/j.sleep.2016.07.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 01/18/2023]
Abstract
Several studies provide information useful to our understanding of restless legs syndrome (RLS), using various imaging techniques to investigate different aspects putatively involved in the pathophysiology of RLS, although there are discrepancies between these findings. The majority of magnetic resonance imaging (MRI) studies using iron-sensitive sequences supports the presence of a diffuse, but regionally variable low brain-iron content, mainly at the level of the substantia nigra, but there is increasing evidence of reduced iron levels in the thalamus. Positron emission tomography (PET) and single positron emission computed tomography (SPECT) findings mainly support dysfunction of dopaminergic pathways involving not only the nigrostriatal but also mesolimbic pathways. None or variable brain structural or microstructural abnormalities have been reported in RLS patients; reports are slightly more consistent concerning levels of white matter. Most of the reported changes were in regions belonging to sensorimotor and limbic/nociceptive networks. Functional MRI studies have demonstrated activation or connectivity changes in the same networks. The thalamus, which includes different sensorimotor and limbic/nociceptive networks, appears to have lower iron content, metabolic abnormalities, dopaminergic dysfunction, and changes in activation and functional connectivity. Summarizing these findings, the primary change could be the reduction of brain iron content, which leads to dysfunction of mesolimbic and nigrostriatal dopaminergic pathways, and in turn to a dysregulation of limbic and sensorimotor networks. Future studies in RLS should evaluate the actual causal relationship among these findings, better investigate the role of neurotransmitters other than dopamine, focus on brain networks by connectivity analysis, and test the reversibility of the different imaging findings following therapy.
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Affiliation(s)
- Giovanni Rizzo
- IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy; Unit of Neurology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Xu Li
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sebastiano Galantucci
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Yong Won Cho
- Department of Neurology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, South Korea.
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Gorges M, Rosskopf J, Müller HP, Lindemann K, Hornyak M, Kassubek J. Patterns of increased intrinsic functional connectivity in patients with restless legs syndrome are associated with attentional control of sensory inputs. Neurosci Lett 2016; 617:264-9. [PMID: 26921454 DOI: 10.1016/j.neulet.2016.02.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Potential alterations of intrinsic functional connectivity in idiopathic restless legs syndrome (RLS) are to be assumed since RLS is considered a network disorder. Whole-brain-based investigation of intrinsic functional connectivity networks including the sensorimotor systems in patients with RLS was compared with matched healthy controls. METHODS 'Resting-state' functional MRI (1.5 T) from 26 patients with RLS and 26 matched controls were analyzed using standardized seed-based analysis procedures. The motor/sensorimotor, sensory thalamic, ventral and dorsal attention, basal ganglia-thalamic, cingulate, and brainstem networks were used for voxel-based group comparisons between RLS patients and controls. RESULTS Significantly increased connectivities were observed in the sensory thalamic, ventral and dorsal attention, basal ganglia-thalamic, and cingulate networks in RLS patients, whereas no differences could be demonstrated for the motor/sensorimotor and the brainstem system. The pattern of functional connectivity alterations was positively correlated with increasing symptom severity. CONCLUSIONS Abnormally increased regional BOLD synchronization appears to be a key feature of intrinsic brain architecture in RLS. Alterations in cortical and sub-cortical functional networks support the notion that the underlying pathophysiology of RLS is beyond the sensorimotor and the brainstem system and may be also associated with altered attentional control of sensory inputs.
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Affiliation(s)
- Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | | | - Magdolna Hornyak
- Department of Neurology, University of Ulm, Ulm, Germany; Neuropsychiatry Centre Erding/München, Erding, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany.
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