Restless legs syndrome due to brainstem stroke: A systematic review

Area of Science:

• Neurology
• Sleep Medicine
• Vascular Neurology

Background:

• Restless Legs Syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs.
• Brainstem pathology can precipitate RLS symptoms, a less common etiology than primary RLS.
• Brainstem strokes, particularly involving the pons, are increasingly recognized as a cause of secondary RLS.

Purpose of the Study:

• To systematically review and summarize the existing literature on Restless Legs Syndrome associated with brainstem stroke.
• To analyze the clinical characteristics, location of infarction, and outcomes of RLS following brainstem stroke.
• To evaluate the efficacy of dopaminergic treatment in RLS secondary to brainstem infarction.

Main Methods:

• A systematic review of articles was performed using PubMed and Web of Science databases.
• Included studies focused on patients diagnosed with RLS secondary to brainstem ischemic lesions.
• Data extracted included symptom onset, infarction location, affected limbs, and treatment response.

Main Results:

• Eight articles comprising 19 subjects with RLS due to brainstem infarction were identified.
• The most frequent infarction site was the pons, often leading to unilateral RLS symptoms, typically affecting the contralateral limb.
• RLS symptoms resolved or improved in nearly 90% of cases within 3 months, with significant improvement or resolution in 91.7% of patients receiving dopaminergic therapy.

Conclusions:

• Brainstem stroke, especially anteromedial pontine infarction, should be considered in patients presenting with acute RLS symptoms.
• The onset of acute unilateral RLS, often with sensorimotor deficits, warrants investigation for a brainstem vascular event.
• RLS secondary to brainstem stroke generally has a favorable prognosis and responds well to dopaminergic treatment.