Phenotypes and course of restless legs syndrome in acute stroke survivors - a prospective observational cohort study

The objective of this study was to determine Restless legs syndrome (RLS) phenotypes and course in patients with recent acute stroke and evaluate the relationship with different cardio-cerebrovascular factors.

Consecutive acute stroke patients were recruited from the stroke unit of the Kingston Health Sciences Centre, Canada. A pre-determined sleep questionnaire was administered, and details of stroke, brain imaging and hematological investigations were collected from the hospital database for analysis. RLS diagnosis was confirmed in accordance with the criteria determined by the International Restless Legs Syndrome Study Group.

Out of 113 acute stroke patients that could be enrolled, 30 patients (26 %) could be diagnosed as RLS, the majority of them being women. Among these, 6 patients (20 %; 5.3 % of entire acute stroke cohort) presented with acute onset symptoms, while 24 (80 %; 21 % of entire stroke cohort) had chronic RLS. Half of these patients showed similar or worsening RLS symptoms upon a three-to-six-month follow-up. RLS diagnosis showed a statistically significant association with subcortical stroke location (p = 0.006; OR3.4 95 % CI1.4-8.1) and cerebral small vessel disease (CSVD)(p = 0.0006; OR4.6 95 %CI 1.9-11.3).

In this prospective observational follow-up study, we observed three distinct RLS phenotypes - chronic bilateral, chronic unilateral and acute, along with association of RLS with subcortical brain location of the stroke and CSVD. Symptom persistence beyond 6 months post-stroke was observed in almost half of those with an RLS diagnosis. Observations from this study can provide a framework for structured diagnostic and treatment strategies for RLS among stroke survivors.