Effects of Transcutaneous Spinal Direct Current Stimulation in Idiopathic Restless Legs Patients

Heide, Anne-Catherine; Winkler, Tobias; Helms, Hans‐Joachim; Nitsche, Michael A.; Trenkwalder, Claudia; Paulus, Walter; Bachmann, Cornelius G.

doi:10.1016/j.brs.2014.06.008

Cited by 68 publications

(40 citation statements)

References 39 publications

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“…The authors concluded from this result that an intact endogenous opioid system and opioid treatment could prevent the dopamine system from dysfunction in iron deficiency patients (Sun et al, 2011). A study of tsDCS in RLS patients showed supportive evidence of spinal cord hyperexcitability (Heide et al, 2014). …”

Section: Pathophysiologymentioning

confidence: 99%

See 1 more Smart Citation

Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management

Guo

Huang

Jiang

et al. 2017

Front. Aging Neurosci.

123

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Restless legs syndrome (RLS), a common neurological sensorimotor disorder in western countries, has gained more and more attention in Asian countries. The prevalence of RLS is higher in older people and females. RLS is most commonly related to iron deficiency, pregnancy and uremia. The RLS symptoms show a significant circadian rhythm and a close relationship to periodic limb movements (PLMs) in clinical observations, while the pathophysiological pathways are still unknown. The diagnostic criteria have been revised in 2012 to improve the validity of RLS diagnosis. Recent studies have suggested an important role of iron decrease of brain in RLS pathophysiology. Dopaminergic (DA) system dysfunction in A11 cell groups has been recognized long ago from clinical treatment and autopsy. Nowadays, it is believed that iron dysfunction can affect DA system from different pathways and opioids have a protective effect on DA system. Several susceptible single nucleotide polymorphisms such as BTBD9 and MEIS1, which are thought to be involved in embryonic neuronal development, have been reported to be associated with RLS. Several pharmacological and non-pharmacological treatment are discussed in this review. First-line treatments of RLS include DA agents and α2δ agonists. Augmentation is very common in long-term treatment of RLS which makes prevention and management of augmentation very important for RLS patients. A combination of different types of medication is effective in preventing and treating augmentation. The knowledge on RLS is still limited, the pathophysiology and better management of RLS remain to be discovered.

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Section: Pathophysiologymentioning

confidence: 99%

“…Other non-pharmacological treatments have been proven to be effective in RLS. tsDCS showed a short-lasting clinical improvement in idiopathic RLS patients (Heide et al, 2014), while high-frequency rTMS resulted in an significant improvement in the motor symptoms and sleep disturbances in RLS patients (Lin Y.C. et al, 2015).…”

Section: Treatmentmentioning

confidence: 99%

Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management

Guo

Huang

Jiang

et al. 2017

Front. Aging Neurosci.

123

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“…[10][11][12][13] Numerous randomized controlled trials (RCTs) have investigated the optimal strategies for titration and optimal final doses. [14][15][16] Nevertheless, no RCTs have been used to guide the man agement of augmentation-the paradoxical worsening of RLS symptoms-which is the most important longterm adverse effect of dopaminergic therapy.…”

Section: Introductionmentioning

confidence: 99%

Restless legs syndrome—current therapies and management of augmentation

et al. 2015

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Idiopathic restless legs syndrome (RLS) can severely affect quality of life and disturb sleep, so that pharmacological treatment is necessary, especially for elderly patients. Treatment guidelines recommend initiation of therapy with dopamine agonists (pramipexole, ropinirole or the rotigotine transdermal patch, all approved in most countries) or α-2-δ ligands (gabapentin enacarbil, approved in the USA and Japan), depending on the country and availability. Where approved, opioids (prolonged release oxycodone-naloxone, approved in Europe) are also recommended as a second-line therapy for severe RLS. Several iron formulations can be effective but are not yet approved for RLS therapy, whereas benzodiazepines and other anticonvulsants are not recommended or approved. Less is known about effective management of RLS that is associated with other conditions, such as uraemia or pregnancy. Furthermore, very little data are available on the management of RLS when first-line treatment fails or patients experience augmentation. In this Review, we summarize state-of-the-art therapies for RLS in the context of the diagnostic criteria and available guidelines, based on knowledge ranging from Class I evidence for the treatment of idiopathic RLS to Class IV evidence for the treatment of complications such as augmentation. We consider therapies, including combination therapies, that are used in clinical practice for long-term management of RLS, despite a lack of trials and approval, and highlight the need for practical long-term evaluation of current trials.

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“…Additionally, symptom improvement was only measured once, immediately following the conclusion of rTMS therapy, so long-term evidence is lacking. Heide et al [9] showed that tsDCS-induced symptom alleviation was associated with decreased spinal excitability, although this effect lasted only a few hours and the patients restarted their medications the day following tsDCS. While these are both promising strategies, SCS in the patients presented here maintained its therapeutic effect on a longer timeline and did so with less direct interference from RLS medications.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation for Restless Legs Syndrome: Case Series and Mechanistic Hypothesis

Adil

Han

Parente

et al. 2019

Stereotact Funct Neurosurg

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Background: Spinal cord stimulation (SCS) is a well-established therapy for chronic pain syndromes, with growing applicability to other conditions. Restless legs syndrome (RLS) is a widespread, chronic movement disorder managed primarily and incompletely by medication, and its etiology can be classified as idiopathic or secondary. Methods: Three patients underwent SCS implantation for chronic back and/or leg pain with concomitant targeting of RLS: (1) a 34-year-old man with sporadic RLS symptoms that strongly intensified after military-related spinal fractures, (2) a 54-year-old man with RLS likely secondary to meralgia paresthetica, and (3) a 42-year-old man with low back and right lower extremity pain after a military motor vehicle accident. Results: Continuing through 40-month, 2-month, and 28-month follow-ups, respectively, the patients experienced exemplary relief of their RLS symptoms. Notably in the case of patient 1, this benefit appears separate from his pain relief, as during the 5-month period directly after surgery but before adjusted targeting, he only experienced pain alleviation. Conclusions: To our knowledge, this is the first reported case of using SCS as a potentially long-lasting, safe, and highly effective therapy for RLS of mixed etiology. Additionally, 2 patients with RLS possibly secondary to chronic pain also benefited from the therapy. This success may be due to increased inhibition from hypothalamic cells controlling dopaminergic input to the spine.

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Effects of Transcutaneous Spinal Direct Current Stimulation in Idiopathic Restless Legs Patients

Cited by 68 publications

References 39 publications

Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management

Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management

Restless legs syndrome—current therapies and management of augmentation

Spinal Cord Stimulation for Restless Legs Syndrome: Case Series and Mechanistic Hypothesis

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