Repetitive Transcranial Magnetic Stimulation for the Treatment of Restless Legs Syndrome

Abstract

Background:Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique used to alter cortex excitability that has been proposed as an efficient method for treating brain hyperexcitability or hypoexcitability disorders. The aim of this study was to investigate whether high-frequency rTMS could have any beneficial effects in restless legs syndrome (RLS).Methods:Fourteen patients with RLS were given high-frequency rTMS (15 Hz, 100% motor threshold) to the leg representation motor cortex area of the frontal lobe for 14 sessions over 18 days. Patients were diagnosed according to the international criteria proposed by the International Restless Legs Syndrome Study Group in 2003. The International RLS Rating Scale (IRLS-RS), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale were used to evaluate the severity of RLS, sleep quality, anxiety and depression, respectively. The scale scores were evaluated at four-time points (baseline, end of the 14th session, and at 1- and 2-month posttreatment). One-way analysis of variance was used to compare scale scores at different time points.Results:There was significant improvement in the IRLS-RS (from 23.86 ± 5.88 to 11.21 ± 7.23, P < 0.05), PSQI (from 15.00 ± 4.88 to 9.29 ± 3.91, P < 0.05), and HAMA (from 17.93 ± 7.11 to 10.36 ± 7.13, P < 0.05) scale scores at the end of 14th session, with ongoing effects lasting for at least 2 months.Conclusions:High-frequency rTMS can markedly alleviate the motor system symptoms, sleep disturbances, and anxiety in RLS patients. These results suggest that rTMS might be an option for treating RLS.

Clinical and electrophysiological impact of repetitive low-frequency transcranial magnetic stimulation on the sensory–motor network in patients with restless legs syndrome

“…Each train consisted of 50 stimuli with an intertrain interval of 30 s, giving a total of 1000 stimuli per session. This setup is consistent with those employed in previous rTMS studies in RLS patients, 72 – 74 although the parameter configuration and stimulation modalities were specifically customized.…”

“… 72 Similar results were found using 2-week sessions of high-frequency rTMS on the leg cortical representation, with long-lasting improvement of motor symptoms, sleep disturbances, and anxiety. 74 Finally, high-frequency rTMS delivered to the leg area of M1 may raise functional activity in the sensory–motor and occipital regions, leading to symptom improvement and providing intriguing insights into RLS pathophysiology. 73 Nevertheless, it was speculated that low-frequency rTMS might be even more beneficial for RLS patients, in whom the corticospinal system is hyperexcitable.…”

Targeted disruption of supraspinal motor circuitry reveals a distributed network underlying Restless Legs Syndrome (RLS)-like movements in the rat

“…Moreover, strokes occurring within the BG, internal capsule, pons and cerebellum are strongly associated with the development of RLS 34 , 35 . Finally, transcranial magnetic stimulation (TMS) over motor cortex reduces RLS 36 , 37 . Thus it is likely that the anatomic, genetic and biochemical etiological bases of RLS is diverse.…”

Avaliação dos efeitos da estimulação magnética transcraniana repetitiva sobre a ansiedade em pacientes com lesão axonial difusa traumática

“…A IDATE Estado foi a escala escolhida para avaliação dos sintomas ansiosos em nosso estudo, corroborando com a literatura, esta também é uma das principais escalas utilizadas para avaliação dos sintomas de ansiedade (165,173,175,185).…”

“…A EMTr já é estabelecida como alternativa não invasiva de estimulação cerebral com estudos demonstrando ser uma ferramenta válida para medição das alterações plásticas do córtex cerebral, tem sido sugerida para o tratamento de diversas doenças neurológicas e psiquiátricas (5,6,146), principalmente para o tratamento da depressão (164,166,172,173,176,182,184), o que favoreceu o embasamento da escolha do protocolo de intervenção da EMTr desta pesquisa. Os níveis de ansiedade moderado e grave encontrados em nossa amostra também pode ter influenciado em nossos resultados, se tivéssemos definido apenas pacientes em nível grave, poderíamos ter obtido efeito de melhora diferente.…”