Nerve Decompression and Restless Legs Syndrome: A Retrospective Analysis

Overview

Journal Front Neurol

Specialty Neurology

Date 2017 Jul 22

PMID 28729849

Citations 1

Authors

James C Anderson

Megan L Fritz

John-Michael Benson

Brian L Tracy

Affiliations

Soon will be listed here.

Abstract

Introduction: Restless legs syndrome (RLS) is a prevalent sleep disorder affecting quality of life and is often comorbid with other neurological diseases, including peripheral neuropathy. The mechanisms related to RLS symptoms remain unclear, and treatment options are often aimed at symptom relief rather than etiology. RLS may present in distinct phenotypes often described as "primary" vs. "secondary" RLS. Secondary RLS is often associated with peripheral neuropathy. Nerve decompression surgery of the common and superficial fibular nerves is used to treat peripheral neuropathy. Anecdotally, surgeons sometimes report improved RLS symptoms following nerve decompression for peripheral neuropathy. The purpose of this retrospective analysis was to quantify the change in symptoms commonly associated with RLS using visual analog scales (VAS).

Methods: Forty-two patients completed VAS scales (0-10) for pain, burning, numbness, tingling, weakness, balance, tightness, aching, pulling, cramping, twitchy/jumpy, uneasy, creepy/crawly, and throbbing, both before and 15 weeks after surgical decompression.

Results: Subjects reported significant improvement among all VAS categories, except for "pulling" ( = 0.14). The change in VAS following surgery was negatively correlated with the pre-surgery VAS for both the summed VAS ( = -0.58, < 0.001) and the individual VAS scores (all < 0.01), such that patients who reported the worst symptoms before surgery exhibited relatively greater reductions in symptoms after surgery.

Conclusion: This is the first study to suggest improvement in RLS symptoms following surgical decompression of the common and superficial fibular nerves. Further investigation is needed to quantify improvement using RLS-specific metrics and sleep quality assessments.

Citing Articles

Perioperative outcomes of patients with restless legs syndrome: a single-center retrospective review.

Gali B, Silber M, Hanson A, Portner E, Gay P J Clin Sleep Med. 2022; 18(7):1841-1846.

PMID: 35393939 PMC: 9243276. DOI: 10.5664/jcsm.10000.

References

Nakamura A, Hasegawa M, Minami K, Kanbara T, Tomii T, Nishiyori A . Differential activation of the μ-opioid receptor by oxycodone and morphine in pain-related brain regions in a bone cancer pain model. Br J Pharmacol. 2012; 168(2):375-88. PMC: 3572564. DOI: 10.1111/j.1476-5381.2012.02139.x. View

Allen R, Chen C, Garcia-Borreguero D, Polo O, Dubrava S, Miceli J . Comparison of pregabalin with pramipexole for restless legs syndrome. N Engl J Med. 2014; 370(7):621-31. DOI: 10.1056/NEJMoa1303646. View

Schattschneider J, Bode A, Wasner G, Binder A, Deuschl G, Baron R . Idiopathic restless legs syndrome: abnormalities in central somatosensory processing. J Neurol. 2004; 251(8):977-82. DOI: 10.1007/s00415-004-0475-3. View

Nineb A, Rosso C, Dumurgier J, Nordine T, Lefaucheur J, Creange A . Restless legs syndrome is frequently overlooked in patients being evaluated for polyneuropathies. Eur J Neurol. 2007; 14(7):788-92. DOI: 10.1111/j.1468-1331.2007.01856.x. View

Allen R, Picchietti D, Garcia-Borreguero D, Ondo W, Walters A, Winkelman J . Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med. 2014; 15(8):860-73. DOI: 10.1016/j.sleep.2014.03.025. View

Webster L . Opioid-Induced Constipation. Pain Med. 2015; 16 Suppl 1:S16-21. DOI: 10.1111/pme.12911. View

Garcia-Borreguero D, Silber M, Winkelman J, Hogl B, Bainbridge J, Buchfuhrer M . Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Med. 2016; 21:1-11. DOI: 10.1016/j.sleep.2016.01.017. View

Vishwakarma K, Kalra J, Gupta R, Sharma M, Sharma T . A double-blind, randomized, controlled trial to compare the efficacy and tolerability of fixed doses of ropinirole, bupropion, and iron in treatment of restless legs syndrome (Willis-Ekbom disease). Ann Indian Acad Neurol. 2016; 19(4):472-477. PMC: 5144468. DOI: 10.4103/0972-2327.194424. View

Partinen M, Hirvonen K, Jama L, Alakuijala A, Hublin C, Tamminen I . Efficacy and safety of pramipexole in idiopathic restless legs syndrome: a polysomnographic dose-finding study--the PRELUDE study. Sleep Med. 2006; 7(5):407-17. DOI: 10.1016/j.sleep.2006.03.011. View

10.

Beard J . Iron deficiency alters brain development and functioning. J Nutr. 2003; 133(5 Suppl 1):1468S-72S. DOI: 10.1093/jn/133.5.1468S. View

11.

Connor J, Patton S, Oexle K, Allen R . Iron and restless legs syndrome: treatment, genetics and pathophysiology. Sleep Med. 2017; 31:61-70. PMC: 5334282. DOI: 10.1016/j.sleep.2016.07.028. View

12.

Gao X, Schwarzschild M, OReilly E, Wang H, Ascherio A . Restless legs syndrome and Parkinson's disease in men. Mov Disord. 2010; 25(15):2654-7. PMC: 3114885. DOI: 10.1002/mds.23256. View

13.

Cervenka S, E Palhagen S, Comley R, Panagiotidis G, Cselenyi Z, Matthews J . Support for dopaminergic hypoactivity in restless legs syndrome: a PET study on D2-receptor binding. Brain. 2006; 129(Pt 8):2017-28. DOI: 10.1093/brain/awl163. View

14.

Gupta R, Lahan V, Goel D . Restless Legs Syndrome: a common disorder, but rarely diagnosed and barely treated--an Indian experience. Sleep Med. 2012; 13(7):838-41. DOI: 10.1016/j.sleep.2012.03.018. View

15.

Chang Y, Paik J, Lee H, Chang H, Moon H, Allen R . Altered white matter integrity in primary restless legs syndrome patients: diffusion tensor imaging study. Neurol Res. 2014; 36(8):769-74. DOI: 10.1179/1743132814Y.0000000336. View

16.

Nickerson D, Rader A . Low long-term risk of foot ulcer recurrence after nerve decompression in a diabetes neuropathy cohort. J Am Podiatr Med Assoc. 2013; 103(5):380-6. DOI: 10.7547/1030380. View

17.

Skomro R, Ludwig S, Salamon E, Kryger M . Sleep complaints and restless legs syndrome in adult type 2 diabetics. Sleep Med. 2003; 2(5):417-22. DOI: 10.1016/s1389-9457(01)00110-1. View

18.

Todorich B, Pasquini J, Garcia C, Paez P, Connor J . Oligodendrocytes and myelination: the role of iron. Glia. 2008; 57(5):467-78. DOI: 10.1002/glia.20784. View

19.

Lewis F . The role of the saphenous nerve in insomnia: a proposed etiology of restless legs syndrome. Med Hypotheses. 1991; 34(4):331-3. DOI: 10.1016/0306-9877(91)90049-5. View

20.

Cuellar N, Dorn J . Peripheral diabetic neuropathy or restless legs syndrome in persons with type 2 diabetes mellitus: Differentiating diagnosis in practice. J Am Assoc Nurse Pract. 2015; 27(12):671-5. DOI: 10.1002/2327-6924.12311. View