Prevalence of stroke in Restless Legs Syndrome: Initial Results Point to the Need for More Sophisticated Studies



Arthur S Walters*, 1, Michael Moussouttas2, Fouzia Siddiqui3, Diosely C Silveira4, Karel Fuentes4, Lily Wang5, Klaus Berger6
1 Dept of Neurology Vanderbilt University School of Medicine, Nashville, Tennessee, USA
2 Dept of Neurology Thomas Jefferson Medical School, Philadelphia Pennsylvania, USA
3 Dept of Neurology, University of Toledo Medical Center, Toledo, Ohio USA
4 Dept. of Neurology, Cleveland Clinic, Cleveland, Ohio, USA
5 Dept of Biostatistics, Vanderbilt University School of Medicine
6 Institute of Epidemiology and Social Medicine, University of Muenster, Germany


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© Walters et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License(http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to these authors at the Dept of Neurology, Vanderbilt University Medical Center, Medical Center North Room A-0118, 1161 21st Ave South, Nashville, Tennessee 37232-2551, USA; Tel: 615-322-0283; Fax: 615-936-0223; E-mail: artumdnj@aol.com, arthur.walters@vanderbilt.edu


Abstract

Background:

Recent studies suggest a potential relationship between Restless Legs Syndrome (RLS) and hypertension and heart disease. Acute clinical stroke has been linked to the immediate onset of RLS, and epidemiological studies suggest the possibility that RLS may also lead to stroke.

Methods:

MRI scans from 26 RLS cases and 241 controls from the population based MEMO-Study (Memory and Morbidity in Augsburg Elderly) were assessed for the presence of clinical stroke, silent infarction, subcortical lesions and cortical atrophy. T1, T2, proton density images were obtained and infarcts and their characteristics were determined by visual inspection. RLS status was assessed according to the minimal criteria of the International RLS Study Group. Scans from the 26 RLS patients and a subset of 26 age and sex matched controls were reexamined by a separate rater using the same methodology. Descriptive statistics, logistic and linear regression models were used to determine the risk of the three types of CNS changes associated with RLS case status.

Results:

Among the 267 participants there was no difference in the prevalence of cardiovascular diseases or risk factors between RLS patients and the 241 controls. The prevalences of cerebrovascular events of all types, were greater in RLS patients, as were the amounts of cortical atrophy and the volume of subcortical lesions. However, these differences were not statistically significant. When age, sex and co-morbidities were taken into account in a logistic regression model, there was a statistically non-significant greater risk for stroke (Odds Ratio 2.46 with 95% CI 0.97-6.28, p = .06) associated with RLS case status.

Conclusions:

Future similar studies need to be performed on younger patients without other potential vascular risk factors, using Flair images and computerized programs for detection of cerebral ischemia. Improved methods for detection may allow for a reasonable sample size.

Keywords: Magnetic resonance imaging, restless legs syndrome, cerebrovascular disease, stroke, cardiovascular disease, hypertension, periodic limb movements in sleep, leukoaraiosis.