Idiopathic restless legs syndrome: abnormalities in central somatosensory processing.
OBJECTIVE
Neurophysiological studies have shown an impairment of temperature perception in secondary and idiopathic restless legs syndrome (RLS). It is unclear whether these deficits are caused by peripheral nerve fibre damage or by central impairment of somatosensory processing. The aim of the present study was (1) to determine the frequency of thermal hypaesthesia in a large population of secondary and idiopathic RLS patients; (2) to differentiate between a peripheral and central disturbance of somatosensory processing and (3) to correlate these findings with the clinical manifestation of the disease.


METHODS
From the results of clinical examination, nerve conduction studies and blood samples the patients were divided into secondary and idiopathic RLS groups. The severity of RLS symptoms was assessed by standardized questionnaires. Quantitative sensory testing (QST) assessing temperature perception was performed in all patients. The peripheral function of small nerve fibres was evaluated by the quantitative nociceptor axon reflex test (QNART).


RESULTS
22 secondary and 20 idiopathic RLS patients participated in the study. Impairment of temperature perception (QST) was found in 72% of the secondary RLS patients and in 55% of idiopathic RLS patients. The peripheral C-fibre function (QNART) was normal in idiopathic RLS patients. In contrast it was significantly impaired in secondary RLS patients compared with idiopathic RLS patients and age matched controls. There was no correlation between the results obtained in QST and clinical scores.


CONCLUSIONS
Impairment of temperature perception is present in a high percentage of RLS patients. In secondary RLS the sensory deficits are at least in part caused by small fibre neuropathy. In idiopathic RLS a functional impairment of central somatosensory processing is present.
Dept. of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Niemannsweg 147, 24105 Kiel, Germany. j.schattschneider@neurologie.uni-kiel.de
Jörn
J
Schattschneider
Andre
A
Bode
Gunnar
G
Wasner
Andreas
A
Binder
Günther
G
Deuschl
Ralf
R
Baron
D001783:Blood Flow Velocity / Q000187:drug effects; D005260:Female; D006632:Histamine / Q000494:pharmacology; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D036421:Nerve Fibers, Unmyelinated / Q000502:physiology; D009431:Neural Conduction / Q000502:physiology*; D009460:Neurologic Examination; D010147:Pain Measurement; D012148:Restless Legs Syndrome / Q000503:physiopathology*; D020886:Somatosensory Disorders / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013697:Thermosensing / Q000502:physiology*
D006632:Histamine