title: Substantia nigra hypoechogenicity: definition and findings in restless legs syndrome.
abstract: Pathological studies demonstrate a decreased iron content in the substantia nigra (SN) contributing to the pathophysiology of restless legs syndrome (RLS). SN echogenicity as measured by transcranial sonography (TCS) correlates with the SN iron content. The objective of this study was to determine a critical value to define SN hypoechogenicity as a potential marker for RLS. There were 49 RLS patients (39 idiopathic, 10 secondary) and 49 age- and sex-matched controls who underwent TCS by 2 independent and blinded examiners to determine the area of SN echogenicity. We found that SN echogenicity is significantly decreased in RLS patients compared to healthy controls (P < 0.001). SN hypoechogenicity (sum area of SN echogenicity of both sides < 0.2 cm(2)) is more common in idiopathic than in secondary RLS patients. The area under curve for idiopathic RLS versus controls (receiver operating characteristics) is 0.91, specificity is 0.90, and sensitivity is 0.82. TCS provides an interesting additional instrument in the diagnosis of RLS. Therefore, SN hypoechogenicity (SN sum area < 0.2 cm(2)), which is supposed to indicate a decreased SN iron content, is a marker for RLS. Further studies are needed to investigate its significance for the pathophysiology of this frequent movement disorder and possible clinical applications.
authors.affiliation: Hertie Institute of Clinical Brain Research, Division of Neurodegeneration, University of Tübingen, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Godau
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Schweitzer
authors.forename: Inga
authors.initials: I
authors.lastname: Liepelt
authors.forename: Christian
authors.initials: C
authors.lastname: Gerloff
authors.forename: Daniela
authors.initials: D
authors.lastname: Berg
mesh_terms: D005260:Female; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012148:Restless Legs Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D012720:Severity of Illness Index; D013378:Substantia Nigra / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*