title: Investigation of unmedicated early onset restless legs syndrome by voxel-based morphometry, T2 relaxometry, and functional MR imaging during the night-time hours.
abstract: OBJECTIVE
  The pathophysiology of eRLS has not yet been elucidated. The purpose of the study was to assess, in patients with eRLS, the volume, iron content, and activation of the brain during night-time episodes of SLD and PLMs.
  
  
  METHODS
  Eleven right-handed unmedicated patients with eRLS (mean age, 55.3 ± 8.4 years; disease duration, 17.5 ± 14.05 years) and 11 matched control subjects were studied with a T1-weighted high-resolution 3D spoiled gradient-echo sequence used for VBM and a multisection spin-echo T2-weighted sequence used for T2 relaxometry. Additionally, a single-shot multisection gradient echo-planar sequence was used for fMRI. Brain activation was recorded during spontaneous SLD and PLMs. SPM software was used for analysis of the functional data.
  
  
  RESULTS
  The patients showed no regional brain volume change, but T2 relaxometry revealed decreased T2 relaxation time in the right globus pallidus internal and the STN, indicating increased iron content. The patients were observed to activate the following areas: in the left hemisphere, the primary motor and somatosensory cortex, the thalamus, the pars opercularis, and the ventral anterior cingulum; and in the right hemisphere, the striatum, the inferior and superior parietal lobules, and the dorsolateral prefrontal cortex. Bilateral activation was observed in the cerebellum, the midbrain, and the pons.
  
  
  CONCLUSIONS
  eRLS is associated with increased iron content of the globus pallidus internal and STN, suggesting dysfunction of the basal ganglia. Activation of the striatofrontolimbic area may represent the neurofunctional substrate mediating the repetitive compulsive movements seen in RLS.
authors.affiliation: Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: P N
authors.initials: PN
authors.lastname: Margariti
authors.forename: L G
authors.initials: LG
authors.lastname: Astrakas
authors.forename: S G
authors.initials: SG
authors.lastname: Tsouli
authors.forename: G M
authors.initials: GM
authors.lastname: Hadjigeorgiou
authors.forename: S
authors.initials: S
authors.lastname: Konitsiotis
authors.forename: M I
authors.initials: MI
authors.lastname: Argyropoulou
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007501:Iron / Q000378:metabolism*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012148:Restless Legs Syndrome / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D014018:Tissue Distribution
chemical_list: D007501:Iron