Restless legs syndrome, a predictor of subcortical stroke: a prospective study in 346 stroke patients.
The objective of this study was to assess the prevalence of restless legs syndrome (RLS) among patients with stroke and to examine the anatomical correlation between location of stroke and RLS symptoms.



We administered a pre-structured sleep questionnaire to consecutive stroke patients seen in our neurology services department over a 3-year period. Unconscious (Glasgow Coma Scale score <15) or aphasic, renally impaired, or neuropathic patients were excluded. Diagnosis of RLS was established according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG), and polysomnography was conducted.



Of 346 stroke patients, 35 (10.11%) fulfilled IRLSSG diagnostic criteria for RLS, which had existed for an average (±standard deviation) of 60 ± 40 months before stroke. The mean age of onset was 52.94 (±10.32) years. Twenty-four patients (68%) had RLS symptoms contralateral to the hemisphere involved in the stroke (eight with unilateral and 16 with grossly asymmetrical RLS). Twenty-nine of 35 patients (82.86%) had imaging evidence of subcortical (16 with hemorrhagic and 13 with ischemic) stroke. Patients with pre-stroke RLS differed from those without it only by subcortical location of the stroke (82.9% vs 31.5% respectively, p < 0.001). The most significant differentiating factor between patients with subcortical stroke and those with cortical stroke was pre-stroke RLS (22.83% vs 2.74%, p < 0.001), the others being history of hypertension and hemorrhagic stroke type.



RLS, especially unilateral or asymmetrical, might frequently pre-exist in patients presenting with subcortical stroke. The common laterality may suggest an important predictive value for RLS, and may form an important point for future research.
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Anupama
A
Gupta
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: garimashukla@hotmail.com.
Garima
G
Shukla
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Afsar
A
Mohammed
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Vinay
V
Goyal
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Madhuri
M
Behari
D000328:Adult; D000368:Aged; D002540:Cerebral Cortex / Q000473:pathology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D012148:Restless Legs Syndrome / Q000453:epidemiology*; D020521:Stroke / Q000150:complications*; D011795:Surveys and Questionnaires
Cerebrovascular disease; Restless legs syndrome; Sleep; Stroke