title: Transcranial magnetic stimulation for evaluation of motor cortical excitability in restless legs syndrome/Willis-Ekbom disease.
abstract: There is no consensus about mechanisms underlying restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED). Cortical excitability may be abnormal in RLS. Transcranial magnetic stimulation (TMS) can provide insight about cortical excitability. We reviewed studies about measures of excitability to TMS in RLS. Original studies published between January 1999 and January 2015 were searched in PubMed, Scopus, and Web of Science databases. Inclusion criteria were as follows: original studies involving primary RLS in patients from both sexes and ages between 18 and 85 years; TMS protocols clearly described; and they were written in English, in peer-reviewed journals. Fifteen manuscripts were identified. TMS protocols were heterogeneous across studies. Resting motor threshold, active motor threshold, and amplitudes of motor-evoked potentials were typically reported to be normal in RLS. A reduction in short-interval intracortical inhibition (SICI) was the most consistent finding, whereas conflicting results were described in regard to short-interval intracortical facilitation and the contralateral silent period. Decreased SICI can be reversed by treatment with dopaminergic agonists. Plasticity in the motor cortex and sensorimotor integration may be disrupted. TMS may become a useful biomarker of responsiveness to drug treatment in RLS. The field can benefit from increases in homogeneity and sizes of samples, as well as from decrease in methodological variability across studies.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: samircm@gmail.com.
authors.forename: Samir Câmara
authors.initials: SC
authors.lastname: Magalhães
authors.affiliation: Neurocenter of Southern Switzerland, Lugano, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Kaelin-Lang
authors.affiliation: University of Surrey, Surrey, UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Sterr
authors.affiliation: Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Gilmar Fernandes
authors.initials: GF
authors.lastname: do Prado
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da USP, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Alan Luiz
authors.initials: AL
authors.lastname: Eckeli
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Adriana Bastos
authors.initials: AB
authors.lastname: Conforto
mesh_terms: D006801:Humans; D009044:Motor Cortex / Q000503:physiopathology*; D012148:Restless Legs Syndrome / Q000503:physiopathology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods
keywords: Cortical; Dopaminergic agonists; Excitability; Restless legs syndrome; Transcranial magnetic stimulation; Willis–Ekbom disease