title: Dopaminergic treatment of restless legs syndrome in spinal cord injury patients with neuropathic pain.
abstract: Recent studies report high incidence of restless legs syndrome (RLS) in patients with spinal cord injury (SCI), who may also present pain and sensory disturbances. In the present manuscript, we examine and discuss diagnostic and treatment challenges of comorbid RLS and neuropathic pain (NP) in SCI. We evaluated seven men with a mean age of 55.6 (s.d.=14.0) years, with chronic complete or incomplete SCI at the thoracic or lumbar level, for complaints of sensory disturbances in the legs, which initially were attributed to drug-resistant NP. Because overlapped RLS was suspected, clinical evaluation of NP and RLS, serum ferritin and iron level assessment, and video polysomnographic (VPSG) studies were conducted. Pramipexole (0.18 mg q.d.-1) was added to treat RLS, and a follow-up was performed at 2 months. We found that in six subjects the RLS was comorbid with NP and in one subject the symptoms of RLS were misdiagnosed as NP. VPSG revealed periodic limb movements (PLMs) in all patients, including PLMs of the legs, arms or both. Serum ferritin was <50 ng ml-1in two patients. RLS improved significantly after 2 months with pramipexole. On the basis of current findings, we recommend physicians to be aware of the comorbidity between RLS and NP secondary to SCI to include suitable diagnostic procedures and effective treatments.
authors.affiliation: Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Universidad Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.
authors.forename: Hatice
authors.initials: H
authors.lastname: Kumru
authors.affiliation: Department of Psychology, Texas A&M University , College Station, TX, USA.
authors.forename: Sergiu
authors.initials: S
authors.lastname: Albu
authors.affiliation: Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Universidad Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Vidal
authors.affiliation: Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain; Universidad Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.
authors.forename: Manuela
authors.initials: M
authors.lastname: Barrio
authors.affiliation: Servei de Neurologia, Hospital Clinic de Barcelona, Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona , Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Santamaria
keywords: Movement disorders; Neuropathic pain; Spinal cord diseases