Conference given at the 2018 Vancouver World Sleep Congress
Summary
In recent years, there is more progress in the pathophysiology of restless legs syndrome (RLS), especially electrophysiological and neuroimaging investigations in sensory-motor disorder of RLS.
Novel imaging techniques such as functional magnetic resonance imaging and diffusion tractography images have demonstrated activation or connectivity changes in the sensory-motor network.
The cortex, basal ganglia, cerebellum, thalamus, and connections appear to play a key role in sensory-motor processing abnormalities in RLS.
Furthermore, patients with RLS exhibit increased excitability of the sensorimotor cortex, a marked abnormality in early control of somatosensory activation, and an attenuated interneuron inhibitory network.
But in vivo excitability studies in motor and sensory axons provide evidence that increased excitability of peripheral motor neurons but not sensory axons contribute to the pathophysiology of RLS. Movement disorders are modulated by internal and external sensory signals, and such abnormal sensorimotor integration can disrupt normal motor control.
It has been shown in patients with RLS that Transcranial Magnetic Stimulation (TMS) can reduce short-latency afferent inhibition, a marker for sensorimotor integration.
In addition, the low frequency rTMS in S1-M1 connectivity alleviates sensory-motor complaints
of patients with RLS modulating cortical excitability and inducing synaptic plasticity in the short term.
This symposium will provide electrophysiology and imaging tests of sensory-motor network abnormality to gain new insight into the mechanism pathophysiology of RLS to better guide treatment.
Written by
Arjiji
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It would be good to know if an effective therapy has been developed from this theory. Has the therapy been shown to be effective by clinical trials as yet?
When and where is the therapy likely to become available?
Have you tried this Transcranial Magnetic Stimulation (TMS), Arjiji? I recall that you are treated by Dr. Garcia-Borreguero who has to be one of the great heroes of the rls world - along with Dr. Allen.
Arjiji
Another question, do you have any access to technical data on rTMS
Is the device referred to in the folllowing link genuine do you think?
I have heard if this before, but thats all, heard about it. Not seen any studies altho they might be out there somewhere. The fact that non of us know too much about it, maybe means it not been taken forward to studies, or clinical trials, for various reasons, could be funds. ? Perhaps you can tell us more Arjiji
I hate to have the role as the fun police here, but this is not helpful for general RLS sufferers and may help with associated insomnia. Transcranial magnetic stimulation is long study in itself with many claims, and some positive results but not overall conclusive. I rate it as ‘interesting’.
As for RLS this is the best summary.
"The main finding of this study is that a single evening session of inhibitory rTMS applied over the M1-S1 network was able to transiently alleviate the clinical complaints of RLS patients with regard to initiating or maintaining sleep."
" a single evening session of inhibitory rTMS applied over the M1-S1 network was able to transiently alleviate the clinical complaints of RLS patients with regard to initiating or maintaining sleep."
In other words they slept better
No mention of symptom relief.
I have come across some subjective claims that it helps and I may even have read of someone on here benefiting from it, if not for RLS then for depression.
The problem is access to a machine and the cost. The machines that the people had results on were tens of thousands of pounds, I could find no success with the smaller machines like the ones linked above.
I will be commencing rTMS in two weeks time. I will have 30 sessions over a six-week period.
The clinic performing the treatment mainly performs it on persons with psychiatric conditions or chronic pain.
I understand that targeting the precise part of the brain is critical to the success of the treatment.
I'll be sharing the few published studies with the consultant physician but really need to ensure that he will be targeting the correct part of the brain.
Are you able to advise which rTMS protocol your physician followed (or any other pertinent details about the treatment)?
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