Recent Developments in RLS : rTMS and rDCS

[WideBody]

Every hear of :

tDCS transcranial direct current stimulation

or

TMS transcranial magnetic stimulation

From my paper... this was the best part.....

"Lastly, further understandings come from

recent investigations using noninvasive stimulation techniques:DCS has proved

to be a painlessway of reducing spinal cord excitability (Heide et al., 2014);rTMS

may restore the normal balance between descending excitatory and inhibitory

pathways, hence preventing abnormal central somatosensory processing (Lin

et al., 2015). Given the subjective clinical improvement produced (Altunrende,

Yildiz,Cevik,&Yildiz, 2014; Lanza,Cantone, et al.,2018; Lin et al., 2015), these

approaches might represent a new nonpharmacological option for RLS."

I don't know about you guys, but I am interested and would love to give it a go, it beats the alternatives.

[Ebi1909]

There was a post by Arjiji about his treatment with RTMS. Unfortunately, he hasn't applied yet, if the improvement still lasts.

[Hidden]

As Ebi1909 says Arjiji has tried RTMS and did say it had some positive effect.

It's also used for pain and I believe it's been found to be useful for treating depression.

I'm not sure where you could access such treatment, Arjiji lives in Spain!

There is a Do It Yourself kind of headband device you can buy which claims to use the RTMS principle They're about 300GBP (special offer if you buy today!)

I'd avoid that!

[Camry2020 in reply to Hidden]

Would love to understand more about RTMS. What is it? Already had series of 5 iron infusions. Been on every prescription that exists. Nothing works. RLS wrecks life!

[WideBody in reply to Camry2020]

I am not a Doctor, as I understand it those are two separate issues. The iron helps with the sensation of movement. I believe the RTMS is dealing with the hyperarousal insomnia phase.

In my case I had one infusion and can easily supplement to keep my ferritin up. The sensations are , um under control. I can manage to get to sleep. It stay asleep. The way I read it, RTMS will help with that part.

If the series of 5 infusions was iron sucrose (200mg * 5) and recent. It takes time for the iron to kick in. I think it takes time for the body to adjust. I had iron sucrose and I kept seeing benefits for 6-8 months.

If you had 5 separate infusions of iron, usually years apart, that implies a different issue.

If you want to read more about it I think it is Chapter 5 of The Pharmacology of Restless legs.

[Hidden in reply to Camry2020]

repetitive Transcranial Magnetic Stimulation is where a magnetic field is passed through the brain (and skull) hence transcranial - across the skull)

[Hidden]

Yes I have heard of it and also read Arijiji's posts. It is available in Australia primarily as a treatment for depression. It is also used for Parkinson's patients. I asked my sleep specialist about it some time ago and he maintained that there is insufficient evidence as to its effectiveness for PLMD/RLS.

I'm going to ask again at my next appointment (as well as for a broad spectrum cbd oil that an acquaintance is having considerable benefits from).

[WideBody in reply to Hidden]

I have a Neurologist's appointment July 19th. You bet this one made the list! Let me know how you get on with yours.

[Hidden in reply to WideBody]

My appointment is mid May...will let you know how I get on. My specialist is very progressive and open to trying out different therapies so a good starting point!

[Hidden in reply to WideBody]

My specialist wasn't in favour of rTMS as I'm about to trial medical cannabis (cbd oil) but in my mind, it remains an option to explore. The cost here in Australia is approx 180 AUD per session. Apparently you need 20 to 30 initial sessions and then maintenance sessions eg one/month. There is no Government funding unless it is for depression. However, that may change come November 🤞

[WideBody in reply to Hidden]

Thanks

[kicker2 in reply to Hidden]

Yes, let us know! My naturo recommended Repetitive Transcranial Magnetic Stimulation. Same thing?

[Hidden in reply to kicker2]

Yes, rTMS is what I was referring to.

[1Ginge1]

I have been wondering how many with RLS also have bad back? Seems to go together. Kind of what your article was saying

[WideBody in reply to 1Ginge1]

I am not quite sure how you got that impression. I did post study that said even paraplegics with no use of their legs still have RLS sensations (and involuntary movements).

I will say, if I am uncomfortable or in pain, my RLS seems to act up. Since RLS is an enhanced cortico-spinal excitability disorder creating a state of hyper-arousal.

[1Ginge1 in reply to WideBody]

I think I was reading about the spinal cord excitability . I think I just homed in on that because so many talk about their back problems.

[Munroist in reply to 1Ginge1]

I was aware of very occasional RLS in my childhood and early adulthood but maybe a few times a year, often connected with intense exercise (and maybe nerve stimulation?) but my RLS really kicked in after a back problem where discs were touching the spinal cord and left me with permanent altered sensations in lower legs e.g. tingling in feet. The pain specialists told me I had “nerve sensitivity” i.e. everything was revved up so I also feel there is a connection between back/spine issues and RLS. My tinnitus also increased which again may be related to nerve excitation.

[Hidden in reply to Munroist]

I believe there is a connection between spinal neuropathy and RLS, as you say nerves get "revved" up. There is a known connection between peripheral neuropathy and RLS. Sometimes it's diffcult to tell the two kinds of neuropathy apart.

There's also evidence that signs of RLS can be detected not just in the brain but also in the spinal chord and peripheral nerves.

Another factor may be that sometimes a compressed spinal nerve can cause some inflammation. In 2018 when my back pain/sciatica was acuute, I had a course of an anti-inflammatory which had a definite effect on the pain.

Inflammation can also be a major factor in RLS.

If rTMS reduces nerve excitabaility, that would be great.

[Hidden in reply to WideBody]

Interesting fact number (I've lost count).

Paraplegics may still have RLS sensations in their legs, but even people who've had their leg, arm, hand etc amputated can still get pain in their missing part.

Alos, I don't know if you've heard of Kirlian photography. This appears to show an electrical field around the body. So a Kirlian photpgraph of a hand will show a narrow electric field stretching a few mm around all the fingers.

If one of the fingers is amputated, the Kirlian phoitograph stills shows it there for a while after.

Stranger still is "strange hand syndrome" where people experience losing control of one of their hands. They feel their hand is moving indpendently of its own accord.

[WideBody in reply to Hidden]

the way I read it paraplegics get movement, jerks, kicks or tics, whatever we call it these days. (Nocturnal Myoclonus, there are so many names it is hard to diagnose anything!)

[s_gc]

Thanks for sharing, I am awaiting for an appointment with a neurologist, I have already suggested to go this route in my notes so it is helpful to have more information on it.

[WideBody in reply to s_gc]

I really hope you succeed and it works! Please let us know!

[RCHD]

Where is it being done ? How to find out more ?

[WideBody in reply to RCHD]

I think the only way is to talk to a Doctor or even better a qualified Neurologist. Good luck.

[kicker2]

My naturo recommended Repetitive Transcranial Magnetic Stimulation. I'm assuming they are the same thing.

[Hidden]

Interesting what you say about the rTMS dealing with the hyperarousal aspect of RLS.

I do know that dopamine agonists are more effective with the motor symptoms of RLS and the gabapentinoids more effective with the hyperarousal.

Dopamine agaonists can actually make insomnia worse

Gabapentinoids can also be effective for the motor symptoms. This is because they decrease overall nerve excitability. Because they reduce excitability they can be useful for RLS but also pain, epilepsy, anaxiety and insomnia.

The excitability in RLS seems to be a matter of an imbalance between GABA and glutamate.

It's a gap in what I know, but I'm not sure why there should be an excess of glutamate in RLS and whether this is also due to iron, but certainly iron is important for the dopamine aspect.,

[WideBody in reply to Hidden]

Hi Manerva! As I understand it, one of the mechanisms of Gabapentin is that it blocks the build up of glutamate in the brain, a sort of "glutamate-blocker". That is why I think it helped me if I started taking it earlier in the day, 2pm.

As for why there is an imbalance, there is a detailed hypothesis that this is caused by the iron imbalance in Chapter 5 (I have a pdf if you want to PM me). I only read it once so far, so please read and formulate your own opinion, I will not be offended.

The whole book can be read fairly quickly. I of course went to the parts that I was most concerned about. I don't really do book reviews, but I really would highly recommend it to anyone suffering from RLS.

For those not following, I got all this information from "The Pharmacology of RLS", elsevier.com/books/pharmaco...

[Hidden in reply to WideBody]

Hi,

I'm a bit confused by gabapentin. Some sources say it boosts GABA, some say it inhibits glutamate, if I recall correctly "pre-synaptically". I suspect it might do both. Either way it does seem to work.

When it does!

You may have filled a gap for me, if iron is also involved in glutamate, then it is involved with both aspects of RLS (dopamine), the motor symptoms AND the hyperarousal.

I still have a gap about the nature of the connection between iron and dopamine/glutamate and I also think adenosine comes into this somewhere.

I can't help feeling that RLS is like particle physics.

When I was at school atoms were made up of electrons, proton and neutrons and nothing smaller.

Now protons and neutrons are made up of "quarks".

Protons have two "up" quarks and one "down" quark.

Neutrons have one "up" quark and two "down" quarks.

There are also top quarks, bottom quarks, strange quarks and charm quarks.

What does a durck sound like? "quark, quark"!

Unfortunately, in Healthunlocked, there doesn't seem to be any way of attaching files, but thanks for the offer.

Apologies for the terrible pun.

[WideBody in reply to Hidden]

FYI, I switched to pregabalin, way more consistent and effect. In my opinion.

[Hidden in reply to WideBody]

Pregabalin has definite advantages over gabapentin. Gabapentin has its querks.

Its top querk is a strange querk, i.e. inconsistency.

[WideBody in reply to Hidden]

BTW, you want chapter 1. "Adenosine mechanisms and hypersensitive corticostriatal terminals in restless legs syndrome. Rationale for the use of inhibitors of adenosine transport"

Here are the contents.

Contents

1. Introduction 4

2. Materials and methods 8

2.1 Animals 8

2.2 Assessment of iron deficiency 9

2.3 Surgical procedures 9

2.4 Intracranial optogenetic stimulation 10

2.5 In vivo microdialysis 10

3. Results 11

4. Discussion 13

Acknowledgments 17

Conflict of interest 17

References 17

Abstract

[Hidden]

Thanks. The contents siund like an article in a research journal. If this is in a book, it may be that the book is put together from such articles, which is not unusual.

[ziggypiggy]

I underwent TMS a couple years ago for depression. The doctor was one of the original pioneers of it's use. It's amazing how precise they fine tune where to give you the treatment. It's was a pinpoint spot. Felt like a small hammer tapping on your skull in short bursts every 30 seconds for a few seconds at a time, lasting about 25 minutes. They are trying to activate a small area of the brain about two inches deep. Thirty six treatments over a couple months time. I didn't get any relief from depression. I mentioned my RLS to him before we started and he wasn't aware at the time of specific use of TMS for RLS but wasn't counting out that maybe if they found the right area of the brain it may be something to look into. He had me monitor my RLS throughout the treatment just for kicks(pun intended) but I didn't notice any short or long term relief, to be honest it wasn't my first concern.