Objective: The goal of this study was to evaluate the impact of deep brain stimulation (DBS) of the globus pallidus interna (GPi) on Restless Legs Syndrome (RLS) within a cohort of patients with Parkinson’s Disease (PD).

Background: PD is the second most common neurodegenerative disorder and is characterized by both motor and non-motor symptoms, including sleep disorders. RLS negatively affects sleep quality and is fairly common in PD, with a prevalence between 8 and 24%. DBS is an established treatment for motor fluctuations present in PD, but less is known about its impact on sleep disturbances such as RLS. Only one study of five patients evaluated the impact of GPi DBs on RLS, with a non-significant improvement after six months. Long-term effects of GPi DBS on RLS have remained unclear.

Method: An International Restless Legs Syndrome Study Group (IRLSSG) survey was administered in clinic, at baseline and one year after DBS implantation, to patients with PD undergoing GPi DBS. Questions in the survey assessed the presence of RLS and produced a severity score. Demographic data and medications were collected at baseline and one year.

Results: Out of 12 patients, three were found to have RLS at baseline. Patient 1 is 80 years old and had an increase in IRLSSG score from 8 to 21. This patient takes pramipexole and reduced their dose from 1 mg to 0.5 mg three times a day one year after DBS. Patient 2 is 76 years old and had a decrease in IRLSSG score from 19 to 0. She reduced carbidopa 36.25 mg/levodopa 145 mg sustained action capsules from 9 caps daily to 4 caps daily one year after DBS. Patient 3 is 66 years old and had a slight decrease in IRLSSG score from 10 to 8. There was no change in this patient’s medications.

Conclusion: The relationship between GPi DBS and RLS in patients with PD remains unclear. Decreasing doses of dopamine agonists would be expected to increase the presence of RLS, which was seen for Patient 1. Patient 2 experienced a dramatic decrease in IRLSSG score despite significantly reducing medication, suggesting either the presence of augmentation or a direct impact on RLS from DBS itself. There was no significant change in RLS in patient 3. The absence or presence of RLS can be influenced by dopaminergic medications or DBS itself, as well as confounded by PD symptoms that can mimic RLS, highlighting a complicated relationship between all three of these factors.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/globus-pallidus-interna-deep-brain-stimulation-for-parkinsons-disease-impact-on-restless-legs-syndrome/