Objective: A recent study suggested that 1.6% of RLS patients developed PD vs 1% of controls.The authors questioned whether RLS could be a premonitory symptom of PD but they concluded that RLS predisposes to PD. This concerns millions of RLS sufferers. Our data suggests that RLS is more likely a premotor manifestation of RLS.

Background: The association of PD and RLS is well-known but not well-understood. RLS is seen in up to 50% of PD patients and contributes to pain and sleep disturbance.  Many conditions antedate motor manifestations of PD including constipation, depression, REMSBD and, possibly essential tremor. RLS may affect more than 10% of the population. The distinction between predisposing condition or antecedent symptom of PD is more than trivial.

Method: Between 2005 and 2015 we surveyed 900 RLS patients addressing demographics, comorbidites, family history and onset of symptoms.

78 patients with PD and RLS completed the questionnaire and were compared to the primary RLS group.

Results: PD preceded RLS in 41 (53%) and in 33 (42%) RLS was antecedent. RLS patients with PD were 59% female vs. 74% in primary RLS. 

The mean age of RLS onset was 62.5 years in the PD and 40.4 years in the primary RLS groups. The mean age at dignosis of RLS was 76.7 years in PD and 53.4 years in the primary group. 16 PD patients (20%) had symptoms of RLS 10 or more years before developing motor manifestations. The rest of the PD group manifested RLS in a Bell-shaped distribution with 20% developing RLS within 1 year, and 9% more than 5 years after motor manifestations of PD.

Other features distinguished between the 2 groups: Migraine headaches (65 vs 43%); history of growing pains (50 vs.28%); and family history (FH) of RLS (43 vs 18%) were more common in the Primary RLS population. These rates were not significantly different when we examined the groups with antecedent or subsequent RLS  or those with RLS more than 10 years before PD.

Conclusion: Our study shows features that distiguish primary RLS from those with PD and RLS. It does not preclude that RLS may predispose to PD but does suggest that RLS may be a premotor manifestation of PD. RLS may precede motor manifestations by more than 10 years. Absence of headaches, age at onset and presentation, history of growing pains and FH of RLS may help distinguish PD from primary RLS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/restless-limbs-syndrome-rls-is-more-likely-a-premotor-symptom-of-parkinsons-disease-then-a-predisposing-condition/