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May 22, 2018; 90 (21) Article

Involvement of the central somatosensory system in restless legs syndrome

A neuroimaging study

Byeong-Yeul Lee, Jongmyeong Kim, James R. Connor, Gerald D. Podskalny, Yeunchul Ryu, Qing X. Yang
First published April 25, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005562
Byeong-Yeul Lee
From the Department of Radiology (B.-Y.L.), University of Minnesota, Minneapolis; Biomedical Engineering (J.K.), Duke University, Durham, NC; Departments of Neurosurgery (J.R.C.), Neurology (G.D.P.), and Radiology, Neurosurgery, and Bioengineering (Q.X.Y.), Pennsylvania State Hershey Medical Center; and Department of Radiological Science (Y.R.), Gachon University, South Korea.
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Jongmyeong Kim
From the Department of Radiology (B.-Y.L.), University of Minnesota, Minneapolis; Biomedical Engineering (J.K.), Duke University, Durham, NC; Departments of Neurosurgery (J.R.C.), Neurology (G.D.P.), and Radiology, Neurosurgery, and Bioengineering (Q.X.Y.), Pennsylvania State Hershey Medical Center; and Department of Radiological Science (Y.R.), Gachon University, South Korea.
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James R. Connor
From the Department of Radiology (B.-Y.L.), University of Minnesota, Minneapolis; Biomedical Engineering (J.K.), Duke University, Durham, NC; Departments of Neurosurgery (J.R.C.), Neurology (G.D.P.), and Radiology, Neurosurgery, and Bioengineering (Q.X.Y.), Pennsylvania State Hershey Medical Center; and Department of Radiological Science (Y.R.), Gachon University, South Korea.
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Gerald D. Podskalny
From the Department of Radiology (B.-Y.L.), University of Minnesota, Minneapolis; Biomedical Engineering (J.K.), Duke University, Durham, NC; Departments of Neurosurgery (J.R.C.), Neurology (G.D.P.), and Radiology, Neurosurgery, and Bioengineering (Q.X.Y.), Pennsylvania State Hershey Medical Center; and Department of Radiological Science (Y.R.), Gachon University, South Korea.
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Yeunchul Ryu
From the Department of Radiology (B.-Y.L.), University of Minnesota, Minneapolis; Biomedical Engineering (J.K.), Duke University, Durham, NC; Departments of Neurosurgery (J.R.C.), Neurology (G.D.P.), and Radiology, Neurosurgery, and Bioengineering (Q.X.Y.), Pennsylvania State Hershey Medical Center; and Department of Radiological Science (Y.R.), Gachon University, South Korea.
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Qing X. Yang
From the Department of Radiology (B.-Y.L.), University of Minnesota, Minneapolis; Biomedical Engineering (J.K.), Duke University, Durham, NC; Departments of Neurosurgery (J.R.C.), Neurology (G.D.P.), and Radiology, Neurosurgery, and Bioengineering (Q.X.Y.), Pennsylvania State Hershey Medical Center; and Department of Radiological Science (Y.R.), Gachon University, South Korea.
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Citation
Involvement of the central somatosensory system in restless legs syndrome
A neuroimaging study
Byeong-Yeul Lee, Jongmyeong Kim, James R. Connor, Gerald D. Podskalny, Yeunchul Ryu, Qing X. Yang
Neurology May 2018, 90 (21) e1834-e1841; DOI: 10.1212/WNL.0000000000005562

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Abstract

Objective To investigate morphologic changes in the somatosensory cortex and the thickness of the corpus callosum subdivisions that provide interhemispheric connections between the 2 somatosensory cortical areas.

Methods Twenty-eight patients with severe restless legs syndrome (RLS) symptoms and 51 age-matched healthy controls were examined with high-resolution MRI at 3.0 tesla. The vertex-wise analysis in conjunction with a novel cortical surface classification method was performed to assess the cortical thickness across the whole-brain structures. In addition, the thickness of the midbody of the corpus callosum that links postcentral gyri in the 2 hemispheres was measured.

Results We demonstrated that a morphologic change occurred in the brain somatosensory system in patients with RLS compared to controls. Patients with RLS exhibited a 7.5% decrease in average cortical thickness in the bilateral postcentral gyrus (p < 0.0001). Accordingly, there was a substantial decrease in the corpus callosum posterior midbody (p < 0.008) wherein the callosal fibers are connected to the postcentral gyrus, suggesting altered white matter properties in the somatosensory pathway.

Conclusion Our results provide in vivo evidence of morphologic changes in the primary somatosensory system, which could be responsible for the sensory functional symptoms of RLS. These results provide a better understanding of the pathophysiology underlying the RLS sensory symptoms and could lead to a potential imaging marker for RLS.

GLOSSARY

ANCOVA=
analysis of covariance;
AUC=
area under the curve;
CC=
corpus callosum;
CI=
confidence interval;
FDR=
false discovery rate;
IRLS=
International Restless Legs Scale;
PSC=
primary sensory cortex;
RLS=
restless legs syndrome;
ROC=
receiver operating characteristic;
ROI=
region of interest;
T1w=
T1-weighted;
VBM=
voxel-based morphometry

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial page 945

  • CME Course: NPub.org/cmelist

  • Received October 27, 2017.
  • Accepted in final form February 23, 2018.
  • © 2018 American Academy of Neurology
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