Hyperdopaminergism in lenticulostriate stroke-related restless legs syndrome: an imaging study |
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| Institution: | 1. Department of Neurology, Sleep Disorders Center – CIRCSom, Hôpitaux Universitaires de Strasbourg, Strasbourg, France;2. CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France;3. Fédération de Médecine Translationnelle de Strasbourg (FMTS), University of Strasbourg, Strasbourg, France;4. Department of Biophysics and Nuclear Medicine, Hôpitaux Universitaires de Strasbourg, Strasbourg, France;5. ICube, CNRS, UMR 7237, University of Strasbourg, Strasbourg, France;6. Department of Anatomy, UFR Sciences Médicales et Pharmaceutiques, University of Franche-Comté, Besançon, France;7. Department of Neuromuscular Diseases, CHU Besançon, Besançon, France;8. Department of Neurology, Stroke Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France;1. Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain;2. CIBERNED, Barcelona, Spain;1. Academy of Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China;2. Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China;3. College of Engineering, Peking University, Beijing 100871, China;1. Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Medical University of Warsaw, Warsaw, Poland;2. Department of Otolaryngology–Head Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA;3. Divisions of Pediatric Otolaryngology & Pulmonary Medicine, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio, USA;4. Third Department of Psychiatry and Sleep Disorders Center, Institute of Psychiatry and Neurology, Warsaw, Poland |
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| Abstract: | ObjectiveThe pathophysiology of restless legs syndrome (RLS) involves a dopaminergic dysregulation that remains poorly understood, with controversial data from the literature. Stroke-related RLS is a rare condition that involves primarily the basal ganglia, the paramedian pons, and the thalamus. Given these elements, we studied dopaminergic metabolism in patients with RLS secondary to lenticulostriate infarction using structural and nuclear imaging in the striatum ipsilateral to the infarction area, as compared to the contralateral side. We hypothesized that dopaminergic metabolism would be impaired in the striatum ipsilateral to stroke.MethodsIn this observational case-control study, we aimed to prospectively include patients with RLS secondary to lenticulo-striate infarction, for analyses of dopamine dysfunction ipsilateral to stroke as compared to the contralateral striatum and to a control population. Four patients fulfilled inclusion criteria with either de novo RLS or major exacerbation of RLS existing prior to stroke, and all four patients were included. Structural imaging was performed using brain magnetic resonance imaging, and the stroke-induced metabolic modifications were assessed by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET). Dopamine reuptake via DAT was explored using 123I-FP-CIT SPECT. PET with 18F-FDOPA was used to evaluate the functional integrity of the presynaptic dopaminergic synthesis.ResultsThe only structure damaged in all patients was the body of the caudate nucleus, right-sided for three and left-sided for one, as illustrated by magnetic resonance imaging. 18F-FDG PET showed a hypometabolism in the infarcted area, the ipsilateral thalamus, and the contralateral cerebellum. All patients displayed, in the ipsilateral putamen, increased dopaminergic tone.ConclusionThe present findings suggest that increased dopaminergic tone in the striatum may participate in the pathogenesis of RLS. These observations should encourage further research on RLS symptomatic with well-defined lesions as a promising way to further improve our understanding of its pathophysiology. |
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| Keywords: | Restless legs syndrome Post stroke RLS RLS pathophysiology Dopamine dysregulation Caudate nucleus Basal ganglia |
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