Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Imaging Research Center, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil.
Brain Institute, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil; Universidade de Fortaleza (UNIFOR), Unifor, Fortaleza, CE, Brazil.
Sleep Med. 2020 Sep;73:106-116. doi: 10.1016/j.sleep.2020.05.040. Epub 2020 Jun 6.
Restless Legs Syndrome, a potentially disabling sleep disorder, also known as Willis-Ekbom disease (RLS/WED), may be caused by loss of inhibitory modulation of descending central motor pathways, structural changes in the somatosensory cortex, abnormal connectivity between motor and sensory areas, as well as by subtle abnormalities in white matter micro-organization.
To compare diffusion-tensor imaging (DTI) metrics in areas associated with sensory or motor function, as well as sensorimotor integration, between subjects with primary mild-to-severe RLS/WED and controls.
DTI metrics were assessed in 38 subjects with RLS/WED (14 mild to moderate, 24 severe to very severe) and 24 healthy age-matched controls with whole-brain Tract Based Spatial Statistics (TBSS), Region-of-interest (ROI) and probabilistic tractography based analyses. The ROIs corresponded to the corticospinal tract (CST) at the level of the cerebral peduncle; the superior, middle and inferior cerebellar peduncles. Subgroup analyses were made according to the severity of RLS/WED symptoms. The corticospinal tract was evaluated with probabilistic tractography. We also explored associations between significant findings and severity of symptoms with the Spearman's correlation coefficient.
TBSS analysis revealed decreased axial diffusivity (AD) in the left posterior thalamic radiation in RLS/WED. In subjects with severe RLS/WED, AD was reduced in the left posterior corona radiata and this reduction was negatively correlated with severity of symptoms. ROI-based analysis showed that radial diffusivity (RD) was increased in the superior cerebellar peduncles of individuals with severe RLS/WED. Tractography did not show between-group or subgroup differences.
Our results are consistent with subtle white matter changes, prominently in RLS/WED subjects with more severe symptoms, in areas related to sensory or motor function, as well as to sensorimotor integration, compared to controls. These findings support the hypothesis, raised by prior pathophysiological studies, of defective integration within these networks.
不宁腿综合征（RLS）是一种潜在致残的睡眠障碍，也被称为 Willis-Ekbom 病（RLS/WED），其病因可能是下行中枢运动通路抑制性调节丧失、躯体感觉皮层结构改变、运动区与感觉区之间异常连接以及白质微观结构的细微异常。
比较原发性轻至重度 RLS/WED 患者与对照组之间与感觉或运动功能以及感觉运动整合相关的弥散张量成像（DTI）指标。
使用全脑基于束的空间统计学（TBSS）、感兴趣区（ROI）和概率性纤维束追踪分析对 38 例 RLS/WED 患者（14 例为轻度至中度，24 例为重度至非常重度）和 24 例年龄匹配的健康对照者进行 DTI 指标评估。ROI 对应于大脑脚水平的皮质脊髓束（CST）、上、中、小脑脚。根据 RLS/WED 症状的严重程度进行亚组分析。采用概率性纤维束追踪评估皮质脊髓束。我们还使用 Spearman 相关系数探索了显著发现与症状严重程度之间的相关性。
TBSS 分析显示 RLS/WED 患者左侧丘脑后辐射的轴向弥散度（AD）降低。在重度 RLS/WED 患者中，左侧后放射冠的 AD 降低，且这种降低与症状严重程度呈负相关。ROI 分析显示，严重 RLS/WED 患者的上小脑脚的径向弥散度（RD）增加。纤维束追踪未显示组间或亚组间差异。
与对照组相比，RLS/WED 患者，尤其是症状更严重的患者，在与感觉或运动功能以及感觉运动整合相关的区域中，存在轻微的白质变化，这与之前的病理生理学研究提出的这些网络内整合缺陷的假说一致。
