Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Italy.
Neurology Unit and Stroke Center, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.
Sleep Med. 2021 Dec;88:74-80. doi: 10.1016/j.sleep.2021.10.025. Epub 2021 Oct 22.
Although several studies have shown the involvement of specific structures of the central nervous system, the dopaminergic system, and iron metabolism in restless legs syndrome (RLS), the exact location and extent of its anatomical substrate is not yet known. The scope of this new study was to investigate the brain subcortical gray structures, by means of structural magnetic resonance imaging (MRI) studies, in RLS patients in order to assess the presence of any volume or shape abnormalities involving these structures.
Thirty-three normal controls (24 females and nine males) and 45 RLS patients (34 females and 11 males) were retrospectively recruited and underwent a 1.5 Tesla MRI study with two-dimensional T1 sequences in the sagittal plane. Post-processing was performed by means of the Functional Magnetic Resonance Imaging of the Brain Analysis Group Integrated Registration and Segmentation Tool (FIRST) software, and both volumetric and morphological analyses of the thalamus, caudate, putamen, globus pallidus, brainstem, hippocampus, and amygdala, bilaterally, were carried out.
A statistically significant volumetric reduction in the left amygdala and left globus pallidus was found in subjects with RLS, as well as large surface morphological alterations affecting the amygdala bilaterally and other less widespread surface changes in both hippocampi, the right caudate, the left globus pallidus, and the left putamen.
These findings seem to indicate that the basic mechanisms of RLS might include a pathway involving not only the hypothalamus-spinal dopaminergic circuit (nucleus A11), but also pathways including the basal ganglia and structures that are part of the limbic system; moreover, structural alterations in RLS seem to concern the morphology as well as the volume of the above structures. The role of basal ganglia in the complex neurophysiological and neurochemical mechanism of RLS needs to carefully reconsidered.
尽管有几项研究表明中枢神经系统的特定结构、多巴胺能系统和铁代谢与不宁腿综合征（RLS）有关，但确切的解剖学基础的位置和范围尚不清楚。本项新研究的目的是通过结构磁共振成像（MRI）研究，调查 RLS 患者的脑皮质下灰质结构，以评估这些结构是否存在任何体积或形状异常。
回顾性招募了 33 名正常对照者（24 名女性和 9 名男性）和 45 名 RLS 患者（34 名女性和 11 名男性），并对他们进行了 1.5T MRI 研究，使用矢状面二维 T1 序列。通过功能磁共振成像脑分析组集成注册和分割工具（FIRST）软件进行后处理，对双侧丘脑、尾状核、壳核、苍白球、脑干、海马和杏仁核进行了容积和形态分析。
RLS 患者的左侧杏仁核和左侧苍白球体积明显减小，双侧杏仁核大面积表面形态改变，双侧海马以及其他较少的海马、右侧尾状核、左侧苍白球和左侧壳核也存在较小面积的表面改变。
这些发现似乎表明，RLS 的基本机制可能不仅包括涉及下丘脑-脊髓多巴胺能回路（A11 核）的通路，还包括包括基底节和边缘系统一部分结构的通路；此外，RLS 的结构改变不仅涉及上述结构的体积，还涉及它们的形态。基底节在 RLS 复杂的神经生理和神经化学机制中的作用需要重新仔细考虑。
