Eguchi Sachiko, Yokotsuka-Ishida Saeko, Arai Yusuke, Sasayama Daimei, Maeda Takugo, Kanaya Kohei, Fukuyama Tetsuhiro, Nomura Kensuke, Washizuka Shinsuke
Department of Psychiatry Shinshu University School of Medicine Nagano Japan.
Department of Epilepsy Shinshu University School of Medicine Nagano Japan.
PCN Rep. 2024 Jun 19;3(2):e213. doi: 10.1002/pcn5.213. eCollection 2024 Jun.
Restless legs syndrome (RLS) is a neurological sensorimotor disorder characterized by an uncontrollable urge to move the legs. In the perioperative period, patients with RLS may experience an acute exacerbation of symptoms. Although studies on the exacerbation of RLS after brain surgery are limited, we present a case wherein symptoms worsened following left amygdalohippocampectomy.
A 58-year-old woman diagnosed with mesiotemporal lobe epilepsy accompanied by left hippocampal sclerosis underwent a left amygdalohippocampectomy. The patient reported uncomfortable sensations in the lower limbs preoperatively. However, the urge to move her legs was manageable and not distinctly diagnosed with RLS. The symptoms began to deteriorate on the fifth postoperative day primarily affecting the legs and back, with a notable emphasis on the right side. Pramipexole treatment effectively ameliorated these symptoms.
No reports are available highlighting the exacerbation of RLS after amygdalohippocampectomy. Perioperative factors, such as anesthesia and iron deficiency due to hemorrhage, have been proposed as aggravating factors for RLS; however, the asymmetry of RLS, particularly the atypical right-sided exacerbation in this case, makes it unlikely that this was the primary cause. A negative correlation between opioid receptor availability in the amygdala and RLS severity has been reported, suggesting that amygdalohippocampectomy contributes to the exacerbation of RLS symptoms. This case provides valuable insights into the possible involvement of the amygdala in the pathophysiology of RLS and practical considerations for the clinical management of the condition.
不宁腿综合征（RLS）是一种神经感觉运动障碍，其特征为无法控制的腿部活动冲动。在围手术期，RLS患者可能会经历症状的急性加重。尽管关于脑手术后RLS加重的研究有限，但我们报告了一例在左侧杏仁核海马切除术之后症状恶化的病例。
一名58岁女性被诊断为伴有左侧海马硬化的颞叶内侧癫痫，接受了左侧杏仁核海马切除术。患者术前报告下肢有不适感。然而，其腿部活动冲动是可控的，未被明确诊断为RLS。术后第5天症状开始恶化，主要影响腿部和背部，以右侧更为明显。普拉克索治疗有效缓解了这些症状。
尚无关于杏仁核海马切除术后RLS加重的报道。围手术期因素，如麻醉和出血导致的缺铁，已被认为是RLS的加重因素；然而，RLS的不对称性，尤其是本例中不典型的右侧加重，使得这不太可能是主要原因。有报道称杏仁核中阿片受体可用性与RLS严重程度呈负相关，这表明杏仁核海马切除术会导致RLS症状加重。该病例为杏仁核在RLS病理生理学中的可能作用以及该病临床管理的实际考量提供了有价值的见解。
