Park Kang Min, Kim Keun Tae, Lee Dong Ah, Cho Yong Won
Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.
J Sleep Res. 2025 Feb;34(1):e14303. doi: 10.1111/jsr.14303. Epub 2024 Aug 4.
The pathophysiology of restless legs syndrome (RLS) remains incompletely understood. Although several studies have investigated the alterations of brain connectivity as one of the pathophysiological mechanisms of RLS, there are only few reports on functional connectivity changes after RLS treatment. Forty-nine patients with newly diagnosed RLS and 50 healthy controls were prospectively enrolled. The patients underwent resting-state functional magnetic resonance imaging (rs-fMRI) at baseline, and 39 patients underwent follow-up rs-fMRI, 3 months after treatment with pramipexole or pregabalin. Patients were divided into good or poor medication response groups. Functional brain connectivity was analysed using rs-fMRI and graph theoretical analysis. Significant differences in functional connectivity were observed between the RLS patients and healthy controls. The average path length, clustering coefficient, transitivity, and local efficiency were lower (2.02 vs. 2.30, p < 0.001; 0.45 vs. 0.56, p < 0.001; 3.08 vs. 4.21, p < 0.001; and 0.71 vs. 0.76, p < 0.001, respectively) and the global efficiency was higher (0.53 vs. 0.50, p < 0.001) in patients with RLS than in healthy controls. Differences in functional connectivity at the global level were also observed between post- and pre-treatment RLS patients who showed a good medication response. Transitivity in the post-treatment group was higher than that in the pre-treatment group (3.22 vs. 3.04, p = 0.007). Global efficiency was positively correlated with RLS severity (r = 0.377, p = 0.007). This study demonstrates that RLS is associated with distinct alterations in brain connectivity, which can be partially normalised following symptom management. These findings suggest that therapeutic interventions for RLS modulate brain function, emphasising the importance of symptom-focussed treatment in managing RLS.
不宁腿综合征（RLS）的病理生理学仍未完全明确。尽管有多项研究将脑连接性改变作为RLS的病理生理机制之一进行了调查，但关于RLS治疗后功能连接性变化的报道却很少。前瞻性纳入了49例新诊断的RLS患者和50例健康对照者。患者在基线时接受静息态功能磁共振成像（rs-fMRI）检查，39例患者在接受普拉克索或加巴喷丁治疗3个月后接受随访rs-fMRI检查。患者被分为药物反应良好或不良组。使用rs-fMRI和图论分析对脑功能连接性进行分析。在RLS患者和健康对照者之间观察到功能连接性存在显著差异。RLS患者的平均路径长度、聚类系数、传递性和局部效率较低（分别为2.02对2.30，p<0.001；0.45对0.56，p<0.001；3.08对4.21，p<0.001；0.71对0.76，p<0.001），而全局效率较高（0.53对0.50，p<0.001）。在药物反应良好的RLS治疗前后患者之间，也观察到了全局水平上功能连接性的差异。治疗后组的传递性高于治疗前组（3.22对3.04，p=0.007）。全局效率与RLS严重程度呈正相关（r=0.377，p=0.007）。本研究表明，RLS与脑连接性的明显改变有关，症状管理后这种改变可部分恢复正常。这些发现表明，RLS的治疗干预可调节脑功能，强调了针对症状的治疗在RLS管理中的重要性。
