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2017 ; 31
(ä): 39-48
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Brain imaging and networks in restless legs syndrome
#MMPMID27838239
Rizzo G
; Li X
; Galantucci S
; Filippi M
; Cho YW
Sleep Med
2017[Mar]; 31
(ä): 39-48
PMID27838239
show ga
Several studies provide information useful to our understanding of restless legs
syndrome (RLS), using various imaging techniques to investigate different aspects
putatively involved in the pathophysiology of RLS, although there are
discrepancies between these findings. The majority of magnetic resonance imaging
(MRI) studies using iron-sensitive sequences supports the presence of a diffuse,
but regionally variable low brain-iron content, mainly at the level of the
substantia nigra, but there is increasing evidence of reduced iron levels in the
thalamus. Positron emission tomography (PET) and single positron emission
computed tomography (SPECT) findings mainly support dysfunction of dopaminergic
pathways involving not only the nigrostriatal but also mesolimbic pathways. None
or variable brain structural or microstructural abnormalities have been reported
in RLS patients; reports are slightly more consistent concerning levels of white
matter. Most of the reported changes were in regions belonging to sensorimotor
and limbic/nociceptive networks. Functional MRI studies have demonstrated
activation or connectivity changes in the same networks. The thalamus, which
includes different sensorimotor and limbic/nociceptive networks, appears to have
lower iron content, metabolic abnormalities, dopaminergic dysfunction, and
changes in activation and functional connectivity. Summarizing these findings,
the primary change could be the reduction of brain iron content, which leads to
dysfunction of mesolimbic and nigrostriatal dopaminergic pathways, and in turn to
a dysregulation of limbic and sensorimotor networks. Future studies in RLS should
evaluate the actual causal relationship among these findings, better investigate
the role of neurotransmitters other than dopamine, focus on brain networks by
connectivity analysis, and test the reversibility of the different imaging
findings following therapy.