To investigate deep brain stimulation effect on restless legs syndrome at different implantation sites

Restless legs syndrome (RLS) has been associated with conditions like Parkinson’s disease and essential tremors, to which DBS is also a treatment option. Both relief and worsening of restless legs syndrome after deep brain stimulation has been reported in subthalamic nucleus (STN), ventral intermediate (Vim) and Globus Pallidus internus (GPi).

Embase, PubMed, Cochrane, ClinicalTrials.gov are searched extensively using terms such as restless legs syndrome and deep brain stimulation. We specifically include studies that have clinical scales for restless legs syndrome such as the International Restless Legs Rating Scale (IRLS), Parkinson’s Disease Sleep Scale (PDSS), and DBS location pre- and post- implantation. The details will be reported according to PRISMA guidelines for systemic review. A meta-analysis is then performed on final studies.

1287 articles result from our database inquiries. 173 duplicates are removed. 1105 articles are excluded by our exclusion criteria. 9 studies are included for meta-analysis. DBS at STN, Vim and GPi all improve IRLS by 9.2 (95% CI 5.5-12.9, p<0.001), a mean levodopa equivalent dose (LED) decrease of 500.59 (95% CI 70.26-930.92, p=0.017). There is no statistical difference between STN and other sites (p=0.202). STN and GPi DBS also improve PDSS by 14.41 (95% CI 1.98-26.84, p=0.015), with LED decrease of 431.93 (95% CI 284.96-578.91, p<0.001).

STN, Vim and GPi DBS improve RLS syndrome regarding IRLSS and PDSS, with no significant difference between the targets; indicating that DBS, regardless of target site, can be treatment consideration for RLS, in the setting of associated conditions currently indicated for DBS. More studies, including RLS only DBS studies,  especially for Vim and GPi, as well as head-to-head trial of different targets are needed.