RLS and knee prostheses

[PhilGB]

A recent Brazilian study in San Paolo titled 'Restless legs syndrome in subjects with a knee prosthesis: evidence that symptoms are generated in the periphery' again points to peripheral generation of some sort of signal in RLS. It appears to me to definitely be raising the question of the role of peripherally generated signals in the perception of limb feeling. Ekbom also did a study in the 60's about RLS and amputees. I am not sure if the RLS community is aware of this potential mechanism; it may be a commonly discussed topic, I don't know (I am realtively new to the forum). Still I find it very interesting. The dysthesia in my left leg caused by sacro-lumbar pathology and the concentration of RLS symptoms in my left leg in my case, can only be anecdotally correlated. I would love to discover that there are scientific underpinnings to this, as it could be the start of a whole new approach in treatment.

The study can be found via PubMed
Clinics (Sao Paulo). 2011 November; 66(11): 1955–1959. doi: 10.1590/S1807-59322011001100017 PMCID: PMC3203970

Restless legs syndrome in subjects with a knee prosthesis: evidence that symptoms are generated in the periphery

José Carlos Pereira, Jr.,I João Luiz Pereira da Silva Neto,II and Márcia Pradella-HallinanIII

[ViewsAskew]

I didn't read it, but did they account for blood loss, anemia, and low ferritin? Surgery of any kind seems to worsen RLS/WED symptoms.

[badnights]

There has been other evidence that peripheral nerves are involved. There was an editorial in Sleep Medicine (2010, p503) that hypothesizes that both peripheral and descending (brain-generated) inputs are required to activate RLS, possibly at the spinal cord level. There are probably papers in that issue that prompted the editorial but I didn't check.

Another paper in a book I have deals with spinal structures and the action of opioids in improving RLS, and they seemed to be implying that opioids suppress afferent-nerve feedback (nerves that send signals from the periphery to the brain) that is somehow generated normally during brain-initiated movement but fails to be suppressed in RLS.

[PhilGB]

So is there a possibility of a structurally based CURE for RLS? Either through surgery, physical therapy, etc. I know very well first hand the power of (in my case) Requip to manage the disease. And I cynically suspect where there is money to be made in managing a disease, there is very little money funneled to finding a cure. I have posited a possibility of some structural involvement in the disease to my neurologist, but he dismisses me with the prevailing attitude that it is simply a neurological (a la Parkinson's) problem. I did not want to mention that when all you have is a hammer, everything looks like a nail.
There is always a chance that this sort of orthodox thinking will be shown historically to be inaccurate. I always remember the push back by GI doctors over the outrageous proposition that H. Pylori was the causative agents in gastric ulcers and not stress, etc. And now H. Pylori is viewed as the primary causative agent.

[rthom]

Well put. True you probably shouldn't mention that to him (not till your last visit anyway).

[ViewsAskew]

Philg - just too many unknowns. At one time the earth was flat and baths made you sick....

I can only hope that more research - or someone seeing a missed connection, as you are looking for - will find the missing pieces soon. As you noted, whenever money is not going to be made on the solution, the solution is not usually found.

[badnights]

Anyway the impression I got was that BOTH peripheral and brain-originating signals were involved, which isn't as simple as peripheral-only. But let's keep thinking about it!

[Chipmunk]

You know, you are the type of patient that leads to breakthroughs in the disease. Since you only have symptoms in one leg, if someone could figure out what is different from one leg to the other......so fascinating!