Remission of Severe Restless Legs Syndrome and Periodic Limb Movements in Sleep after Bilateral Excision of Multiple Foot Neuromas: A Case Report

Ludwig A Lettau; Charles J Gudas; Thomas D Kaelin

J Med Case Reports. 2010;4(306)

Conclusions

The immediate and near-complete remission of symptoms, the histopathological documentation, and the marked improvement in polysomnographic parameters together clearly indicate that our patient's severe RLS and PLMS was of peripheral nerve (foot neuroma) origin. Further study of foot neuromas as a source of PLMS and as a cause of sleep dysfunction in patients with or without concomitant RLS, is warranted.

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Table 1. Pre/post second neuroma surgery polysomnography results
	Pre-operative (Baseline) (-16 weeks)	Post-operative (+6.3 weeks)
Total sleep time (efficiency)	309 minutes (71%)	346 minutes (88%)
SLEEP STAGE%
Stage 1	21.5%	03.3%
Stage 2	73.2%	64.0%
Stage 3/4	0%	0%
REM sleep	05.3%	32.7%
Respiratory events (AHI rate)	16 (3.1 events/hour)	47 (8.2 events/hour)
Periodic limb movements	782	61
Periodic limb movements with
arousal (rate)	698 (135.5 movements/hour)	19 (3.3 movements/hour)
Spontaneous arousals (rate)	89 (17.3 arousals/hour)	0 (0 arousals/hour)

AHI = apnea hyperpnea index.

Table 2. Pre/post-second neuroma surgery questionnaire and rating scale results
	Pre-operative (baseline)	Post-operative
	(-1 week)	(+2.6 weeks)	(+9 weeks)	(+115 weeks)
NEUROPATHIC SYMPTOM SCORES
VAS forefoot numbness	0.5	0	0	7.6
VAS burning and/or tingling	7.9	0	2.5	4.1
VAS electric shock pains	8.8	1.4	1	3.8
VAS foot hypersensitivity	6.4	0	5.1	7.5
RLS SCORES
International RLS rating scale	36	4	1	10
VAS evening leg restlessness	9.0	0.6	0	1.9
DEPRESSION SCORE
Beck depression inventory II	29	1	1	8
FATIGUE SCORES
VAS daytime fatigue	6.3	0	1.5	2.8
Fatigue severity scale	52.2	16.2	12.6	41
MAF Global fatigue index	35.1	1	12	15.1
SLEEP QUALITY SCORES
VAS poor quality sleep	10.0	1	0	1.9
PSQI Global score	18	1	2	8

MAF = multidimensional assessment of fatigue; PSQI = Pittsburgh Sleep Quality Index; RLS = restless legs syndrome; VAS = visual analog scale.

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