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)

Consent

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the journal's Editor-in-Chief.

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Acknowledgements
None. There was no outside funding source for this work.

Authors' contributions
LAL directed our patient's care, administered and interpreted the rating scales and questionnaires, and wrote the manuscript. CJG administered all neuroma injections, performed and interpreted all ultrasound evaluations, performed the neuroma surgeries, and contributed to the methods portion of the manuscript. TDK helped manage our patient's RLS and performed and interpreted the polysomnographic studies. All authors read and approved the final manuscript.

Competing interests
The authors declare that they have no competing interests.

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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