Unraveling the pathophysiology of restless legs syndrome from multimodal MRI techniques: A systematic review

IF 3.8 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine Pub Date : 2024-11-13 DOI:10.1016/j.sleep.2024.11.020

Tapas Pani , Maria Paola Mogavero , Raffaele Ferri , Giuseppe Lanza

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引用次数: 0

Abstract

Background

Restless Legs Syndrome (RLS) is a common neurological disorder currently diagnosed based on clinical features only, and characterized by a compulsive urge to move the legs triggered by rest or diminished arousal. This systematic review aimed at integrating all current brain magnetic resonance imaging (MRI) modalities for a convergent pathophysiological understanding of RLS phenomenology.

Methods

We performed a MEDLINE (PubMed)-based systematic review for research articles in patients with primary RLS published in English from 2010 till November 2023. Studies meeting the inclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were systematically assessed for quality using modality-specific checklists, bias using AXIS tool and a narrative synthesis of the results was conducted.

Results

A total of 49 studies (22 structural, 12 DTI, 7 iron-imaging, 4 spectroscopy with 10 datasets combining multiple approaches) involving 1273 patients (414 males) and 1333 healthy controls (478 males) met the eligibility criteria. Despite participant, technical/device-related and statistical heterogeneity, most agree that patients with primary RLS have structural and metabolite alterations, changes in multiple white matter tract architectures, and disrupted functional connectivity within multiple brain areas. Most of the studies (n = 43, 88 %) have a low-risk of bias on the AXIS scale. Scores on the modality-specific checklist ranged from 46 to 92 %, 70–93 % and 54–92 % for structural MRI, DTI and MRS Datasets, respectively.

Conclusions

Notwithstanding the large heterogeneity in the methods employed, global connectivity alterations suggest the utility of casting RLS within a system-level perspective rather than viewing it as related to the dysfunction of a single or particular brain region. A holistic approach and its integration within the framework of molecular vulnerability and neurotransmitter alterations are warranted to disentangle the complex pathophysiology of RLS and to identify new therapeutic targets.

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从多模态磁共振成像技术揭示不安腿综合征的病理生理学：系统综述。

背景：不宁腿综合征（RLS）是一种常见的神经系统疾病，目前仅根据临床特征进行诊断，其特征是休息或唤醒减弱时会引发强迫性的腿部活动冲动。本系统性综述旨在整合目前所有的脑磁共振成像（MRI）模式，以便对 RLS 现象有一个趋同的病理生理学认识：我们以 MEDLINE (PubMed) 为基础，对 2010 年至 2023 年 11 月期间用英语发表的有关原发性 RLS 患者的研究文章进行了系统综述。根据《系统综述和Meta分析首选报告项目》标准，我们对符合纳入标准的研究进行了系统评估，包括使用特定模式核对表评估质量、使用AXIS工具评估偏倚，以及对结果进行叙述性综合：共有 49 项研究（22 项结构性研究、12 项 DTI 研究、7 项铁成像研究、4 项光谱学研究和 10 项结合多种方法的数据集）符合资格标准，涉及 1273 名患者（414 名男性）和 1333 名健康对照者（478 名男性）。尽管存在参与者、技术/设备相关性和统计异质性，但大多数研究一致认为原发性 RLS 患者存在结构和代谢物改变、多种白质束结构改变以及多个脑区功能连接紊乱。大多数研究（n = 43，88%）的 AXIS 量表偏倚风险较低。结构 MRI、DTI 和 MRS 数据集在特定模式核对表上的得分分别为 46%-92%、70%-93% 和 54%-92%：尽管所采用的方法存在很大的差异，但整体连接性的改变表明，从系统层面的角度来看待 RLS 是有用的，而不是将其视为与单一或特定脑区的功能障碍有关。有必要采用整体方法并将其整合到分子脆弱性和神经递质改变的框架中，以揭示 RLS 复杂的病理生理学并确定新的治疗目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Sleep medicine 医学-临床神经学

CiteScore

8.40

自引率

6.20%

发文量

1060

审稿时长

49 days

期刊介绍： Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.