Improved restless legs syndrome symptoms after lower leg nerve decompression surgery

Abstract Purpose The relationship between restless legs syndrome (RLS) and nerve entrapment was initially observed among patients presenting for nerve decompression surgery for the alleviation of symptoms related to peripheral neuropathy. These clinical findings were published in a retrospective analysis. However, the data from this novel observation did not include metrics specific to RLS or sleep quality. The purpose of this research was to assess changes in sleep quality and RLS symptoms using validated questionnaires. Methods Patients with an RLS diagnosis completed the International Restless Legs Syndrome Study Group Rating Scale (IRLS) before and 3 months after surgery. Results Subjects demonstrated improvement at the post-surgical follow-up assessment for IRLS score ( P = 0.001), PSQI (time to fall asleep, P = 0.039 and leg movements during sleep, P = 0.002), all VAS symptom severity scores ( P < 0.05), RLS symptom severity (at night, P < 0.001 and while falling asleep, P = 0.008), and PSSD values (Dorsal foot spacing, P = 0.025). NIM evoked potential values (peroneus longus, P = 0.006 and tibialis anterior, P = 0.031) also improved intraoperatively immediately after the surgical release of the nerve. Conclusion Surgical decompression of nerves in lower extremities improved symptoms associated with RLS as assessed by the IRLS, which is the standard assessment for IRLS severity classification. Improvements in both motor and sensory function indicate that peripheral intervention may affect RLS symptoms to the degree that nerve entrapment could be considered a potential contributor to RLS etiology in patients with these characteristics.