ABSTRACT NUMBER: ESOC2026A1992 RESTLESS LEGS SYNDROME IN ACUTE STROKE PREDOMINANTLY PREDATES THE CEREBROVASCULAR EVENT

Abstract Background and aims Restless legs syndrome (RLS) has been described in patients with stroke, but insufficient data related to its temporal relationship with cerebrovascular events is know up to the present day. To better characterize the mechanisms between RLS and stroke, it should be determined whether RLS represent a pre-existing condition or a post-stroke complication. The aim of the study is to assess the temporal onset of RLS in patients with acute stroke and its relationship with stroke subtype and lesion location. Methods Consecutive patients admitted with ischemic stroke, hemorrhagic stroke, or transient ischemic attack were prospectively screened for RLS using International Restless Legs Syndrome Study Group criteria. RLS severity was assessed with the IRLSSG severity scale. Stroke subtype and lesion location were recorded from neuroimaging. RLS onset was classified as pre-stroke or post-stroke based on structured interviews. Results Among 754 patients with acute cerebrovascular events, 105 (13.9%) met the criteria for a positive RLS diagnosis. RLS symptoms were, in most cases, present prior to the stroke (68/105, 64.8%), while post-stroke onset was reported in 37 patients (35.2%). RLS prevalence was highest in ischemic stroke (16.5%), followed by hemorrhagic stroke (13.3%) and transient ischemic attack (1.8%). The majority of patients with RLS (86.7%) had lesions involving subcortical structures. Conclusions In patients with acute stroke, RLS more frequently predates the cerebrovascular event rather than emerging as a de novo post-stroke disorder. These findings argue against stoke as a primary trigger of RLS and support the concept of shared vulnerability within subcortical sensorimotor networks. Conflict of interest Nothing to disclose