0668 Small Fiber Neuropathy in Patients with Refractory RLS: A Case Series. (27th April 2018)

• Record Type: Journal Article
• Authors: Bhartee, H; Sahota, P; Sivaraman, M; Govindarajan, R; Bollu, P C; Thakkar, M; Goyal, M; Johnson, J; Singh, S
• Is Part Of: Sleep. Volume 41(2018)Supplement 1
• Page Start: A247
• Page End: A248
• Publication Date: 2018-04-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy061.667
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Small Fiber Neuropathy (SFN) has been implicated as an associated mechanism in the causation and worsening of Restless Leg Syndrome (RLS) symptoms. Refractory RLS is defined as RLS not responsive to monotherapy with tolerable doses of a dopamine agonist or alpha-2-delta ligand due to reduced efficacy, augmentation, or adverse effects. Our objective is to characterize the spectrum of SFN in patients with refractory RLS. Methods: Ten previously diagnosed patients with refractory RLS were analyzed retrospectively with chart review between 2014 and 2016. These patients had undergone nerve conduction study and electromyography that did not show large fiber neuropathy. These patients subsequently underwent skin biopsy for evaluation for SFN as they had a pin prick gradient. Results: Ten patients (age range: 45 years-65 years, median 56 years, all Caucasians) were analyzed. Seven patients had length dependent SFN and the three had non-length dependent SFN. Of the seven with length dependent SFN, three had pre-diabetes, one had an autoimmune case with TS-HDS antibody (titer=1:30000, normal less than 1: 10000, Washington University St. Louis neuromuscular lab) and in three patients the cause of neuropathy was unknown. In one patient with non-length dependent SFN, the cause was unknown. In second case the cause was due to hepatitis C and in the third case it was due to high TS-HDS antibody (titer=1:40000, normal <1:10000). Two patients with pre-diabetes underwent lifestyle changes resulting in correction of the pre-diabetic state and improvement in their restless leg symptoms. The patient with hepatitis C was treated with interferon and resulted in improvement of RLS symptoms. Two patients with elevated TS-HDS antibody were treated with pulse dose intravenous methylprednisolone which provided temporary relief in symptoms. Conclusion: Patients with refractory RLS can have co-existing small fiber neuropathy. Further workup and treatment of neuropathy might help to reduce RLS symptoms in some cases. Support (If Any):