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Session Schedule

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0:00:00
Restless legs syndrome and stroke – association and role in risk stratification
Garima Shukla (Canada)

0:18:10
Role of periodic limb movements as a risk factor for cerebrovascular disease
Raffaele Ferri (Italy)

0:38:45
Restless legs syndrome and coronary artery disease
Anupama Gupta (India)

0:58:30
Stroke related Restless legs syndrome – phenotypes and course
Elisabeth Ruppert (France)

1:16:00
Question and answer

Summary

Restless legs syndrome (RLS) remains commonly associated with several medical and neurological conditions, significantly worsening quality of life and sleep.
The introductory talk will feature lessons from our work on prevalence and characterization of pre-stroke Restless legs syndrome with unique features, leading up to determination of specific associations with and differentiation from other cardiocerebrovascular risk factors like Resistant hypertension and also with cerebral small vessel disease. Evidence suggests that pre-existing RLS (and possibly association periodic limb movements) could exacerbate stroke risk through mechanisms like sympathetic overactivity and sleep disruption. While more common in subcortical strokes, role of RLS in post-stroke recovery prognostication remains underexplored. This talk will review the current evidence, emphasizing the need for incorporating RLS into risk stratification models for better stroke prevention and management.
The second presentation will explore the role of PLMS as a significant risk factor for cerebrovascular disease, emphasizing both neurophysiological findings and epidemiological evidence. PLMS are associated with transient autonomic arousals, increased sympathetic activity, and fluctuations in blood pressure, all of which can contribute to vascular stress. Epidemiological studies have further linked the presence and severity of PLMS to an elevated risk of stroke and other cardio- and cerebrovascular events, highlighting their potential impact on long-term vascular health. This presentation integrates objective data from sleep studies with population-level research, underscoring the clinical importance of addressing PLMS in individuals at risk for cerebrovascular disease.
RLS disrupts night-time sleep in coronary artery disease, daytime dysfunction, and is associated with adverse cardiovascular consequences even after revascularization, with a significant impact on sleep and life quality. RLS in the CAD population has a distinct clinical profile and is possibly secondary to cardiovascular pathology. The recently observed changes in sympathovagal balance during sleep in RLS patients using heart rate variability (HRV) spectral analysis and autonomic system disorders in patients with RLS suggest that RLS increases the risk of cardio-vascular diseases. Importantly, RLS is a treatable sleep disorder that causes disturbed sleep, and treating RLS is associated with reduced risk of myocardial infarction and angina. The third talk will incorporate data on recognition and optimal treatment of RLS in this population through pharmacological as well as non-pharmacological (yoga, exercise, and massage) interventions which could improve quality of life and reduce serious clinical consequences.
The third part of the symposium focuses on the emerging entity of stroke-related restless legs syndrome (sRLS), characterized by new-onset or worsening RLS symptoms following a stroke. sRLS symptoms typically appear shortly after stroke onset but can occasionally manifest beforehand. The stroke's topography significantly influences sRLS development, with higher prevalence in supratentorial and brainstem infarctions. Especially subcortical lesions may lead to RLS. While rare cases of RLS regression following stroke have been reported, the neuroanatomical pathways remain unclear, suggesting involvement of multiple brain structures. Small lesion-induced sRLS could serve as a valuable model for studying RLS mechanisms. This presentation will explore the clinical presentation, course, response to treatment, and underlying pathophysiology of sRLS, offering insights into this underrecognized yet impactful condition.

Learning Objectives:

Upon completion of this CME activity, participants will be able to:
• Explain how Restless legs syndrome may have a unique role in risk stratification for stroke prevention and rehabilitation strategies
• Obtain an update on clinical, neurophysiological and epidemiological evidence on role of periodic limb movements as a risk factor for cerebrovascular disease
• Recognize the link between Restless legs syndrome and coronary artery disease, and review specific treatment strategies for RLS in patients with coronary artery disease
• Compare and contrast different clinical presentations of Restless legs syndrome in patients with stroke that aid phenotyping of stroke related RLS