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Comparisons of akathisia and restless legs syndrome: an electrophysiological study [Turk J Neurol]
Turk J Neurol. Ahead of Print: TJN-92679

Comparisons of akathisia and restless legs syndrome: an electrophysiological study

Bengi Gül Türk1, Ayşegül Gündüz1, Sinem Metin2, Barış Metin3, Derya Karadeniz1, Meral E. Kızıltan1
1Department Of Neurology, Istanbul University Cerrahpasa Faculty Of Medicine, Istanbul, Turkey
2Department of Psychiatry, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey; Department of Psychology, Uskudar University, Istanbul, Turkey
3Department of Neurology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey; Department of Neurology, Uskudar University, Istanbul, Turkey

Objective: There are clinical similarities between akathisia and restless legs syndrome (RLS). Thus, we aimed to investigate the functional changes of the brainstem and its rostral connections in akathisia in comparison to RLS.
Materials and Methods: Seven patients with akathisia were included in the study. We also included a group of patients with restless legs syndrome (n=14) and a control group was formed including healthy volunteers (n=39). Blink reflex (BR), auditory startle reflex (ASR) and somatosensory startle (SSS) reflexes were studied in all participants. Onset latency, probability, amplitude, pattern and duration of responses were compared between the 3 groups.
Results: Mean onset latencies of bilateral R2 and R2c were longer in akathisia group compared to RLS patients and healthy individuals. The mean latencies of responses after auditory stimulation were similar among groups. The total ASR probability was higher in akathisia and RLS groups compared to healthy subjects and this difference showed a borderline significance (p=0.047). Duration of responses after auditory stimulation was longer in the akathisia group. Presence and latency of SSS were similar among three groups.
Conclusion: Longer onset latencies and higher probability of ASR in akathisia group suggest that there is a hypodopaminergic state in this group. On the other hand longer latencies of R2-BR in akathisia patients suggest a delayed transmission in its pathway, indirectly showing involvement of serotoninergic pathways in the absence of a structural lesion. Thus, in akathisia, there are findings suggestive of serotoninergic involvement, differing from RLS whereas findings attributed to dopaminergic deficits were quite similar to patients with RLS.

Keywords: akathisia, restless legs syndrome, brainstem reflexes, blink reflex, auditory startle reflex

Corresponding Author: Bengi Gül Türk, Türkiye

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