Spinal cord injuries (SCI) are common in veteran populations. 1 Veterans with spinal cord injuries and disorders (SCI/D) also may have concurrent sleep disturbances. Spinal cord injury typically causes spasticity. 2,3 Hypersensitivity of the flexor reflex pathways is believed to cause painful muscle spasms in patients with SCI. 4 Neuropathic pain at or below the level of the lesion also is common.
Restless legs syndrome (RLS) is a common sleep disorder that affects sleep quality and can occur concomitantly with spinal cord lesions. 5 In about 80% of RLS cases, involuntary movements of legs across hip, knee, and ankle joints during sleep, known as periodic limb movement during sleep (PLMS), occurs. 6 Several studies showed increased prevalence of PLMS in patients with SCI, and some case reports suggest an increased prevalence of RLS in this population. 7,8 One small study showed that 100% of patients with SCI had symptoms of RLS. 6 Another study found that SCI could trigger PLMS. 8
The pathophysiology of RLS and PLMS in patients with SCI is not fully understood, but case reports describing PLM in SCI patients points to a possible role of central pattern generators and the flexor reflex afferents in the pathophysiology of PLMS. 9,10 Changes of the tissue microstructure in the midbrain and upper cervical spinal cord have been described in patients with RLS. 11The objective of this study was to assess the prevalence of RLS in a veteran population with SCI/D and to determine possible neuroanatomical patterns involved in RLS and SCI/D.