Electromyographic Abnormalities in Restless Legs Syndrome: The Predominant Role of Aging Beyond Iron Deficiency

Yıl 2026, Cilt: 2 Sayı: 1, 19 - 29, 25.02.2026

Emiş Cansu Yaka

https://doi.org/10.65308/gjohbs.2026.003

https://izlik.org/JA32ZL97LZ

Öz

Purpose: Restless Legs Syndrome (RLS) pathophysiology involves central iron deficiency and dopaminergic dysfunction, but the role of peripheral nerves and patient-specific factors like age remains unclear. This study investigated the relationships between serum ferritin, age, and peripheral electrophysiological findings in drug-naïve RLS patients. 

Methods: A retrospective cohort study was conducted with 95 drug-naïve RLS patients. Comprehensive analysis included serum ferritin levels, detailed nerve conduction studies, and clinical assessments. Statistical evaluations involved subgroup comparisons (based on ferritin and EMG status), correlation analyses, and binary logistic regression to identify independent predictors of abnormal electromyography (EMG). 

Results: The cohort had a mean age of 53.8 years, with 14.7% having low ferritin. A striking dissociation was observed: all patients (100%) with low ferritin had normal EMG, whereas 41.2% of those with normal ferritin had abnormal EMG (p=0.002). Patients with abnormal EMG were significantly older (62.7 vs. 48.9 years, p<0.001) and had longer symptom duration. Multivariate analysis confirmed advancing age as the sole independent predictor of abnormal EMG (aOR=1.14 per year, p=0.001). 

Conclusion: This study demonstrates a strong association between peripheral nerve abnormalities and advanced age, particularly in patients with accompanying comorbidities, in drug-naïve RLS patients, while such abnormalities were absent in younger patients with low ferritin.These findings point to potential subgroups with differing pathophysiology. Future research should incorporate advanced electrophysiological methods to better define these subgroups and their clinical relevance.

Anahtar Kelimeler

Restless Legs Syndrome , Ferritin , Electromyography , Peripheral Neuropathy , Phenotype

Huzursuz Bacak Sendromunda Elektromiyografik Anormallikler: Demir Eksikliğinin Ötesinde Yaşlanmanın Baskın Rolü

https://izlik.org/JA32ZL97LZ

Öz

Amaç: Huzursuz Bacak Sendromu (RLS) patofizyolojisi, merkezi demir eksikliği ve dopaminerjik disfonksiyonu içerir, ancak periferik sinirlerin ve yaş gibi hastaya özgü faktörlerin rolü hala belirsizdir. Bu çalışma, ilaç tedavisi almamış RLS hastalarında serum ferritin, yaş ve periferik elektrofizyolojik bulgular arasındaki ilişkileri araştırmıştır. Yöntemler: İlaç tedavisi almamış 95 RLS hastası ile retrospektif bir kohort çalışması yapılmıştır. Kapsamlı analiz, serum ferritin düzeyleri, ayrıntılı sinir iletim çalışmaları ve klinik değerlendirmeleri içermektedir. İstatistiksel değerlendirmeler, anormal elektromiyografi (EMG) için bağımsız belirleyicileri tanımlamak amacıyla alt grup karşılaştırmaları (ferritin ve EMG durumuna göre), korelasyon analizleri ve ikili lojistik regresyon içermektedir. Bulgular: Kohortun ortalama yaşı 53,8 olup, %14,7'sinde düşük ferritin düzeyi saptanmıştır. Çarpıcı bir ayrışma gözlemlendi: düşük ferritin düzeyine sahip tüm hastaların (%100) EMG'si normal iken, normal ferritin düzeyine sahip hastaların %41,2'sinde anormal EMG saptandı (p=0,002). Anormal EMG'si olan hastalar önemli ölçüde daha yaşlıydı (62,7 yaşa karşı 48,9 yaş, p<0,001) ve semptom süreleri daha uzundu. Çok değişkenli analiz, ilerleyen yaşın anormal EMG'nin tek bağımsız belirleyicisi olduğunu doğruladı (yılda aOR=1,14, p=0,001). Sonuç: Bu çalışma, özellikle eşlik eden komorbiditeleri olan hastalarda, ilaç tedavisi almamış RLS hastalarında periferik sinir anormallikleri ile ileri yaş arasında güçlü bir ilişki olduğunu gösterirken, ferritin düzeyi düşük olan daha genç hastalarda bu tür anormallikler görülmemiştir. Bu bulgular, farklı patofizyolojiye sahip potansiyel alt gruplara işaret etmektedir. Gelecekteki araştırmalar, bu alt grupları ve bunların klinik önemini daha iyi tanımlamak için gelişmiş elektrofizyolojik yöntemleri içermelidir.

Anahtar Kelimeler

Huzursuz Bacak Sendromu , Ferritin , Elektromiyografi , Periferik Nöropati , Fenotip

Kaynakça

• 1. Liu Z, Guan R, Pan L. Exploration of restless legs syndrome under the new concept: a review. Medicine (Baltimore). 2022;101:e32324.
• 2. Xu Y, Guan Y, Lang B. Unraveling restless legs syndrome: a comprehensive review of current research and future directions. Int J Gen Med. 2025;18:4041-4055.
• 3. Kim J, Kim JR, Park HR, Joo EY. Sex-specific patterns of discomfort in patients with restless legs syndrome. J Clin Sleep Med. 2024;20(2):253-259.
• 4. Chenini S, Delaby C, Rassu AL, et al. Hepcidin and ferritin levels in restless legs syndrome: a case–control study. Sci Rep. 2020;10(1):11914.
• 5. Alzaabi FM, Al Tarawneh DJ, Al Tarawneh YJ, et al. Restless legs and iron deficiency: unraveling the hidden link and unlocking relief. Cureus. 2025;17:e357328.
• 6. Li YS, Yeh WC, Hsu CY. Association of low serum ferritin levels with augmentation in patients with restless legs syndrome: a systematic review and meta-analysis. Sleep Med. 2023;112:173-180.
• 7. Üstün Özek S. A study of the correlation between magnesium and ferritin levels and the severity of the disease and sleep quality in restless legs syndrome. J Surg Med. 2024;8(1):1-6.
• 8. Khan A, Kumar H, Rai KD, et al. Efficacy and safety of intravenous ferric carboxymaltose in the treatment of restless legs syndrome: a systematic review and meta-analysis. Front Neurol. 2024;15:1503342.
• 9. Eren F, Demir A, Öztürk Ş. Evaluation of sensory nerve conduction studies and hematologic parameters in restless legs syndrome. Turk Norol Derg. 2020;26(4):292-296.
• 10. Mogavero MP, Marchese G, Ventola GM, et al. Exploring the role of ferroptosis in the pathophysiology and circadian regulation of restless legs syndrome. Biomolecules. 2025;15(8):1184.
• 11. Zhang X, Zhou X, Shen Y, et al. Case series and literature review on phenotypic variants of restless legs syndrome (RLS): a unique phase of typical RLS? Nat Sci Sleep. 2025;17:2145-2154.
• 12. Alaçam Köksal S, Boncuk Ulaş S, Acar BA, et al. Evaluation of the relationship between idiopathic restless legs syndrome and serum hepcidin levels. Brain Behav. 2023;13(11):e3259.
• 13. Chmiel J, Kurpas D. Neural correlates of restless legs syndrome (RLS) based on electroencephalogram (EEG)—a mechanistic review. Int J Mol Sci. 2025;26:10675.
• 14. Kim TJ, Cha KS, Lee S, et al. Brain regions associated with periodic leg movements during sleep in restless legs syndrome. Sci Rep. 2020;10(1):58365.
• 15. Iannaccone S, Zucconi M, Marchettini P, et al. Evidence of peripheral axonal neuropathy in primary restless legs syndrome. Mov Disord. 1995;10(1):2-9.
• 16. Abdulhadi IG, Al-Mahdawi AM, Hamdan FB. Electrophysiological findings in patients with restless legs syndrome. Sleep Med. 2021;87:151-157.
• 17. Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025;21(1):137-152.
• 18. İsmayilov R, Değirmenci Y. Restless legs syndrome: from diagnosis to treatment. Duzce Med J. 2023;25:212-217.
• 19. Wang T, Xu J, Xu Q, et al. Peripheral iron metabolism is associated with leg movements on polysomnography but not with the severity of restless legs syndrome or its impact on patients. Nat Sci Sleep. 2022;14:1829-1842.