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• W137398297 abstract "WE THANK GEMIGNANI ET AL1 FOR THEIR INTEREST IN OUR PAPER.2 THE ASSOCIATION OF RESTLESS LEGS SYNDROME (RLS) AND DIABETES HAS BEEN frequently suggested, but no sufficiently powerful case-control study has ever been performed.3,4 Our study was the first to confirm the presence of a statistically significant relationship between RLS and diabetes. Although the association of two clinical variables in a cross-sectional study demonstrates neither a causal link nor the direction of the effect, the characteristics of RLS in diabetics are those of a symptomatic form. In addition, in order to detect the presence of clinical symptoms of polyneuropathy we carried out a careful neurological examination, based on recognized criteria. On our multivariate analysis, polyneuropathy represented the only independent risk factor for RLS in diabetics; however diabetic neuropathy was observed in only one-quarter of diabetic patients with RLS, suggesting other pathophysiological mechanisms in addition to polyneuropathy. The observation of a higher prevalence (close to statistical significance) of RLS in our diabetics without polyneuropathy, compared to case-controls, and to the epidemiological data in the Caucasian general population, confirmed this hypothesis. We believe that, altogether, these observations support a primary role of diabetes, independently of neuropathy, in inducing RLS.Although diabetes can cause small-fiber neuropathy (SFN), its assessment in asymptomatic diabetics is not simple at all and requires neurophysiological and morphological evaluations.3 However, each one of the most sensitive tests has important disadvantages.5Our study demonstrated the existence of a secondary form of RLS associated with diabetes, although the ascertainment of the exact pathophysiological mechanism was beyond its scope. In particular, whether RLS in this specific population is only an expression of SFN or may be a latent genetic trait unveiled by diabetes is unknown to date. In order to answer to this question, Gemignani et al. propose a specific screening of all diabetic patients with RLS. We consider this suggestion interesting, but not easily feasible, especially for nerve biopsy. In addition, we believe that a well-designed clinical trial (comparing the efficacy in controlling RLS symptoms in diabetics of dopaminergic agents versus drugs acting on peripheral nerves) could give information useful in solving the dilemma." @default.
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• W137398297 date "2008-08-01" @default.
• W137398297 modified "2023-09-23" @default.
• W137398297 title "Response to Restless Legs Syndrome and Diabetic Neuropathy—Commentary by Gemignani, et al." @default.
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• W137398297 doi "https://doi.org/10.5665/sleep/31.8.1069" @default.
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