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NEUROLOGY 2008;70:1620-1622
© 2008 American Academy of Neurology

Low-dose hydrocortisone in the evening modulates symptom severity in restless legs syndrome

M. Hornyak, MD, A. Rupp, D. Riemann, PhD, B. Feige, M. Berger and U. Voderholzer, MD

From the Center for Sleep Research and Sleep Medicine, Department of Psychiatry and Psychotherapy, University Medical Center, Freiburg, Germany.

Address correspondence and reprint requests to Dr. Magdolna Hornyak, Interdisciplinary Pain Center, Breisacher Strasse 64, D-79106 Freiburg, Germany magdolna.hornyak{at}uniklinik-freiburg.de

Background: Circadian symptom manifestation in the evening and night is one of the main characteristics of restless legs syndrome (RLS). Although the inverse temporal course of corticosteroid rhythm and RLS symptom severity is obvious, this relationship has yet to be studied. We investigated the effect of late-evening application of exogenous cortisol (hydrocortisone) on sensory leg discomfort (SLD), one of the main complaints of patients with RLS.

Methods: Ten untreated patients with idiopathic RLS participated in the study. Change of SLD was rated on a visual analogue scale during the 60 minutes resting period of the so-called Suggested Immobilization Test. Patients received either hydrocortisone 40 mg or placebo (saline) IV in random order in a double-blind crossover design, with 1 week between the experiments.

Results: Severity of SLD was lower during hydrocortisone infusion than during placebo (p = 0.032). Though blind to the experimental condition, 5 of the 10 patients experienced improvement in symptoms during hydrocortisone administration, but no patient felt an amelioration during the placebo condition.

Conclusions: Our data indicate a probable physiologic relationship between evening and early night hour restless legs syndrome symptom increase and low cortisol level.

Abbreviations: ANOVA = analysis of variance; HPA = hypothalamic-pituitary-adrenal axis; PLMW = periodic leg movements during the resting wake state; PSG = polysomnography; RLS = restless legs syndrome; SIT = suggested immobilization test; SLD = sensory leg discomfort.

Disclosure: The authors report no conflicts of interest.

Received October 29, 2006. Accepted in final form January 8, 2008.






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