Restless legs syndrome shows increased silent postmortem cerebral microvascular disease with gliosis

Arthur S. Walters, Paisit Paueksakon, Charles H. Adler, Michael Moussouttas, Leonard B. Weinstock, Karen Spruyt, Kanika Bagai

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Patients with restless legs syndrome (RLS) have increased silent microvascular disease by magnetic resonance imaging. However, there has been no previous autopsy confirmation of these magnetic resonance imaging findings. RLS is also frequently associated with inflammatory and immunologically mediated medical disorders. The postmortem cortex in patients with RLS was therefore evaluated for evidence of microvascular and immunological changes. METHODS AND RESULTS: Ten microvascular injury samples of precentral gyrus in 5 patients with RLS (3 men, 2 women; mean age, 81 years) and 9 controls (2 men, 7 women; mean age, 90 years) were studied by hematoxylin and eosin stains in a blinded fashion. None of the subjects had a history of stroke or neurologic insults. In a similar manner, the following immunohisto-chemistry stains were performed: (1) glial fibrillary acidic protein (representing gliosis, reactive change of glial cells in response to damage); (2) CD3 (a T-cell marker); (3) CD19 (a B-cell marker); (4) CD68 (a macrophage marker); and (5) CD117 (a mast cell marker). Patients with RLS had significantly greater silent microvascular disease (P=0.015) and gliosis (P=0.003). T cells were increased in RLS compared with controls (P=0.009) and tended to colocalize with microvascular disease (P=0.003). Other markers did not differ. There was no correlation between microvascular lesion load and RLS severity or duration. CONCLUSIONS: Patients with RLS had statistically significantly more silent cerebral microvascular disease and gliosis than controls compatible with previous magnetic resonance imaging studies and with studies showing a link between RLS and hypertension, clinical stroke, and cardiovascular disease. T-cell invasion may be a secondary phenomenon.

Original languageEnglish (US)
Article numbere019627
JournalJournal of the American Heart Association
Issue number11
StatePublished - Jun 1 2021


  • Cortex
  • Gliosis
  • Microvascular disease
  • Restless legs syndrome
  • T cells

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Restless legs syndrome shows increased silent postmortem cerebral microvascular disease with gliosis'. Together they form a unique fingerprint.

Cite this