The Effect of Motor Imagery on the Excitability of Spinal Segmentary Reflexes in Restless Legs Syndrome Patients

Context: Restless legs syndrome (RLS) is a neurological sleep disorder which causes an overwhelming urge to move the legs. However, this spinal excitability can be decreased through the use some motor movements such as walking or stretching. Aims: This study aimed to investigate the effect of motor imagery (MI) on spinal excitability in relation to the H reflex (HR). Settings and Design: In this study, 11 patients diagnosed with RLS (3 males and 8 females, mean age: 41.2) and 14 controls (8 males and 7 females, mean age: 38.4) were tested. HR was studied while participants in the supine position were imagining walking and also while imagining both dorsiflexion (DF) and plantar flexion (PF). Results: There was significant decrease in the Hmax/Mmax at 90° DF in both groups (p = 0.002, p = 0.001). There was no significant decrease in the RLS group on imagery; however, there was a significant decrease in the control group with movement imagination compared to the resting state (p = 0.021). There was no significant increase in Hmax/Mmax at 135° PF in both groups on movement and imagery. There was a decrease in the ratio on the imagery of walking in the RLS group (p = 0.038), but the same ratio increased in the control group (p = 0.010). Conclusion: As motor movements decrease corticospinal excitability in RLS, the imagery of movement mimicking the actmovement can relieve the symptoms of RLS. As a conclusion, further electrophysiological studies can be useful to gauge the effects of MI on spinal excitability in RLS.