A Topical Review on Transcranial Magnetic Stimulation in Restless Legs Syndrome

Purpose of Review This topical review aims to explore the potential of transcranial magnetic stimulation (TMS) as both a neurophysiological diagnostic tool and a novel therapeutic approach for restless legs syndrome (RLS). Recent Findings Overall, TMS data suggest that RLS should be regarded as a complex sensory-motor disorder in which cortical, subcortical, and spinal cord generators are involved, resulting in an enhanced cortical excitation and decreased inhibition. In this context, RLS symptoms are likely to arise at different levels of a complex network, eventually resulting in a modified, possibly temporary and circadian, excitability of a multifaceted neurophysiological drive. Therapeutically, the stimulation of the primary motor cortex (especially of the leg area), unilaterally or bilaterally, as well as of the primary somatosensory cortex (at least unilaterally), seems to safely reduce subjective symptoms and severity scale scores, with effects lasting for up to weeks. Summary This review delves into the pathophysiology of RLS through the “looking glass” of TMS and the existing clinical evidence and neuroplastic changes induced by TMS, as well as into the current challenges for clinicians and future directions for researchers. By examining all these aspects, the review sheds light on the promise and limitations of applying TMS in the diagnostic refinement and therapeutic management of RLS.