Acta Neurol Scand. 2018;1–12. wileyonlinelibrary.com/journal/ane | 1 © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Accepted: 8 December 2017 DOI: 10.1111/ane.12890 ORIGINAL ARTICLE Acute-onset Restless legs syndrome in acute neurological conditions—a prospective study on patients with the Guillain-Barre syndrome and acute stroke S. Chandan | G. Shukla | A. Gupta | A. Srivastava | D. Vibha | K. Prasad Department of Neurology, All India Institute of Medical Sciences, New Delhi, India Correspondence G. Shukla, Department of Neurology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India. Email: garimashukla@hotmail.com Objectives: While the Restless legs syndrome (RLS) is usually recognized as a chronic condition, it has often been diagnosed among patients with acute neurological ill- nesses, in which limb discomfort is reported. This study was conducted to determine how many among these, actually have acute-onset RLS, and also to evaluate charac- teristics of this subgroup of patients with Guillain-Barre syndrome (GBS) and stroke developing acute-onset RLS. Methods: Consecutive patients diagnosed with GBS and eligible stroke patients, ad- mitted to our Neurology services over a 1-year period, were enrolled. They were eval- uated for symptoms of RLS based on IRLSSG consensus criteria and the AIIMS RLS Questionnaire for Indian patients (ARQIP). Results: Forty adults with GBS and 58 with stroke were included. A total of 10 of the 40 (25%) patients with GBS developed definite acute RLS, which was mostly mono- phasic. Seven (70%) of these had demyelinating type of GBS, a significant association with acute RLS (P = .024). Six of the 58 stroke patients (10%) developed definite acute-onset, often persistent RLS. Subcortical location showed significant association with increased risk of developing acute RLS (P < .001). All patients diagnosed with acute-onset RLS had an immediate and good response to dopamine agonists. Conclusion: This is the first study showing that acute-onset RLS is common, affecting nearly 25% of patients with GBS and 10% patients with acute stroke. Recognizing and treating it can majorly contribute toward symptom relief and early improvement in the quality of life for this population. KEYWORDS acute, Guillain-Barre syndrome, Restless legs syndrome, stroke 1 | INTRODUCTION Restless legs syndrome (RLS) is characterized by an urge to move limbs, (usually accompanied by unpleasant leg sensations), exac- erbation of this urge with rest, relief with activity, and worsening of symptoms toward evening. 1 The prevalence of the RLS in gen- eral populations is approximately 10%. 2 Several lines of evidence point to abnormalities of the central nervous system (CNS) in the pathophysiology of RLS. Pathology studies have demonstrated loss of dopamine receptor staining in substantia nigra pars compacta in patients with RLS. 3 Additionally, there is evidence that RLS may be related to abnormal dopaminergic transmission in the A11 cell group located near the hypothalamus and to the failure of CSF transport of iron into the CNS. 4 While most research on the pathogenesis of RLS focuses on mechanisms within the CNS, peripheral neuropathy has also been shown to be closely associated with RLS (which may be secondary). The reported prevalence of RLS in neuropathy is high but extremely variable, ranging from 5.2% to 54%. 5 Similarly, few