# Case Report: A novel use of Transcranial Pulse Stimulation in refractory Restless Legs Syndrome

## TL;DR

This case report explores the use of Transcranial Pulse Stimulation (TPS) in a patient with severe Restless Legs Syndrome (RLS) who did not respond to other treatments, showing promising symptom improvement.

## Contribution

This is the first documented use of TPS in treatment-resistant RLS, introducing a novel network-based neuromodulation approach.

## Key findings

- The patient experienced a 95.2% reduction in RLS severity after TPS treatment.
- TPS was well tolerated and associated with significant improvements in sleep and pain/discomfort.
- The results suggest TPS may be a viable non-invasive treatment for refractory RLS.

## Abstract

Restless Legs Syndrome (RLS) is a sensorimotor disorder characterized by an irresistible urge to move the legs. When resistant to pharmacological and psychotherapeutic treatments, RLS remains highly debilitating. This case study represents the first documented case of Transcranial Pulse Stimulation (TPS) applied in treatment-resistant RLS, exploring its feasibility, tolerability, and potential clinical effects.

A 56-year-old male diagnosed with RLS with severe, persistent bilateral leg restlessness and neuropathic cramping pain underwent six sessions of TPS target cortical and subcortical network hubs within the Functional Network-Oriented Neuromodulation (FNON) framework.

At six-week follow-up, the patient reported improved sleep, a 95.2% reduction in RLS severity, a 66.7% decrease in pain/discomfort, and a 25% improvement in overall health status. Depression/Anxiety symptoms decreased by 25% while mobility and self-care remained stable at normal levels.

In this single case, TPS was well tolerated and associated with meaningful symptomatic improvement. While no conclusions regarding safety or efficacy can be drawn from an individual observation, these findings suggest that TPS may warrant further investigation as non-invasive neuromodulatory approach for refractory RLS. This report expands the scientific literature by introducing a novel network-based neuromodulation modality to the RLS field and provides a foundation for future controlled studies to validate efficacy and optimize stimulation protocols.