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Beyond the urge to move: Impulsivity, aggression and impulse control disorders in restless legs syndrome.

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Title: Beyond the urge to move: Impulsivity, aggression and impulse control disorders in restless legs syndrome.
Authors: Frijo A; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: ariannafrijo@gmail.com., Casoni F; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: casoni.francesca@hsr.it., Proserpio P; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: paola.proserpio@outlook.com., Ferini Strambi L; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Psychology, 'Vita-Salute' San Raffaele University, Milan, Italy. Electronic address: ferinistrambi.luigi@hsr.i., Galbiati A; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Psychology, 'Vita-Salute' San Raffaele University, Milan, Italy. Electronic address: andrea.galbiati.unisr@gmail.com.
Source: Sleep medicine [Sleep Med] 2026 Aug; Vol. 144, pp. 108984. Date of Electronic Publication: 2026 Apr 20.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 100898759 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-5506 (Electronic) Linking ISSN: 13899457 NLM ISO Abbreviation: Sleep Med Subsets: MEDLINE
Imprint Name(s): Original Publication: Amsterdam ; New York : Elsevier Science, c2000-
MeSH Terms: Restless Legs Syndrome*/psychology , Restless Legs Syndrome*/complications , Impulsive Behavior*/physiology , Aggression*/psychology , Aggression*/physiology , Disruptive, Impulse Control, and Conduct Disorders*/psychology, Humans ; Female ; Male ; Surveys and Questionnaires ; Case-Control Studies ; Middle Aged ; Adult ; Severity of Illness Index
Abstract: Restless Legs Syndrome (RLS) is typically defined as a sleep-related sensorimotor disorder, yet converging evidence indicates that it also involves clinically relevant behavioral dimensions. This case-control study systematically examined impulsivity, aggression, and impulse control disorders (ICDs) in 27 RLS patients compared to 21 healthy controls, using standardized questionnaires (BIS-11, Barratt Impulsiveness Scale-11; AQ, Aggression Questionnaire; mMIDI, Modified Minnesota Impulsive Disorders Interview), a Go/NoGo inhibitory control task, and clinical sleep measures, with reassessment after three months.A markedly elevated prevalence of binge eating emerged in the RLS group compared to controls (44.4% vs 4.5%), suggesting vulnerability to reward-related dysregulation. Although total BIS-11 impulsivity scores did not differ significantly between groups, RLS severity (IRLSRS) correlated with attentional impulsivity and slower reaction times in the Go/NoGo task, pointing to a cognitive impulsivity profile rather than motor disinhibition. RLS severity was also associated with higher verbal aggression and hostility, but not with physical aggression, indicating cognitive-emotional irritability rather than outward violence. Sleep alterations (shorter total sleep time, prolonged latency, reduced REM sleep) were linked to poorer inhibitory control and ICD-related behaviors, implying that sleep fragmentation may exacerbate emotional dysregulation and maladaptive reward seeking. Behavioral measures remained stable at three-month follow-up, supporting the notion that these traits represent persistent characteristics rather than transient states. Overall, findings support conceptualizing RLS as a multisystem disorder extending beyond motor symptomatology to include intrinsic deficits in cognitive control and affective regulation, with implications for systematic behavioral screening and individualized management.
(Copyright © 2026 Elsevier B.V. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author “Luigi Ferini-Strambi” is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for this journal and was not involved in the editorial review or the decision to publish this article.
Contributed Indexing: Keywords: Aggression; Binge eating; Cognitive control; Emotional dysregulation; Impulse control disorders (ICDs); Impulsivity; Restless legs syndrome (RLS); Sleep fragmentation
Entry Date(s): Date Created: 20260423 Date Completed: 20260715 Latest Revision: 20260715
Update Code: 20260716
DOI: 10.1016/j.sleep.2026.108984
PMID: 42025099
Database: MEDLINE
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  Data: Beyond the urge to move: Impulsivity, aggression and impulse control disorders in restless legs syndrome.
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  Data: <searchLink fieldCode="AU" term="%22Frijo+A%22">Frijo A</searchLink>; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: ariannafrijo@gmail.com.<br /><searchLink fieldCode="AU" term="%22Casoni+F%22">Casoni F</searchLink>; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: casoni.francesca@hsr.it.<br /><searchLink fieldCode="AU" term="%22Proserpio+P%22">Proserpio P</searchLink>; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: paola.proserpio@outlook.com.<br /><searchLink fieldCode="AU" term="%22Ferini+Strambi+L%22">Ferini Strambi L</searchLink>; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Psychology, 'Vita-Salute' San Raffaele University, Milan, Italy. Electronic address: ferinistrambi.luigi@hsr.i.<br /><searchLink fieldCode="AU" term="%22Galbiati+A%22">Galbiati A</searchLink>; Sleep Disorders Centre, Department of Clinical Neurosciences, Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Psychology, 'Vita-Salute' San Raffaele University, Milan, Italy. Electronic address: andrea.galbiati.unisr@gmail.com.
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  Data: <searchLink fieldCode="JN" term="%22100898759%22">Sleep medicine</searchLink> [Sleep Med] 2026 Aug; Vol. 144, pp. 108984. <i>Date of Electronic Publication: </i>2026 Apr 20.
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  Data: <searchLink fieldCode="MM" term="%22Restless+Legs+Syndrome%22">Restless Legs Syndrome*</searchLink>/<searchLink fieldCode="MM" term="%22Restless+Legs+Syndrome+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Restless+Legs+Syndrome%22">Restless Legs Syndrome*</searchLink>/<searchLink fieldCode="MM" term="%22Restless+Legs+Syndrome+complications%22">complications</searchLink> <br /><searchLink fieldCode="MM" term="%22Impulsive+Behavior%22">Impulsive Behavior*</searchLink>/<searchLink fieldCode="MM" term="%22Impulsive+Behavior+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Aggression%22">Aggression*</searchLink>/<searchLink fieldCode="MM" term="%22Aggression+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Aggression%22">Aggression*</searchLink>/<searchLink fieldCode="MM" term="%22Aggression+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Disruptive%2C+Impulse+Control%2C+and+Conduct+Disorders%22">Disruptive, Impulse Control, and Conduct Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Disruptive%2C+Impulse+Control%2C+and+Conduct+Disorders+psychology%22">psychology</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Surveys+and+Questionnaires%22">Surveys and Questionnaires</searchLink> ; <searchLink fieldCode="MH" term="%22Case-Control+Studies%22">Case-Control Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Severity+of+Illness+Index%22">Severity of Illness Index</searchLink>
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  Data: Restless Legs Syndrome (RLS) is typically defined as a sleep-related sensorimotor disorder, yet converging evidence indicates that it also involves clinically relevant behavioral dimensions. This case-control study systematically examined impulsivity, aggression, and impulse control disorders (ICDs) in 27 RLS patients compared to 21 healthy controls, using standardized questionnaires (BIS-11, Barratt Impulsiveness Scale-11; AQ, Aggression Questionnaire; mMIDI, Modified Minnesota Impulsive Disorders Interview), a Go/NoGo inhibitory control task, and clinical sleep measures, with reassessment after three months.A markedly elevated prevalence of binge eating emerged in the RLS group compared to controls (44.4% vs 4.5%), suggesting vulnerability to reward-related dysregulation. Although total BIS-11 impulsivity scores did not differ significantly between groups, RLS severity (IRLSRS) correlated with attentional impulsivity and slower reaction times in the Go/NoGo task, pointing to a cognitive impulsivity profile rather than motor disinhibition. RLS severity was also associated with higher verbal aggression and hostility, but not with physical aggression, indicating cognitive-emotional irritability rather than outward violence. Sleep alterations (shorter total sleep time, prolonged latency, reduced REM sleep) were linked to poorer inhibitory control and ICD-related behaviors, implying that sleep fragmentation may exacerbate emotional dysregulation and maladaptive reward seeking. Behavioral measures remained stable at three-month follow-up, supporting the notion that these traits represent persistent characteristics rather than transient states. Overall, findings support conceptualizing RLS as a multisystem disorder extending beyond motor symptomatology to include intrinsic deficits in cognitive control and affective regulation, with implications for systematic behavioral screening and individualized management.<br /> (Copyright © 2026 Elsevier B.V. All rights reserved.)
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author “Luigi Ferini-Strambi” is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for this journal and was not involved in the editorial review or the decision to publish this article.
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  Data: <i>Keywords: </i>Aggression; Binge eating; Cognitive control; Emotional dysregulation; Impulse control disorders (ICDs); Impulsivity; Restless legs syndrome (RLS); Sleep fragmentation
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        Value: 10.1016/j.sleep.2026.108984
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      – TitleFull: Beyond the urge to move: Impulsivity, aggression and impulse control disorders in restless legs syndrome.
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              Text: 2026 Aug
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