Tonic motor activation (TOMAC) reduces periodic leg movements during sleep and improves sleep reinitiation in adults with medication-refractory restless legs syndrome.
In 20 adults with medication-refractory RLS, 30-minute mid-sleep TOMAC sessions led to rapid sleep reinitiation (median 6.7 minutes) in 82.8% of sessions, with a 47.9% reduction in PLMS/hour and a 70.8% reduction in PLMS associated with arousal/hour. EEG power analysis showed a transition towards deeper sleep during stimulation.
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Tonic motor activation (TOMAC) reduces periodic leg movements during sleep and improves sleep reinitiation in adults with medication-refractory restless legs syndrome. The current body of evidence comprises 1 study. EvidenceHub rates the overall confidence at 34/100 (low).
The Claim
Tonic motor activation (TOMAC) reduces periodic leg movements during sleep and improves sleep reinitiation in adults with medication-refractory restless legs syndrome.
This conclusion is most relevant to: 20 adults with medication-refractory restless legs syndrome..
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸Acute effects of tonic motor activation (TOMAC) on sleep in adults with medication-refractory restless legs syndrome. (Sleep advances : a journal of the Sleep Research Society, 2026) —
How It Works
The proposed biological pathway:
- ▸High-frequency electrical stimulation activates the common peroneal nerve
- ▸Stimulation reduces RLS symptoms and facilitates sleep reinitiation
- ▸EEG changes show increased delta and decreased alpha power, indicating deeper sleep
- ▸Result: Reduced PLMS and improved sleep continuity
Who Might Benefit
Evidence fit by population:
- ▸20 adults with medication-refractory restless legs syndrome.
Recommended Dose
30-minute session as needed
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Cross-sectional design with no control group or sham stimulation
- ▸Small sample size (n=20) and limited generalizability to broader RLS populations
Frequently Asked Questions
What is TOMAC and how does it work for RLS?▼
TOMAC (tonic motor activation) delivers high-frequency electrical stimulation to the common peroneal nerve to reduce RLS symptoms and improve sleep.
How quickly did participants fall back asleep after using TOMAC?▼
The median time to sleep reinitiation was 6.7 minutes, with 82.8% of sessions resulting in sleep during the 30-minute stimulation.
Did TOMAC reduce leg movements during sleep?▼
Yes, PLMS/hour decreased by 47.9% and PLMS associated with arousal decreased by 70.8% after mid-sleep TOMAC sessions.
Is this study a randomized controlled trial?▼
No, it is a cross-sectional analysis providing the first objective evaluation of TOMAC during polysomnography, without a control group.
References
- 1.Rigot SK, St Louis EK, Baker FC, Alawieh H, Singh H, Ojile J, Tekchandani J, Kolotovska V, Adlou B, Charlesworth JD. “Acute effects of tonic motor activation (TOMAC) on sleep in adults with medication-refractory restless legs syndrome..” Sleep advances : a journal of the Sleep Research Society, 2026. PMID: 42488517 DOI: 10.1093/sleepadvances/zpag060