CSF and serum ferritin levels in narcolepsy type 1 comorbid with restless legs syndrome

Introduction: Restless Legs Syndrome (RLS) also known as Willis Ekbom Disease (WED) which manifests as a neurologic disorder among patients with anaemia, particularly with iron deficiency anaemia. Aim: To find the association of anaemia with RLS in the elderly population. Materials and Methods: In this cross-sectional study, 100 patients of age ≥60 years were enrolled and categorised into mild, moderate, and severe anaemia as per World Health Organisation (WHO) criteria. Every participant was enquired about RLS via a questionnaire based on the International RLS Study Group Rating Scale (IRLSSGRS) for its Severity and for the diagnosis (Essential clinical criteria for the diagnosis of RLS). Results: The study showed that patients with anaemia had a statistically significant correlation with RLS (p=0.04) and severity of RLS (p=0.032). Serum ferritin levels too showed a statistically significant correlation with RLS (p=0.032). Conclusion: Patients with severe anaemia and lower serum ferritin levels were more prone to RLS and had more RLS severity.

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1001 Intravenous Ferric Carboxymaltose For Restless Legs Syndrome In Children And Adolescents

SLEEP ◽

10.1093/sleep/zsaa056.997 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A380-A380

Author(s):

L M DelRosso ◽

R Ferri ◽

R P Allen ◽

M L Chen ◽

S Kotagal ◽

...

Keyword(s):

Side Effects ◽

Children And Adolescents ◽

Serum Ferritin ◽

Restless Legs Syndrome ◽

Iron Supplementation ◽

Oral Iron ◽

Ferric Carboxymaltose ◽

Chi Square ◽

Restless Legs ◽

Post Infusion

Abstract Introduction Substantial scientific evidence implicates brain iron deficiency in the pathophysiology of restless legs syndrome (RLS). Current clinical guidelines recommend oral and intravenous iron (IV) in the treatment of both adult and pediatric RLS but studies using ferric carboxymaltose (FCM) are lacking in children and adolescents. Methods Retrospective case series of children and adolescents with RLS treated with IV FCM who had serum ferritin levels <50 μg/L. Patients were offered a single dose of IV FCM, 15 mg/kg if weighting <50 kg or 750 mg if weighting >50 kg. Iron profile, serum ferritin, and severity assessment by the International Restless Legs Study Group severity scale (IRLS) were collected pre- and post-infusion. Clinical Global Impression Scale (CGI) was used instead of the IRLS for children. Phosphorus level and adverse effects were assessed post-infusion in all patients. Age and sex-matched children with RLS treated with oral iron supplementation (mean dosage 1.5±0.62 mg/kg/day) were included as a comparison group. Results Twenty-eight subjects (15 females, mean age 11.5 years, SD 4.23) and 24 controls were included. Baseline ferritin levels were not significantly different from those of controls but increased significantly from 13.9±7.02 to 112.9±12.00 μg/L after 8 weeks from infusion (p<0.000001), when they were also significantly higher than control values (34.2±21.64 μg/mL, p<0.000001). Transferrin saturation increased from 22.8±9.77% to 31.7±6.81% (p<0.0001), total iron binding capacity decreased from 366.7±51.32 to 302.0±37.83 μg/dL (p<0.0000035). RLS was reported to be resolved or improved in all children treated with IV iron (vs. 62.5% of controls) while none of them reported no change (vs. 37.5% of controls; Chi-square test 9.84, p<0.002). IRLS Score decreased in adolescents from 30.7±22.68 to 3.2±4.21 (p<0.000008) while CGI-I was “very much improved” in six children and “much improved” in four. Side effects were reported in 17.8% of patients treated IV and 20.8% controls (Chi-square 0.0169, p=0.897). FCM side effects included lightheadedness and gastrointestinal discomfort. Post IV phosphorus levels were normal in all participants. Conclusion This open-label, observational and retrospective study indicates that FCM IV infusion is an effective treatment for pediatric RLS with higher efficacy than oral iron supplementation. Support

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Treatments for Insomnia and Restless Legs Syndrome

A Guide to Treatments that Work ◽

10.1093/med:psych/9780195304145.003.0022 ◽

2007 ◽

pp. 611-640

Author(s):

Douglas E. Moul ◽

Charles M. Morin ◽

Daniel J. Buysse ◽

Charles F. Reynolds ◽

David J. Kupfer

Keyword(s):

Restless Legs Syndrome ◽

Clinical Trial Data ◽

Benzodiazepine Receptor ◽

Cognitive Behavioral ◽

Psychiatric Practice ◽

Restless Legs ◽

Third Line ◽

Core Problem ◽

Iron Replacement

Treating a chief complaint of inability to sleep is a core problem in psychiatric practice, together with treating other comorbid physical or mental disorders. The treatments for insomnia and restless legs syndrome (RLS) are well within the scope of psychiatric practice. Treatments for insomnia have been controversial over the past several decades, with practice patterns being driven partly by nonmedical influences operating in the setting of limited data. In recent years, the need to consider both cognitive-behavioral and pharmacological approaches together has become more apparent, with less insistence on strict either-or approaches. Clinical trial data clearly point to the efficacy of cognitive-behavioral approaches such as stimulus control, bed restriction, and related approaches. The literature on the short-term efficacy of benzodiazepine receptor agonists (BZRAs) as hypnotics has strengthened. There is a great amount of use of non-BZRAs as hypnotics, even though there are limited studies supporting their use. For RLS, the use of low-dose dopamine agonists has been substantially supported in Type 1 clinical trials. For iron-deficiency-induced RLS, iron replacement is strongly encouraged. Approaches such as using benzodiazepines are second-line treatments. Limited support for the use of gabapentin and carbamazepine is available, but the centuries-old approach of using opiates for the treatment of RLS remains a third-line approach.

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