Richard P Allen1, Daniel L Picchietti2, Michael Auerbach3, Yong Won Cho4, James R Connor5, Christopher J Earley6, Diego Garcia-Borreguero7, Suresh Kotagal8, Mauro Manconi9, William Ondo10, Jan Ulfberg11, John W Winkelman12. 1. Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA. Electronic address: richardjhu@mac.com. 2. University of Illinois College of Medicine at Urbana-Champaign and Carle Foundation Hospital, Urbana, IL, USA. 3. Department of Medicine, Georgetown University, Washington DC, USA. 4. Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea. 5. Department of Neurosurgery, Penn State Hershey Medical Center, Hershey PA, USA. 6. Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA. 7. Sleep Research Institute, Madrid, Spain. 8. Department of Neurology and the Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA. 9. Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland. 10. Methodist Neurological Institute, Weill Cornell Medical School Houston, TX, USA. 11. Sleep Disorders Department, Capio Health Center, Örebro, Sweden. 12. Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Brain iron deficiency has been implicated in the pathophysiology of RLS, and current RLS treatment guidelines recommend iron treatment when peripheral iron levels are low. In order to assess the evidence on the oral and intravenous (IV) iron treatment of RLS and periodic limb movement disorder (PLMD) in adults and children, the International Restless Legs Syndrome Study Group (IRLSSG) formed a task force to review these studies and provide evidence-based and consensus guidelines for the iron treatment of RLS in adults, and RLS and PLMD in children. METHODS: A literature search was performed to identify papers appearing in MEDLINE from its inception to July 2016. The following inclusion criteria were used: human research on the treatment of RLS or periodic limb movements (PLM) with iron, sample size of at least five, and published in English. Two task force members independently evaluated each paper and classified the quality of evidence provided. RESULTS: A total of 299 papers were identified, of these 31 papers met the inclusion criteria. Four studies in adults were given a Class I rating (one for IV iron sucrose, and three for IV ferric carboxymaltose); only Class IV studies have evaluated iron treatment in children. Ferric carboxymaltose (1000 mg) is effective for treating moderate to severe RLS in those with serum ferritin <300 μg/l and could be used as first-line treatment for RLS in adults. Oral iron (65 mg elemental iron) is possibly effective for treating RLS in those with serum ferritin ≤75 μg/l. There is insufficient evidence to make conclusions on the efficacy of oral iron or IV iron in children. CONCLUSIONS: Consensus recommendations based on clinical practice are presented, including when to use oral iron or IV iron, and recommendations on repeated iron treatments. New iron treatment algorithms, based on evidence and consensus opinion have been developed.
BACKGROUND:Brain iron deficiency has been implicated in the pathophysiology of RLS, and current RLS treatment guidelines recommend iron treatment when peripheral iron levels are low. In order to assess the evidence on the oral and intravenous (IV) iron treatment of RLS and periodic limb movement disorder (PLMD) in adults and children, the International Restless Legs Syndrome Study Group (IRLSSG) formed a task force to review these studies and provide evidence-based and consensus guidelines for the iron treatment of RLS in adults, and RLS and PLMD in children. METHODS: A literature search was performed to identify papers appearing in MEDLINE from its inception to July 2016. The following inclusion criteria were used: human research on the treatment of RLS or periodic limb movements (PLM) with iron, sample size of at least five, and published in English. Two task force members independently evaluated each paper and classified the quality of evidence provided. RESULTS: A total of 299 papers were identified, of these 31 papers met the inclusion criteria. Four studies in adults were given a Class I rating (one for IV iron sucrose, and three for IV ferric carboxymaltose); only Class IV studies have evaluated iron treatment in children. Ferric carboxymaltose (1000 mg) is effective for treating moderate to severe RLS in those with serum ferritin <300 μg/l and could be used as first-line treatment for RLS in adults. Oral iron (65 mg elemental iron) is possibly effective for treating RLS in those with serum ferritin ≤75 μg/l. There is insufficient evidence to make conclusions on the efficacy of oral iron or IV iron in children. CONCLUSIONS: Consensus recommendations based on clinical practice are presented, including when to use oral iron or IV iron, and recommendations on repeated iron treatments. New iron treatment algorithms, based on evidence and consensus opinion have been developed.
Authors: Shangru Lyu; Mark P DeAndrade; Stefan Mueller; Alexander Oksche; Arthur S Walters; Yuqing Li Journal: Behav Brain Res Date: 2019-07-31 Impact factor: 3.332
Authors: Pan Chen; Julia Bornhorst; Stephanie Patton; Kanika Bagai; Rachana Nitin; Mahfuzur Miah; Dominic J Hare; Kai Kysenius; Peter J Crouch; Lan Xiong; Guy A Rouleau; Tanja Schwerdtle; James Connor; Michael Aschner; Aaron B Bowman; Arthur S Walters Journal: Sleep Date: 2021-04-09 Impact factor: 5.849