Nitin K.Sethi, Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY[email protected]
Submitted January 03, 2017
I read with interest the practice guideline summary report for treatment of restless leg syndrome (RLS) in adults by the Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. [1] Studies have shown a strong correlation between body iron stores, as determined by serum ferritin level, and the severity of RLS symptoms. [2,3] Typically, in patients with RLS with ferritin level <50 mg/L, oral iron supplementation along with vitamin C, to help enhance iron absorption, is advised. How did the subcommittee arrive at a cutoff ferritin value of 75 mg/L? Can the subcommittee recommend how much iron supplementation is needed? What is the recommended ferritin level after supplementation? While studies looking at the efficacy of clonazepam for RLS symptoms may be lacking, giving it a Level U rating, there is ample anecdotal evidence attesting to its efficacy in RLS symptomatology. [4]
1. Winkelman JW, Armstrong MJ, Allen RP, et al. Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2016;87:2585-2593.
2. Allen RP, Earley CJ. The role of iron in restless legs syndrome. Mov Disord 2007;22 Suppl 18:S440-S448.
3. Halac G, Sezer GM, Saglam NO, et al. The relationship between Willis-Ekbom disease and serum ferritin levels among children in Northwestern Turkey. Neurosciences (Riyadh) 2015;20:336-340.
4. Kobayashi N, Yoshimura R, Takano M. Successful treatment with clonazepam and pramipexole of a patient with sleep-related eating disorder associated with restless legs syndrome: a case report. Case Rep Med 2012;2012:893681.
For disclosures, please contact the editorial office at [email protected].
I read with interest the practice guideline summary report for treatment of restless leg syndrome (RLS) in adults by the Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. [1] Studies have shown a strong correlation between body iron stores, as determined by serum ferritin level, and the severity of RLS symptoms. [2,3] Typically, in patients with RLS with ferritin level <50 mg/L, oral iron supplementation along with vitamin C, to help enhance iron absorption, is advised. How did the subcommittee arrive at a cutoff ferritin value of 75 mg/L? Can the subcommittee recommend how much iron supplementation is needed? What is the recommended ferritin level after supplementation? While studies looking at the efficacy of clonazepam for RLS symptoms may be lacking, giving it a Level U rating, there is ample anecdotal evidence attesting to its efficacy in RLS symptomatology. [4]
1. Winkelman JW, Armstrong MJ, Allen RP, et al. Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2016;87:2585-2593.
2. Allen RP, Earley CJ. The role of iron in restless legs syndrome. Mov Disord 2007;22 Suppl 18:S440-S448.
3. Halac G, Sezer GM, Saglam NO, et al. The relationship between Willis-Ekbom disease and serum ferritin levels among children in Northwestern Turkey. Neurosciences (Riyadh) 2015;20:336-340.
4. Kobayashi N, Yoshimura R, Takano M. Successful treatment with clonazepam and pramipexole of a patient with sleep-related eating disorder associated with restless legs syndrome: a case report. Case Rep Med 2012;2012:893681.
For disclosures, please contact the editorial office at [email protected].