Iron for restless legs syndrome
ABSTRACT Restless legs syndrome (RLS) is a common neurologic syndrome and is associated with iron deficiency in many patients. It is unclear whether iron therapy is effective treatment for RLS.
The objective of this review was to assess the effects of iron supplementation (oral or intravenous) for patients with RLS.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Jan 1995 to April 2011); EMBASE (Jan 1995 to April 2011); PsycINFO (Jan 1995 to April 2011); and CINAHL (Jan 1995 to April 2011). Corresponding authors of included trials and additional members of the International Restless Legs Syndrome Study Group were contacted to locate additional published or unpublished trials.
Controlled trials comparing any formulation of iron with placebo, other medications, or no treatment in adults diagnosed with RLS according to expert clinical interview or explicit diagnostic criteria.
Two review authors extracted data and at least two authors assessed trial quality. We contacted trial authors for missing data.
Six studies (192 total subjects) were identified and included in this analysis. The quality of trials was variable. Our primary outcome was restlessness or uncomfortable leg sensations, which was quantified using the IRLS severity scale in four trials and another RLS symptom scale in a fifth trial. Combining data from the four trials using the IRLS severity scale, there was no clear benefit from iron therapy (mean difference in IRLS severity scores of -3.79, 95% CI: -7.68 to 0.10, p = 0.06). However, the fifth trial did find iron therapy to be beneficial (median decrease of 3 points in the iron group and no change in the placebo group on a 10 point scale of RLS symptoms, p = 0.01). Quality of life was improved in the iron group relative to placebo in some studies but not others. Changes in periodic limb movements were not different between groups (measured in two studies). Objective sleep quality, subjective sleep quality and daytime functioning were not different between treatment groups in the studies that assessed them. The single study of subjects with end stage renal disease did show a benefit of therapy. Most trials did not require subjects to have co-morbid iron deficiency and several excluded patients with severe anemia. The single study that was limited to iron deficient subjects did not show clear benefit of iron supplementation on RLS symptoms. There was no clear superiority of oral or intravenous delivery of iron. Iron therapy did not result in significantly more side effects than placebo (RR 1.39, 95% CI 0.85 to 2.27).
There is insufficient evidence to determine whether iron therapy is beneficial for the treatment of RLS. Further research to determine whether some or all types of RLS patients may benefit from iron therapy, as well as the best route of iron administration, is needed.
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ABSTRACT: The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine. RESUMO O Consenso em síndrome das pernas inquietas contou com a participação de neurologistas de vários estados brasileiros, os quais incansavelmente revisaram a literatura dos últimos anos em busca de evidências, tanto no que se refere ao diagnóstico como ao tratamento, de acordo com a Classificação do Centro de Oxford para Medicina Baseada em Evidências. Palavras-chave: pernas inquietas, critérios diagnósticos, tratamento. Protocols or guidelines presented here seek to systematize the available knowledge and offer a gold standard pattern of clinical management, scientifically safer and consistent for restless legs syndrome. They are evidence-based recommendations, developed from a review of an updated scientific literature.Arquivos de neuro-psiquiatria 03/2015; 73(3). DOI:10.1590/0004-282X20140239 · 0.55 Impact Factor
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ABSTRACT: Restless legs syndrome is a distressing condition that is more common in patients with end‐stage renal failure. Despite the significant impact it has on quality of life and the documented association between restless legs syndrome and increased mortality, limited data regarding the epidemiology of restless legs syndrome in Australian dialysis patients are available. We report a prospective study that assessed the prevalence and factors associated with restless legs syndrome in an in‐centre haemodialysis population.Internal Medicine Journal 10/2014; 44(10). DOI:10.1111/imj.12559 · 1.70 Impact Factor
Edited by Sociedad Española de Neurologia, Sociedad Española de Sueño, 01/2013; Ed. Luzán 5. Madrid., ISBN: 978-84-7989-786-4