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ARTICLES: J.R. Connor, P.J. Boyer, S.L. Menzies, B. Dellinger, R.P. Allen, W.G. Ondo, and C.J. Earley Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome Neurology 2003; 61: 304-309 [Abstract] [Full text] [PDF]

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Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome

Masahiko Watanabe   (27 January 2004)

Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome 27 January 2004
Masahiko Watanabe, University of Tsukuba Tennodai 1-1-1, Tsukuba, Ibaraki, Japan Send Correspondence to journal: Re: Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome masa-wat{at}md.tsukuba.ac.jp Masahiko Watanabe	In the article by Conner et al, the authors report that iron acquisition by neuromelanin cells in patients with restless legs syndrome (RLS) may be impaired. [1] Furthermore, the proteins responsible for maintaining iron homeostasis are reportedly expressed in a pattern consistent with iron deficiency. RLS is a sensory-motor disorder characterized by daytime motor restlessness associated with uncomfortable sensory symptoms and involuntary movements during sleep. [2] We recently encountered a case of periodic limb movements in sleep (PLMS) in a male patient with severe iron deficiency anemia caused by chronic hemorrhage from advanced gastric cancer (serum hemoglobin 4.7 g/dl, red blood cell count 2.38 �E106 cells /�El, MCV 70 fl, MCHC 28.3 g/dl, serum iron 13�Eg/dl, UIBC 379 �Eg/dl, serum ferritin 4 ng/ml). The characteristic involuntary movements during sleep matched diagnostic criteria [2], but the patient displayed no daytime symptoms. Laboratory examination of blood from the patient revealed severe chronic iron deficiency. MRI measurement of regional iron content in the brain was performed according to the methods reported by Allen et al. [3] The substantia nigra displayed decreased free iron (R2�� = 3.78 s-1), while the red nucleus did not (R2�� = 5.52 s-1). Involuntary movements during sleep were quickly resolved with the aid of blood transfusion and iron supplementation. I agree with the theory that iron deficiency in the central nervous system of the patient represents a contributing factor in RLS1,4, and would like to emphasize that the same holds true for isolated PMLS lacking the daytime cardinal symptoms of RLS. References 1. Conner JR, Boyer PJ, Menzies SL, et al. Neuropathological examination suggests impaired iron acquisition in restless legs syndrome. Neurology 2003;61:304-309 2. Walters AS, Aldrich MS, Allen R, et al. (The International Restless legs Syndrome Study Group) Toward a better recognition of the restless legs syndrome. Mov Disord 1995;10:634-642 3. Allen R, Barker PB, Wehrl F, et al. MRI measurement of brain iron in patients with restless legs syndrome. Neurology 2001;56:263-265 4. Ekbom KA. Restless legs syndrome. Neurology 1960;10:868-873