Re: PLMS Alert!

[Guest guest]

,

There is research showing those with only PLMS who have a low ferritin level

and it comes up, involuntary leg movements cease or improve! Warning; if your

doctor tells you yours is normal, the lab often gives the low end of " normal "

as 10-12 -- normal might be RLS&PLMS patients as 50-100, don't know for sure

for PLMS solely but one article below seems to indicate minimum 25, as the

brain needs an abundance of iron to take up dopamine; many are thought to be

on the low side for dopamine.

<< No hematologic or chemical abnormalities have been detected in patients

with PLMS who do NOT also have RLS. >>

I am the facilitator for the Central Florida RLS Support Group which meets in

Orlando, FL, our next meeting is June 13, 1999, Sunday, 2:00 - 4:00 PM. We

have several members who have only PLMS who faithfully attend our meetings.

They say there is no support group for those solely with it; maybe that's our

good luck since the ones we have only with PLMS are such jewels. I would

appreciate treatments and feedback on things that help PLMS to give them.

See the below medical journal articles on ferritin and those with PLMS solely.

Barbara

Ferritin Lady*

*For those of you who are new, my Mother who is 82, is the RLS patient;

formerly, a severe, severe case. When her ferritin level, which was 8, came

up only a modest amount, her RLS symptoms improved approximately 50%. Having

seen how much it helped her, it made me an enthusiastic supporter of checking

it and if below 50, trying to bring it up. Also, since if your body is

already very high on iron, taking iron supplements could be very harmful;

check with you doctor first!

Periodic Limb Movement Disorder and Iron Deficiency

BARAN AS, GOLDBERG R, DIPHILLIPO, MA CURRAN K, FRY JM

Medical College Of Pennsylvania and Hahnemann University, Philadelphia, PA.

It is thought that patients with restless legs syndrome (RLS) are

likely to also have periodic limb movement disorder, although the converse is

not necessarily true. Iron deficiency states have been reported to be

associated with some cases of restless legs syndromel,2, but an association

between periodic limb movement disorder (PLMD) and iron deficiency has not

been identified, to our knowledge. Because of the strong association between

RLS and PLMD, it was hypothesized that iron deficiency plays a role in the

etiology of PLMD. Serum ferritin levels were recommended as part of further

evaluation for patients with the diagnosis of PLMD, with or without RLS,

following polysomnography.

All patients recorded between December 1, 1992 and September 6, 1995

found to have periodic limb movements greater than or equal to 10 per hour of

sleep, with or without symptoms of RLS were identified. Patients with a

concurrent diagnosis of significant obstructive sleep apnea requiring CPAP

were excluded.

Serum ferritin is a sensitive measure of body iron stores. Abnormally

low serum ferritin levels were defined as less than 22 ng/ml, and low normal

levels were defined as falling within the range of 22-25 ng/ml.

Of the 156 patients in whom serum ferritin determination was

recommended to the referring physician and patient laboratory data were

available in 37. The data are presented in the table below.

Patients w/PLMD&RLS # (%) Patients w/PLMD only # (%) Total Patients # (%)

Ferritin >25 ng/ml 12 (32.4) 17 (45.9)

29 (78.4)

Ferritin 22-25 ng/ml 2 (5.4) 1 (2.7)

3 (8.1)

Ferritin <22 ng/ml 3 (8.1) 2 (5.4)

5 (13.5)

Total Patients 17 (45.9) 20 (54.1)

37 (100)

We conclude that there may be an association between iron deficiency

and PLMD in the absence of RLS.

Improvement in nocturnal myoclonus and restless legs syndrome after treatment

of iron-deficiency anemia: case report

POCETA JS, LOUBE DI, HAYDUK R, ERMAN MK

Scripps Clinic and Research Foundation, La Jolla, California, U.S.A .

Restless legs syndrome (RLS), (Ekbom's syndrome) is a condition with

unpleasant leg sensations, often leading to restlessness and sleep

disruption. Nocturnal myoclonus, also called periodic limb movements of sleep

(PLMS), is a movement disorder of repetitive, rhythmic, jerky movements of

the legs during sleep which often accompanies RLS.

The pathophysiology of these conditions is unknown, but there may be

an alteration in central dopamine systems. For example treatment with

dopaminergic agents is usually effective, and RLS has certain similarities to

neuroleptic­induced akathisia. Their appears to be a genetic component as

well. Certain medical conditions appear to predispose to RLS and nocturnal

myoclonus such as neuropathies, uremia, and anemias, but identifiable

causative conditions are not present in the majority of cases.

Ekbom described a series of patients with partial gastrectomy and

iron­deficiency anemia who developed RLS O'Keeffe compared measures of iron

status in a group of elderly patients with RLS to a matched control group and

found that serum ferritin levels were lower in the patient group, even

without anemia. Improvement in RLS symptoms occurred with oral iron

repletion.

However, no studies have assessed nocturnal myoclonus in relationship

to iron­deficiency anemia or ill treatment. We report a case of both

nocturnal myoclonus and RLS in which improvement occurred after treatment

with intravenously administered iron.

Case Report. A 47 year­old male complained of 18 months of sleep

onset and sleep maintenance insomnia; associated with a feeling of an inner

energy boom. He had bilateral restlessness of the legs when trying to sleep,

punctuated by jerky movements and a feeling of electrical impulses in the

legs. During sleep, his wife noted repetitive motions of the legs, and

sometimes of the arms.

Seven years previously he had undergone a gastric stapling procedure

for treatment of obesity. His weight initially decreased from about 250

pounds to 200 pounds, but he had gained most of this back. He was taking B­1

injections prophylactically. The sleep study showed 649 periodic leg

movements, which were of high amplitude with myoclonic onset. He was treated

with temazepam and propoxyphene with fair success. He was found to be anemic

and iron deficient, as described in the Table.

Evaluation found no cause of blood loss, but treatment with oral iron

administration was not effective. He was therefore placed on intravenous iron

infusions which corrected the anemia and normalized serum iron studies. His

symptoms of RLS disappeared, as well as the movements during sleep. Repeat

sleep study showed only 101 periodic leg movements, and a marked decrease in

amplitude of these remaining jerks. He was able to sleep adequately with no

medication.