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Quantitative transcranial sonography of the substantia nigra as a predictor of therapeutic response to intravenous iron therapy in restless legs syndrome.
Garcia-Malo, Celia; Wanner, Vivian; Miranda, Carolina; Romero Peralta, Sofia; Agudelo, Lina; Cano-Pumarega, Irene; Granizo, Juan José; Garcia-Borreguero, Diego.
Afiliação
  • Garcia-Malo C; Sleep Research Institute, Madrid, Spain. Electronic address: celia.garcia.malo@gmail.com.
  • Wanner V; European Sleep Institute, Santiago, Chile.
  • Miranda C; Sleep Research Institute, Madrid, Spain.
  • Romero Peralta S; Sleep Research Institute, Madrid, Spain.
  • Agudelo L; Sleep Research Institute, Madrid, Spain.
  • Cano-Pumarega I; Sleep Research Institute, Madrid, Spain; Sleep Unit, Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain.
  • Granizo JJ; Unidad de Apoyo a la Investigación, Hospital Universitario Infanta Cristina, Parla, Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Majadahonda, Spain.
  • Garcia-Borreguero D; Sleep Research Institute, Madrid, Spain; European Sleep Institute, Santiago, Chile.
Sleep Med ; 66: 123-129, 2020 02.
Article em En | MEDLINE | ID: mdl-31875533
ABSTRACT

OBJECTIVE:

To analyze changes in substantia nigra (SN) iron deposits, assessed by quantitative transcranial sonography (TCS), to obtain and compare substantia nigra echogenicity indices (SNEI) at baseline and after intravenous (IV) iron therapy in patients with restless legs syndrome (RLS)/Willis-Ekbom disease (WED).

METHODS:

A total of 30 consecutive subjects diagnosed with RLS/WED were recruited and underwent IV iron treatment. The SNEI, total daily dose of dopamine equivalents, and International Restless Legs Syndrome Rating Scale (IRLS) scores were obtained at baseline and following IV iron administration. Comparative statistics were performed by means of nonparametric testing.

RESULTS:

The sample was stratified into two groups according to the median baseline SNEI and the grade of SN hypoechogenicity severely hypoechogenic (HE) (n = 13) and moderately HE (n = 17). Following IV iron, the increase in SNEI among severely HE subjects was 19% (0.038 ± 0.046 cm2; P < 0.01), whereas in moderately HE subjects it was 10% (0.021 ± 0.069 cm2; P = 0.28). Among severely HE subjects, the average reduction in IRLS following IV iron was 10 ± 7.12 points (P < 0.01), in contrast to 1.85 ± 9.85 (not significant) among moderately HE subjects. Finally, we quantified the percentage of patients in each group who were able to reduce by ≥30% their total daily dopaminergic requirements (TDR) after IV iron, with a 57.14% reduction in the severely HE group vs 25% in the moderately HE group (P = 0.1). Three of 30 subjects (17%) were able to completely cease all dopaminergic treatment.

CONCLUSION:

Intravenous iron caused changes in SNEI in both groups of patients, reflecting an increase in brain iron stores. However, the increase in SNEI was greater in patients previously defined as severely HE. Furthermore, RLS/WED symptoms also improved more in severely HE subjects, and there was a greater reduction in TDR. This study highlights the role of TCS in quantifying brain iron deposits and in predicting which patients will likely benefit from IV iron.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome das Pernas Inquietas / Substância Negra / Ultrassonografia Doppler Transcraniana / Administração Intravenosa / Ferro Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome das Pernas Inquietas / Substância Negra / Ultrassonografia Doppler Transcraniana / Administração Intravenosa / Ferro Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2020 Tipo de documento: Article