Abstract
Neuroimaging, analysis of cerebrospinal fluid, and studies on postmortem tissue are generating data that support the concept that iron availability to the brain is a contributory process to, if not a cause of, restless legs syndrome. These data are reviewed and related to the dopaminergic system because of the use of dopamine agents in treating restless legs syndrome.
Similar content being viewed by others
References and Recommended Reading
Allen RP, Picchietti D, Hening WA, et al.: Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 2003, 4:101–119.
Ekbom KA: Restless legs syndrome. Neurology 1960, 10:868–873.
Nordlander NB: Therapy in restless legs. Acta Med Scand 1953, 145:453–457.
Sun ER, Chen CA, Ho G, et al.: Iron and the restless legs syndrome. Sleep 1998, 21:371–377.
O’Keeffe ST, Gavin K, Lavan JN: Iron status and restless legs syndrome in the elderly. Age Ageing 1994, 23:200–203.
Trenkwalder C, Högl B, Benes H, Kohnen R: Augmentation in restless legs syndrome is associated with low ferritin. Sleep Med 2007 [Epub ahead of print].
Earley CJ, Heckler D, Horská A, et al.: The treatment of restless legs syndrome with intravenous iron dextran. Sleep Med 2004, 5:231–235.
Beard JL, Connor JR: Iron status and neural functioning. Annu Rev Nutr 2003, 23:41–58.
Hening WA, Allen RP, Earley CJ, et al.: An update on the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep 2004, 27:560–583.
Ortiz E, Pasquini JM, Thompson K, et al.: Effect of manipulation of iron storage, transport or availability on myelin composition and brain iron content in three different animal models. J Neurosci Res 2004, 77:681–689.
Allen RP, Barker PB, Wehrl F, et al.: MRI measurement of brain iron in patients with restless legs syndrome. Neurology 2001, 56:263–265.
Schmidauer C, Sojer M, Septti K, et al.: Transcranial ultrasound shows nigral hypoechogenicity in restless legs syndrome. Ann Neurol 2005, 58:630–634.
Lee BY, Farace E, Wang J, et al.: In vivo measurement of iron deficiency in RLS with voxel-based MRI relaxometry. Neurology 2007, 68(Suppl 1):A356.
Turjanski N, Lees AJ, Brooks DJ: Striatal dopaminergic function in restless legs syndrome: 18F-dopa and 11C-raclopride PET studies. Neurology 1999, 52:932–937.
Trenkwalder C, Walters AS, Hening WA, et al.: Positron emission tomographic studies in restless legs syndrome. Mov Disord 1999, 14:141–145.
Michaud M, Soucy JP, Chabli A, et al.: SPECT imaging of striatal pre-and postsynaptic dopaminergic status in restless legs syndrome with periodic leg movements in sleep. J Neurol 2002, 249:164–170.
Nelson C, Erikson K, Pinero DJ, Beard JL: In vivo dopamine metabolism is altered in iron-deficient anemic rats. J Nutr 1997, 127:2282–2288.
Erikson KM, Jones BC, Beard JL: Iron deficiency alters dopamine transporter functioning in rat striatum. J Nutr 2000, 130:2831–2837.
Earley CJ, Connor JR, Beard JL, et al.: Abnormalities in CSF concentrations of ferritin and transferrin in restless legs syndrome. Neurology 2000, 54:1698–1700.
Mizuno S, Mihara T, Miyaoka T, et al.: CSF iron, ferritin and transferrin levels in restless legs syndrome. J Sleep Res 2005, 14:43–47.
Earley CJ, Connor JR, Beard JL, et al.: Ferritin levels in the cerebrospinal fluid and restless legs syndrome: effects of different clinical phenotypes. Sleep 2005, 28:1069–1075.
Clardy SL, Wang X, Boyer PJ, et al.: Is ferroportin-hepcidin signaling altered in restless legs syndrome? J Neurol Sci 2006, 247:173–179.
Long WI, Lönnerdal B: Hepcidin, the recently identified peptide that appears to regulate iron absorption. J Nutr 2004, 134:1–4.
Tsutsumi M, Skinner MK, Sanders-Bush E: Transferrin gene expression and synthesis by cultured choroid plexus epithelial cells. Regulation by serotonin and cyclic adenosine 3′,5′-monophosphate. J Biol Chem 1989, 5:9626–9631.
Geguchadze RN, Coe CL, Lubach GR, et al.: CSF proteomic analysis reveals persistent iron deficiency-induced alterations in nonhuman primate infants. J Neurochem 2007, In press.
Allen RP, Connor JR, Earley CJ: Abnormally increased CSF 3-ortho-methyldopa (3OMD) in untreated restless legs syndrome (RLS) patients indicates more severe disease. Sleep Med 2007, In press.
Minami M, Takahashi T, Maruyama W, et al.: Allosteric effect of tetrahydrobiopterin cofactors on tyrosine hydroxylase activity. Life Sci 1992, 50:15–20.
Connor JR, Boyer PJ, Menzies SL, et al.: Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome. Neurology 2003, 61:304–309.
Pittock SJ, Parrett T, Adler CH, et al.: Neuropathology of primary restless leg syndrome: absence of specific tau-and alpha-synuclein pathology. Mov Disord 2004, 19:695–699.
Connor JR, Wang XS, Patton SM, et al.: Decreased transferrin receptor expression by neuromelanin cells in restless legs syndrome. Neurology 2004, 62:1563–1567.
Aisen P, Enns C, Wessling-Resnick M: Chemistry and biology of eukaryotic iron metabolism. Int J Biochem Cell Biol 2001, 33:940–959.
Ondo WG, He Y, Rajasekaran S, Le WD: Clinical correlates of 6-hydroxydopamine injections into A11 dopaminergic neurons in rats: a possible model for restless legs syndrome. Mov Disord 2000, 15:154–158.
Qu S, Le W, Zhang X, et al.: Locomotion is increased in A11-lesioned mice with iron deprivation: a possible animal model for restless legs syndrome. J Neuropathol Exp Neurol 2007, 66:383–388.
Frauscher B, Löscher W, Högl B, et al.: Auditory startle reaction is disinhibited in idiopathic restless legs syndrome. Sleep 2007, 30:489–493.
Quatrale R, Manconi M, Gastaldo E, et al.: Neurophysiological study of corticomotor pathways in restless legs syndrome. Clin Neurophysiol 2003, 114:1638–1645.
Morris R: Thy-1 in developing nervous tissue. Dev Neurosci 1985, 7:133–160.
Ye Z, Connor JR: Identification of iron responsive genes by screening cDNA libraries from suppression subtractive hybridization with antisense probes from three iron conditions. Nucleic Acids Res 2000, 28:1802–1807.
Jeng CJ, McCarroll SA, Martin TF, et al.: Thy-1 is a component common to multiple populations of synaptic vesicles. J Cell Biol 1998, 140:685–698.
Wang X, Wiesinger J, Beard J, et al.: Thy1 expression in the brain is affected by iron and is decreased in restless legs syndrome. J Neurol Sci 2004, 220:59–66.
Winkelmann J, Schormair B, Lichtner P, et al.: Genomewide association study of restless legs syndrome identifies common variants in three genomic regions. Nat Genet 2007, 39:1000–1006.
Stefansson H, Rye DB, Hicks A, et al.: A genetic risk factor for periodic limb movements in sleep. N Engl J Med 2007, 357:639–647.
Jones LC, McCarthy KA, Beard JL, et al.: Quantitative genetic analysis of brain copper and zinc in BXD recombinant inbred mice. Nutr Neurosci 2006, 9:81–92.
Clardy SL, Wang X, Zhao W, et al.: Acute and chronic effects of developmental iron deficiency on nRNA expression patterns in the brain. J Neural Transm Suppl 2006, 71:173–196.
McEchron MD, Smith ME, Goletiani J, et al.: Impaired dopaminergic modulation of corticostriatal synaptic transmission in the Thy-1 knockout mouse: a model for restless legs syndrome? Soc Neurosci 2007, Abstract #622.10.
Beard JL, Erikson KM, Jones BC: Neurobehavioral analysis of developmental iron deficiency in rats. Behav Brain Res 2002, 134:517–524.
Burdo JR, Connor JR: Brain iron uptake and homeostatic mechanisms: an overview. BioMetals 2003, 16:63–75.
Dale JC, Burritt MF, Zinsmeister AR: Diurnal variation of serum iron, iron-binding capacity, transferrin saturation, and ferritin levels. Am J Clin Pathol 2002, 117:802–808.
Carmena AO, Portuondo H, Callejas J, Alvarez ME: Ferrokinetic circadian rhythm in normal subjects. Haematologia (Budapest) 1976, 10:179–184.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Connor, J.R. Pathophysiology of restless legs syndrome: Evidence for iron involvement. Curr Neurol Neurosci Rep 8, 162–166 (2008). https://doi.org/10.1007/s11910-008-0026-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11910-008-0026-x