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LETTERS TO THE EDITOR

Ketamine for Restless Legs Syndrome

Department of Anaesthesia, Royal Surrey County Hospital, Guildford, UK

To the Editor:

I read with interest the case report from Kapur et al, outlining the use of ketamine for Restless Legs Syndrome (RLS) (1). I agree that a fundamental mechanism for RLS may be mediated by overactivity at the N-methyl-D-aspartate (NMDA) receptor. I wonder if they have, therefore, considered the use of magnesium as therapy for this condition.

Magnesium is a physiological NMDA antagonist and deficiency of magnesium may be causative factor in RLS (2). It has also been used orally in the treatment for RLS, where it caused a significant improvement in symptoms in 4 to 6 weeks (3).

References

1. Kapur N, Friedman R. Oral Ketamine: A promising treatment for Restless Legs Syndrome. Anesthesia and Analgesia 2002; 94: 1558–1559.[Abstract/Free Full Text]
2. Fawcett WJ, Haxby EJ, Male DA. Magnesium: Physiology and Pharmacology. British Journal of Anaesthesia 1999; 83: 302–20.[Abstract/Free Full Text]
3. Hornyak M, Voderholzer U, Hohagen F, Berger M, Riemann D. Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study. Sleep 1998; 5: 501–505.

Response

Department of Anesthesiology, Cooper Hospital, UMDNJ, Camden, New Jersey

In Response:

While we did not give our patients magnesium, we agree with Dr. Fawcett that more attention needs to be given to the modulation of NMDA receptor activity in the treatment of this common problem. While much effort is being directed toward the development of newer dopaminergic drugs (1), relatively little has been published on treatments that focus on the modulation of dopamine secretion in the brain which include ketamine, dextromethorphan, and magnesium (2).

References

1. Walther BW. Treating restless legs syndrome: current pathophysiological concepts and clinical trial. Expert Opinion of Investigational Drugs. 2002; 11: 501–514.
2. Toner CC, Stamford JA. Characteristics of the NMDA receptor modulating hypoxia/hypoglycemia -induced rat striatal dopamine release in vitro. European Journal of Pharmacology 1997; 340: 133–143.[Web of Science][Medline]

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