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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).
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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).
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