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PD – Iron Before RLS Treatment — SCE Neurology MCQ

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HardMovement DisordersPD – Iron Before RLS TreatmentSCE Neurology

A 55-year-old has an evening urge to move the legs, relieved by walking, with normal neurological examination. Ferritin is 29 micrograms/L and transferrin saturation is low. Which next step offers the best causal and learning-yield approach?

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Correct answer: E — Investigate and replace iron, address exacerbating medicines or causes, and reassess before long-term symptomatic therapy

Low iron stores are a treatable driver of restless legs syndrome. NHS guidance advises correction when ferritin is below 50 micrograms/L and maintenance in roughly the 50 to 75 range, alongside review of secondary causes and exacerbating medicines. Dopaminergic treatment before correcting iron can expose the patient to augmentation; benzodiazepines do not correct the cause, and low ferritin is not a reassuring finding.

Reference: NHS Highland RLS guideline: https://www.rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/adult-therapeutic-guidelines/nervous-system/restless-leg-syndrome-rls-guidelines/