Efficacy of Intravenous Iron in the Treatment of Restless Legs Syndrome in Children - a Systematic Review

Keywords

restless legs syndrome - child - iron

Introduction: Restless Legs Syndrome (RLS) is characterized by the need to move the legs and uncomfortable sensations. Iron deficiency seems to play a central role in the pathophysiology of RLS. Oral iron supplementation is a common approach, but many pediatric patients face challenges. Intravenous iron offers a more effective replenishment of iron stores, potentially relieving symptoms more efficiently.

Objective: To evaluate the efficacy of intravenous iron in the treatment of RLS in children

Methods: This systematic review used the following descriptors: (“Ferric carboxymaltose” OR “Iron carboxymaltose” OR “Intravenous iron”) AND “Restless Legs Syndrome”. Inclusion criteria: studies involving children with RLS and the use of intravenous iron.

Results: 4 articles were selected out of 309. The total sample comprised 104 children (0-19 years). Grim et al. (2013) evaluated 16 children with RLS or periodic limb movement disorder (PLMD) who received iron sucrose. Of these, 87.5% had previously received oral iron, with insufficient benefits. After iron infusion, serum ferritin rose from 16.4+6.6 ng/ml to 45.7+22.4 ng/ml (n=14; [95%CI, 17.2-41.3]; P< .0001). Sleep improved in 62.5% of participants. Ingram et al. (2022) analyzed 30 children with RLS and intravenous iron use. Of these, 10% had at least one side effect (p-value =0.963). At follow-up (n= 26), 84.6% of the children reported an improvement in at least one symptom of RLS (p-value =0.180). In DelRosso et al. (2021), 39 children received ferric carboxymaltose. The mean score on the Clinical Global Impression-Improvement (CGI-I) scale was 1.3, where 1 indicates “very much improved” and 2, “much improved”. There were reports of improvements in nocturnal sleep, a reduction in headaches and daytime sleepiness, and a cessation of nocturnal awakenings. There was also an increase in ferritin levels (from 14.6 μg/L to 112.4 μg/L). DelRosso et al. (2022) analyzed 19 children and their responses after using ferric carboxymaltose. The mean CGI-I score was 1, and 84.2% of the children reported improvement, such as going to sleep earlier, cessation of nocturnal awakenings, and improvement in restlessness. The evolution of the iron indices before and after showed an increase in ferritin (10mg/L vs. 68 mg/L), iron, and transferrin saturation.

Conclusion: Intravenous iron has been shown to be a superior alternative to oral iron in controlling the symptoms of RLS, with fewer side effects and an improvement in symptoms.

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Publikationsverlauf

Artikel online veröffentlicht:
16. September 2025