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Tosto F, Magro G, Laterza V, Romozzi M. Neurological manifestations of hypermagnesemia: a narrative review. Acta Neurol Belg 2024:10.1007/s13760-024-02653-3. [PMID: 39392591 DOI: 10.1007/s13760-024-02653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 10/02/2024] [Indexed: 10/12/2024]
Abstract
Hypermagnesemia is a rare but potentially fatal electrolyte disorder. High serum magnesium levels have been associated with the development of neurological manifestations such as dysautonomia, muscle weakness, respiratory failure, and altered level of consciousness from drowsiness to coma. Although rare, some subjects, such as those with chronic renal failure and those taking magnesium supplements or medications, are at risk of developing this condition. Recognizing this electrolyte alteration promptly allows for an immediate initiation of a therapeutic strategy that is often resolutive when addressed in time. This paper aims to review the neurological complications associated with hypermagnesemia, their pathophysiology, and management.
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Affiliation(s)
- Federico Tosto
- Department of Neuroscience, "Giovanni Paolo II" Hospital, Catanzaro, Italy
| | - Giuseppe Magro
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Vincenzo Laterza
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy
| | - Marina Romozzi
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli N° 8, 00168, Rome, Italy.
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Matar SG, El-Nahas ZS, Aladwan H, Hasanin M, Elsayed SM, Nourelden AZ, Benmelouka AY, Ragab KM. Restless Leg Syndrome in Hemodialysis Patients: A Narrative Review. Neurologist 2022; 27:194-202. [PMID: 35442939 DOI: 10.1097/nrl.0000000000000436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Restless legs syndrome (RLS) is a clinical entity characterized by sensory-motor manifestations commonly observed in end-stage renal illness. Evidence suggests that RLS is a multifactorial phenomenon that can be influenced by many critical factors, including genetic predisposition, dietary patterns, and deficiency in some vitamins. Iron metabolism disorders and metabolic derangements have been generally accepted as predisposing elements in RLS. Furthermore, both pharmacological and neuroimaging studies demonstrated dopamine deficiency and dopamine receptors decrease in basal ganglia during RLS. REVIEW SUMMARY A literature search was done in three databases (PubMed, Google Scholar, and Cochrane) to identify the pertinent articles discussing the epidemiology, pathogenesis, and management of RLS in hemodialysis patients. RLS can affect the morbidity and mortality of patients treated with dialysis. It also has significant impacts on the quality of life since it can lead to insomnia, increased fatigue, mental health troubles, and other movement problems. Appropriate measures should be considered in this particular population so to prevent and treat RLS. Many drugs and other nonpharmacological methods have been investigated to attenuate the disease's severity. No treatment, however, could offer long-term effects. CONCLUSION Further efforts are still required to improve the understanding of RLS pathogenic trends to find more specific and efficient therapies. A wide range of treatment options is available. However, it can be individualized according to the patients' several factors.
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Affiliation(s)
- Sajeda G Matar
- Faculty of Pharmacy, University of Jordan, Amman, Jordan
- International Medical Student's Research Association (IMedRA)
| | - Zeinab S El-Nahas
- International Medical Student's Research Association (IMedRA)
- Faculty of Medicine, Menoufia University, Menoufia
| | - Hala Aladwan
- Faculty of Pharmacy, University of Jordan, Amman, Jordan
- International Medical Student's Research Association (IMedRA)
| | - Menna Hasanin
- International Medical Student's Research Association (IMedRA)
- Faculty of Medicine, Al-Azhar University, Cairo
| | - Sarah M Elsayed
- International Medical Student's Research Association (IMedRA)
- Faculty of Medicine, October 6 University, Giza
| | - Anas Z Nourelden
- International Medical Student's Research Association (IMedRA)
- Faculty of Medicine, Al-Azhar University, Cairo
| | - Amira Y Benmelouka
- International Medical Student's Research Association (IMedRA)
- Faculty of Medicine, University of Algiers, Algiers, Algeria
| | - Khaled M Ragab
- International Medical Student's Research Association (IMedRA)
- Faculty of Medicine, Minia University, Minia, Egypt
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Jiménez-Jiménez FJ, Ayuso P, Alonso-Navarro H, Calleja M, Díez-Fairén M, Álvarez I, Pastor P, Plaza-Nieto JF, Navarro-Muñoz S, Turpín-Fenoll L, Millán-Pascual J, Recio-Bermejo M, García-Ruiz R, García-Albea E, Agúndez JAG, García-Martín E. Serum Trace Elements Concentrations in Patients with Restless Legs Syndrome. Antioxidants (Basel) 2022; 11:antiox11020272. [PMID: 35204155 PMCID: PMC8868060 DOI: 10.3390/antiox11020272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
Increased brain and serum zinc levels in patients with idiopathic restless legs syndrome (idiopathic RLS or iRLS) were described when compared with controls, suggesting a possible role of zinc in the pathogenesis of this disease. However, serum magnesium, calcium, manganese, iron, and copper levels of RLS patients were similar to controls, suggesting a specific impairment of zinc-dependent metabolism in RLS. The aim of this study is to assess the serum concentrations of trace elements involved in oxidative stress or causing peripheral nerve toxicity in a large series of patients with iRLS and controls. We determined serum levels of iron, copper, manganese, zinc, magnesium, selenium, calcium, aluminium, lead, cadmium, arsenic and mercury in 100 patients diagnosed with iRLS and in 110 age- and sex-matched controls using Inductively Coupled Plasma Mass Spectrometry. Serum copper, magnesium, selenium, and calcium concentrations were significantly higher in RLS patients than in controls. These differences were observed both in men and women. There were no major correlations between serum trace metal concentrations and age at onset of RLS or RLS severity, nor was there any association with a family history of RLS or drug response. This study shows an association between increased serum concentrations of copper, magnesium, selenium, and calcium with RLS in a Spanish Caucasian population and does not confirm the previously reported increase in serum zinc concentrations in patients suffering from this disease, suggesting that the different accuracy of the analytical methods used could have influenced the inconsistent results found in the literature.
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Affiliation(s)
- Félix Javier Jiménez-Jiménez
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
- Correspondence: (F.J.J.-J.); (J.A.G.A.)
| | - Pedro Ayuso
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
| | - Hortensia Alonso-Navarro
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Marisol Calleja
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Mónica Díez-Fairén
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - Ignacio Álvarez
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - Pau Pastor
- Fundació per la Recerca Biomèdica i Social Mútua de Terrassa, 08221 Terrassa, Spain; (M.D.-F.); (I.Á.); (P.P.)
- Movement Disorders Unit, Department of Neurology, Univeristy Hospital Mutua de Terrassa, 08221 Terrassa, Spain
| | - José Francisco Plaza-Nieto
- Section of Neurology, Hospital Universitario del Sureste, 28500 Arganda del Rey, Spain; (H.A.-N.); (M.C.); (J.F.P.-N.)
| | - Santiago Navarro-Muñoz
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Laura Turpín-Fenoll
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Jorge Millán-Pascual
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Marta Recio-Bermejo
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Rafael García-Ruiz
- Section of Neurology, Hospital La Mancha-Centro, 13600 Alcázar de San Juan, Spain; (S.N.-M.); (L.T.-F.); (J.M.-P.); (M.R.-B.); (R.G.-R.)
| | - Esteban García-Albea
- Department of Medicine-Neurology, Hospital “Príncipe de Asturias”, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain;
| | - José A. G. Agúndez
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
- Correspondence: (F.J.J.-J.); (J.A.G.A.)
| | - Elena García-Martín
- University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, Universidad de Extremadura, 10071 Cáceres, Spain; (P.A.); (E.G.-M.)
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Mansourian M, Rafie N, Khorvash F, Hadi A, Arab A. Are serum vitamin D, calcium and phosphorous associated with restless leg syndrome? A systematic review and meta-analysis. Sleep Med 2020; 75:326-334. [PMID: 32950014 DOI: 10.1016/j.sleep.2020.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/29/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is hypothesized that vitamin D deficiency, and calcium/phosphate imbalance could be involved in the pathophysiology of restless leg syndrome (RLS). This systematic review and meta-analysis of observational studies were carried out to reach a firm conclusion regarding the possible association between vitamin D, calcium and phosphorous levels with RLS in end-stage renal disease (ESRD) patients, other comorbidities and healthy population. METHODS PubMed, Scopus, ISI Web of Science, and Cochrane's library were systematically searched up to June 2020. Quality assessment of the included observational studies was performed using Newcastle-Ottawa Quality Assessment Scale. Statistical analyses were done using STATA 11.2. A P-value <0.05 were considered statistically significant. RESULTS A total of 36 studies involving 9590 participants were included in this systematic review and meta-analysis. We found that serum vitamin D level is significantly lower (WMD -3.39 ng/mL; 95% CI, -5.96 to -0.81; P = 0.010; I2 = 86.2%) and phosphorous (SMD 0.19; 95% CI, 0.04-0.34; P = 0.011; I2 = 83.6%) is significantly higher in RLS individuals compared to the non-RLS individuals. However, the mean difference of serum calcium was not significant in comparison between RLS and control groups (SMD -0.01; 95% CI, -0.19 to 0.18; P = 0.957; I2 = 89.2%). CONCLUSION Results revealed a significant association between serum vitamin D and phosphorous with RLS. However, further prospective cohort studies and clinical trials are needed for better understanding of the relationship between these variables.
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Affiliation(s)
- Marjan Mansourian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Rafie
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Amir Hadi
- Halal Research Center of IRI, FDA, Tehran, Iran.
| | - Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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