Restless Legs Syndrome as an Early Neurological Manifestation of Vitamin B12 Deficiency

Establishing the Law of Parsimony in a Case of Restless Legs Syndrome

“…Furthermore, elevated levels of inflammatory cytokines that are detected in patients with severe RLS are reduced by vitamin B12 supplementation. 2,3 Interestingly, our patient did not present with other classical manifestations of Vitamin B12 deficiency, such as subacute combined degeneration of the spinal cord, peripheral neuropathy, neuropsychiatric symptoms, or optic neuropathy. 2 Thus RLS may be an early and isolated feature of vitamin B12 deficiency.…”

“…RLS may be idiopathic (primary) or secondary to iron deficiency, diabetes mellitus, liver and renal diseases, inflammatory bowel diseases, pulmonary disease, and gastric surgery. 2 In the only attempt of its kind, a prospective study from India identified 44 patients with RLS and studied their characteristics based on the presence or absence of vitamin B12 deficiency. 2 RLS with co-existent vitamin B12 deficiency demonstrated specific features, such as shorter duration of symptoms, negative family history of RLS, prompt response to vitamin B12 supplementation, and successful taper of dopamine agonists without symptom relapse (unlike patients of RLS without B12 deficiency).…”

“…2 In the only attempt of its kind, a prospective study from India identified 44 patients with RLS and studied their characteristics based on the presence or absence of vitamin B12 deficiency. 2 RLS with co-existent vitamin B12 deficiency demonstrated specific features, such as shorter duration of symptoms, negative family history of RLS, prompt response to vitamin B12 supplementation, and successful taper of dopamine agonists without symptom relapse (unlike patients of RLS without B12 deficiency). In that study, the mean vitamin B12 level among the deficient patients was 148 pg/mL, and 15% had both ferritin and vitamin B12 deficiencies.…”

“…Restless legs syndrome (RLS) is characterised by uncomfortable sensation in the legs with an urge to move the limbs, precipitated by rest and relieved with activity. 1,2 With a prevalence of 5%-15% in adults, RLS remains largely unrecognized and heavily reliant on clinical criteria.…”

“…Furthermore, vitamin B12 deficiency coupled with elevated homocysteine has been linked with neurodegenerative diseases. 2,3 However, the studies focusing on vitamin B12 deficiency as a causative factor for development of RLS are scarce. We describe a patient with RLS as the sole presenting feature of vitamin B12 deficiency which showed complete resolution with vitamin B12 supplementation alone.…”