Transcranial sonography: updates in treating RLS

Diego Garcia-Borreguero, MD, PhD, Sleep Research Institute, Madrid, Spain, discusses the use of transcranial sonography to evaluate iron levels in the brain. A primary cause of restless leg syndrome (RLS) is the deficiency of iron in central-brain stores. Dr Garcia-Borreguero describes intravenous iron administration as a method to increase iron levels in the brain – however, patient response rates are 60-70%, highlighting a large percentage of individuals who are treatment resistant. The diagnostic technique of transcranial sonography allows for the evaluation of the substantial nigra – thus providing insights into iron levels in the brain. This diagnostic approach addresses the difficulty of measuring central-brain iron stores, which is making sophisticated MRI scans and invasive spinal taps redundant for RLS treatment. Imaging the echogenicity of the substantial nigra via transcranial sonography is readily accessible and cheap for most clinics, making it an ideal method for predicting which patients will respond to oral or intravenous iron administration. This interview took place at the World Sleep Conference 2022 in Rome, Italy.