Table 4: Score comparison before and after treatment. Score Placebo mean(SD)a Before After P value Before Male 27.73 (6.91) Female 29.21 (6.34) Total 28.57 (5.82) a SD: Standard Deviation 21.96 (5.32) 22.87 (5.71) 22.48 (4.32) <0.001 <0.001 <0.001 26.32 (5.34) 27.84 (4.86) 27.03 (4.67) disease in females may be more than males which we could not find them precisely. Table 5 shows the comparison between our study and other results, using RLS score for RLS respons- es to treatment. According to Table 5, in most stud- ies, the rate of score decline by placebo ranged be- tween score of 5-8. The role of placebo was investi- gated in declining score of RLS.32 Increasing the opioid and dopaminergic system of brain may play an important role.32 Maximal decrement in score was correlated to dopaminergic agonists (17.2 by trans- dermal rotingtone), but the interesting fact was that despite the more declines in scores by dopminergics, loss of side effects by selenium consumption and safety use of selenium and score decline to 12.86, less compliance and more cost of dopaminergics, selenium may be more and well tolerated. Several studies implicate the role of selenium in reconstruc- tion of the dopaminergic system.23-25 Score declines by 50 and 200 µg of selenium were 12.86 and 14.03 respectively and this difference was statistically sig- Selenium in restless leg syndrome 50 µg After 13.50 (4.24) 14.95 (4.52) 14.17 (4.02) P value Before <0.001 <0.001 <0.001 25.65 (5.09) 27.23 (4.91) 25.89 (5.44) 200 µg After 11.63 (4.57) 13.19 (3.82) 11.86 (4.62) P value <0.001 <0.001 <0.001 nificant (p=0.007) but practically this difference was not cost effective. So we preferred to choose 50 µg of selenium for RLS treatment. Selenium in daily recommended dose of 50 µg de- clines the score of RLS largely which may be due to improvement in the dopaminergic pathway (reverse thyrosine hydroxylase activity and prevention of the striatal dopamine depletion). Finally due to absence of side effects reported form selenium consumption, we can recommend selenium administration next to or instead of dopamine agonist for RLS symptoms improvement. Acknowledgement This study was supported by a grant from the Vice Chancellor for Research of Yazd University of Medi- cal Science. Conflict of interest: None declared. Table 5: Comparison of IRLS score decline between studies. Study Country Year Rahimdel Agarwal et al.26 Hogl et al.27 Walters et al.28 Aizuwa et al.29 a $: US dollar b N/A: Not Available Iran USA Austria USA Japan 2010 2010 2010 2004 2005 Placebo 6.09 8.80 _ _ 8.70 IRLS score decline Drug 12.86 (Selenium) 13.20 (Gabapentine) 17.20 (Transdermal rotigo- tine) 11.20 (Ropinirole) 14.80 (Cabergoline) Price in Iran (Consumption dose per day) 0.2 $a 1 $a N/Ab 0.5 $a 4 $a WWW.ircmj.com Vol 14 January 2012 17