Strategies for the Treatment of Restless Legs Syndrome

Abstract

Restless legs syndrome (RLS) is a common neurological disorder of unknown etiology that is managed by therapy directed at relieving its symptoms. Treatment of patients with milder symptoms that occur intermittently may be treated with nonpharmacological therapy but when not successful, drug therapy should be chosen based on the timing of the symptoms and the needs of the patient. Patients with moderate to severe RLS typically require daily medication to control their symptoms. Although the dopamine agonists, ropinirole and pramipexole have been the drugs of choice for patients with moderate to severe RLS, drug emergent problems like augmentation may limit their use for long term therapy. Keeping the dopamine agonist dose as low as possible, using longer acting dopamine agonists such as the rotigotine patch and maintaining a high serum ferritin level may help prevent the development of augmentation. The α2δ anticonvulsants may now also be considered as drugs of choice for moderate to severe RLS patients. Opioids should be considered for RLS patients, especially for those who have failed other therapies since they are very effective for severe cases. When monitored appropriately, they can be very safe and durable for long term therapy. They should also be strongly considered for treating patients with augmentation as they are very effective for relieving the worsening symptoms that occur when decreasing or eliminating dopamine agonists.

Transcranial direct current stimulation on primary sensorimotor area has no effect in patients with drug-naïve restless legs syndrome: a proof-of-concept clinical trial

“…Dopamine agonists are effective, well tolerated, and can be used as a first-line therapy in the treatment of moderateto-severe RLS. However, while dopamine agonists confer many benefits, drug-emergent problems such as dopamine dysregulation syndrome and augmentation may limit their use for long-term therapy [2].…”

Pramipexole for Chinese people with primary restless legs syndrome: a 12-week multicenter, randomized, double-blind study

“…A wide range of interventions has been used to treat RLS, such as: non-pharmacological therapy, including alerting activities [8]; abstinence from caffeine, nicotine and alcohol [9][10][11]; avoidance of medication that may enhance RLS [12], including antihistamines [8], anti-nausea and anti-emetic drugs [13], antidepressant medications [14,15], neuroleptic medications [16]; and iron-replacement therapy [17,18]. Medication has also been used to treat RLS and includes benzodiazepines [19], low-potency opioids [8], levodopa [20], and dopamine agonists [8].…”

“…Medication has also been used to treat RLS and includes benzodiazepines [19], low-potency opioids [8], levodopa [20], and dopamine agonists [8].…”

Oxycodone/Naloxone PR: A Review in Severe Refractory Restless Legs Syndrome

“…Dopaminergic agents, in particular nonergot dopamine agonists (NEDAs), such as pramipexole, ropinirole and rotigotine, have traditionally been the drugs of choice for adults with moderate to severe RLS, and are licenced for this indication in Europe [8][9][10][11]. The first such agent shown to be successful in the treatment of RLS was levodopa [12]; this dopamine precursor is still used occasionally in some European countries, namely Germany, Austria and Switzerland, mainly for the on-demand treatment of intermittent (as opposed to daily) RLS symptoms [9].…”