New Guidelines for Long-Term Management of Restless Legs Syndrome
Dopamine-receptor agonists and calcium-channel ligands recommended as first-line treatment (July 22)
The International Restless Legs Syndrome Study Group has published a report on the long-term management of restless legs syndrome (RLS) — also known as Willis-Ekbom disease (WED) — using evidence-based guidelines and clinical consensus. The report discusses consensus-based strategies for the prevention and treatment of complications, such as augmentation, loss of efficacy, excessive daytime sleepiness, and impulse control disorders, that may develop during long-term pharmacologic treatment of RLS/WED.
The new recommendations are featured in the current issue of Sleep Medicine.
One major finding of the report is recommended expansion of first-line treatment of RLS/WED for most patients. The use of either a dopamine-receptor agonist or an alpha 2 delta calcium-channel ligand is recommended as first-line treatment.
Other key statements include:
- Pramipexole, rotigotine, and ropinirole are effective for the treatment of RLS/WED for up to 6 months.
- Pregabalin is effective for the treatment of RLS/WED for 1 year.
- Gabapentin enacarbil is probably effective for the treatment of RLS/WED for 1 year. Evidence is insufficient to make a recommendation on the use of this drug in the long-term treatment of RLS/WED.
- Levodopa is probably effective for up to 2 years for the treatment of RLS/WED in the 24% to 40% of patients who tolerate therapy and who do not develop augmentation or loss of efficacy.
- Pergolide and cabergoline should no longer be used in the treatment of RLS/WED, except for patients whose symptoms are refractory to all other treatments and in whom the benefits outweigh the risks.
- Evidence is insufficient to make a recommendation on the use of tramadol, methadone, intrathecal morphine, or any single opioid in the long-term treatment of RLS/WED.