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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.

Sources: Reuters; July 22, 2013; and Sleep Medicine; July 2013.

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