Guidelines Summary
The following organizations have released guidelines for the management of restless legs syndrome (RLS):
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American Academy of Sleep Medicine (AASM)
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European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society (EFNS/ENS/ESRS)
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Willis-Ekbom Disease Foundation (Restless Legs Syndrome Foundation)
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International Restless Legs Syndrome Study Group (IRLSSG)
The 2013 IRLSSG guidelines for the long-term treatment of RLS recommends either a dopamine-receptor agonist or an alpha2-delta calcium-channel ligand as first-line treatment therapy for RLS in most patients, with the choice of medication depending on symptom severity, cognitive status, history, and comorbid conditions. [37]
The use of alpha2-delta calcium-channel ligand should be considered for initial treatment of patients with any of the following:
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Severe sleep disturbance (disproportionate to other symptoms)
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Comorbid insomnia, anxiety, pain
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A previous history of an impulse control disorder (ICD) or comorbid generalized anxiety disorder
The use of a dopamine-receptor agonist should be considered for initial treatment of patients with any of the following:
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Very severe symptoms
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Excessive weight
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Comorbid depression
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Increased risk of falls
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Cognitive impairment
Other IRLSSG recommendations include the following:
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Patients with clinically significant daytime symptoms should be treated with a long-acting agent; multiple daily doses of a short-acting agent can also be tried
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Considerable caution should be exercised with all dopaminergic agents, with frequent monitoring for loss of efficacy or the development or progression of augmentation
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Treatment with the combination of a dopamine-receptor agonist and an alpha2-delta calcium-channel ligand should be considered for patients with symptoms that cannot be controlled with low-dose monotherapy of either drug class
