Restless Legs Syndrome Guidelines

Updated: Feb 22, 2017
  • Author: Ali M Bozorg, MD; Chief Editor: Selim R Benbadis, MD  more...
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Guidelines

Guidelines Summary

The following organizations have released guidelines for the management of RLS:

  • American Academy of Sleep Medicine (AASM)

  • European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society (EFNS/ENS/ESRS)

  • Willis-Ekbom Disease Foundation (Restless Legs Syndrome Foundation)

  • 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:

  • Severe sleep disturbance (disproportionate to other symptoms)

  • Comorbid insomnia, anxiety, pain

  • 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:

  • Very severe symptoms

  • Excessive weight

  • Comorbid depression

  • Increased risk of falls

  • Cognitive impairment

Other IRLSSG recommendations include the following:

  • 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

  • Considerable caution should be exercised with all dopaminergic agents, with frequent monitoring for loss of efficacy or the development or progression of augmentation

  • 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