EAN 2024 | New guidelines: preventing augmentation in restless leg syndrome

Ambra Stefani, MD, PhD, Medical University of Innsbruck, Innsbruck, Austria, discusses current management recommendations for restless leg syndrome (RLS). Dr Stefani emphasizes that the current treatment guidelines are outdated and that updates are needed based on new evidence and clinical experience, particularly regarding the prevention of augmentation. Dopaminergic drugs can cause paradoxical worsening of symptoms at increased dosage that resolve following a decrease in dosage. Augmentation of RLS should be avoided as it is difficult to manage and limits patients’ response to symptomatic treatment. The first line therapy for RLS is currently alpha2-delta ligands, such as gabapentin and pregabalin. Dopaminergic agents are recommended as second line, but dose and duration must be carefully considered to prevent augmentation. Patients also often require iron supplementation, delivered either by oral or intravenous administration. The American Academy of Sleep Medicine (AASM) are drafting new RLS treatment guidelines; current drafts stipulate that dopamine agonists should be avoided due to the increased risk of developing augmentation. This interview took place at the European Academy of Neurology (EAN) Annual Meeting 2024 in Helsinki, Finland.

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