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AAN 2025 | Unmet needs and unanswered questions in the field of RLS
Ambra Stefani, MD, PhD, from the Medical University of Innsbruck, Innsbruck, Austria, comments on the challenges in managing restless legs syndrome (RLS). She highlights hurdles in diagnosis, as well as the relevance of augmentation and the need for education on the use of opioids and iron treatment for RLS. This interview took place at the 77th American Academy of Neurology (AAN) Annual Meeting in San Diego, CA.
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Transcript
Unfortunately, I think there are several aspects. For what concerns the diagnosis, the exclusion of mimics, the diagnosis is clinical for RLS, so it’s really important to know how to address the questions in the right way to go through the diagnostic criteria and to exclude the mimics. This is not always easy and it’s always really important to know even if patients have some mimics, they still can have also RLS and it’s even more difficult to diagnose in this case, but having, for example, polyneuropathy does not exclude that the patient can also have restless legs syndrome...
Unfortunately, I think there are several aspects. For what concerns the diagnosis, the exclusion of mimics, the diagnosis is clinical for RLS, so it’s really important to know how to address the questions in the right way to go through the diagnostic criteria and to exclude the mimics. This is not always easy and it’s always really important to know even if patients have some mimics, they still can have also RLS and it’s even more difficult to diagnose in this case, but having, for example, polyneuropathy does not exclude that the patient can also have restless legs syndrome. I think this is one unmet need in the education and then also the recognition of the augmentation and how relevant this problem is for patients because once they develop augmentation, it’s really difficult to treat augmentation and also then to treat the symptoms with other drugs. An issue can be also the use of opioids, which can be used as a second-line treatment in patients with RLS. And there is still some stigma among doctors, but also patients. So there is some need for education also regarding the use of opioids for treating RLS and the treatment with iron. This is also another big issue because we know that brain iron deficiency is one key aspect of the pathophysiology of restless legs syndrome and that patients with RLS just need more iron than other people without RLS. And so the guidelines suggest giving iron treatment and I don’t want to say iron supplementation because they don’t have a deficit in the blood, but iron treatment if the ferritin levels are below 100. Sometimes it’s hard also with colleagues that are not experts in the field or even general practitioners, even if we recommend this in our report, some colleagues do not want to provide the iron treatment to this patient because the iron levels are in the normal range, but patients with RLS just do need more iron. So this is another big question.
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