Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology

John W Winkelman; Melissa J Armstrong; Richard P Allen; K Ray Chaudhuri; William Ondo; Claudia Trenkwalder; Phyllis C Zee; Gary S Gronseth; David Gloss; Theresa Zesiewicz

doi:10.1212/WNL.0000000000003388

Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology

Neurology. 2016 Dec 13;87(24):2585-2593. doi: 10.1212/WNL.0000000000003388. Epub 2016 Nov 16.

Affiliation

¹ From Harvard Medical School and Massachusetts General Hospital (J.W.W.), Boston; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Department of Neurology (R.P.A.), Johns Hopkins University, Baltimore, MD; King's College and King's College Hospital (K.R.C.), London; Methodist Neurological Institute (W.O.), Houston, TX; Department of Neurology (C.T.), University Medical Center, Göttingen, Germany; Northwestern University Feinberg School of Medicine (P.C.Z.), Chicago, IL; University of Kansas Medical Center (G.S.G.), Kansas City; CAMC Neurology Section (D.G.), Charleston, WV; and Department of Neurology (T.Z.), University of South Florida, James A Haley Veterans Administration Hospital, Tampa.

Abstract

Objective: To make evidence-based recommendations regarding restless legs syndrome (RLS) management in adults.

Methods: Articles were classified per the 2004 American Academy of Neurology evidence rating scheme. Recommendations were tied to evidence strength.

Results and recommendations: In moderate to severe primary RLS, clinicians should consider prescribing medication to reduce RLS symptoms. Strong evidence supports pramipexole, rotigotine, cabergoline, and gabapentin enacarbil use (Level A); moderate evidence supports ropinirole, pregabalin, and IV ferric carboxymaltose use (Level B). Clinicians may consider prescribing levodopa (Level C). Few head-to-head comparisons exist to suggest agents preferentially. Cabergoline is rarely used (cardiac valvulopathy risks). Augmentation risks with dopaminergic agents should be considered. When treating periodic limb movements of sleep, clinicians should consider prescribing ropinirole (Level A) or pramipexole, rotigotine, cabergoline, or pregabalin (Level B). For subjective sleep measures, clinicians should consider prescribing cabergoline or gabapentin enacarbil (Level A), or ropinirole, pramipexole, rotigotine, or pregabalin (Level B). For patients failing other treatments for RLS symptoms, clinicians may consider prescribing prolonged-release oxycodone/naloxone where available (Level C). In patients with RLS with ferritin ≤75 μg/L, clinicians should consider prescribing ferrous sulfate with vitamin C (Level B). When nonpharmacologic approaches are desired, clinicians should consider prescribing pneumatic compression (Level B) and may consider prescribing near-infrared spectroscopy or transcranial magnetic stimulation (Level C). Clinicians may consider prescribing vibrating pads to improve subjective sleep (Level C). In patients on hemodialysis with secondary RLS, clinicians should consider prescribing vitamin C and E supplementation (Level B) and may consider prescribing ropinirole, levodopa, or exercise (Level C).

MeSH terms

Adult
Dopamine Agents / therapeutic use*
Dopamine Agonists / therapeutic use*
Humans
Practice Guidelines as Topic*
Restless Legs Syndrome / diagnosis
Restless Legs Syndrome / therapy*
Societies, Medical
Tetrahydronaphthalenes / therapeutic use*
Thiophenes / therapeutic use*

Substances

Dopamine Agents
Dopamine Agonists
Tetrahydronaphthalenes
Thiophenes
rotigotine

Grants and funding

R01 MH095792/MH/NIMH NIH HHS/United States