TY - JOUR
T1 - The Management of Restless Legs Syndrome
T2 - An Updated Algorithm
AU - Scientific and Medical Advisory Board of the Restless Legs Syndrome Foundation
AU - Silber, Michael H.
AU - Buchfuhrer, Mark J.
AU - Earley, Christopher J.
AU - Koo, Brian B.
AU - Manconi, Mauro
AU - Winkelman, John W.
AU - Becker, Phillip
AU - Berkowski, J. Andrew
AU - Clemens, Stefan
AU - Connor, James R.
AU - Ferré, Sergi
AU - Hensley, Jennifer G.
AU - Jones, Byron C.
AU - Karroum, Elias G.
AU - Koo, Brian
AU - Ondo, William
AU - Richards, Kathy
AU - Sharon, Denise
AU - Trotti, Lynn Marie
AU - Uhl, George
AU - Walters, Arthur S.
N1 - Funding Information:
To prepare the updated algorithm, the RLS Foundation Scientific and Medical Advisory Board established a task force from among its members who produced and revised a draft that was submitted for approval to the other members of the board. The authors have had many years of experience in the treatment of RLS and have conducted original research on this disorder. Some have been members of task forces that have produced the previously discussed evidence-based reviews. The effort was supported by the Board of Directors and Executive Director of the RLS Foundation, but this article is entirely the work of the physicians and scientists on the Scientific and Medical Advisory Board. It is based on both a detailed knowledge of the literature, including evidence-based assessments, and expert opinion from practical experience. A literature search was performed using PubMed identifying all articles on RLS from 2012 (the year before the publication of the previous algorithm) to 2020. Relevant studies of RLS management were included in our recommendations. We recognize that a different group of specialists might have produced a somewhat different algorithm, but we believe that our approach reflects current thinking about the management of RLS. We expect that the development of new medications and further research on existing ones may alter clinical approaches in the future. Of note, the US Food and Drug Administration (FDA) has approved pramipexole, ropinirole, rotigotine patch, and gabapentin enacarbil for the treatment of RLS, and thus all other drugs discussed are being used “off label.” Although we have attempted to produce an accurate document, it is the responsibility of individual physicians to familiarize themselves with all aspects of the medications they prescribe and to decide whether a specific drug is appropriate for a particular patient.
Funding Information:
Potential Competing Interests: Dr Buchfuhrer is a speaker for Arbor Pharmaceuticals. Dr Earley receives research support from American Regent. Dr Koo receives research support from the Department of Defense grant W81XWH2010003. Dr Silber receives royalties from UpToDate. Dr Winkelman is a consultant for Avadel Pharmaceuticals, CVS Health, Eisai Pharmaceuticals, and Noctrix Health and receives research support from American Regent, Merck Pharmaceuticals, and Restless Legs Syndrome Foundation. Dr Manconi reports no relevant financial support or conflict of interest.
Funding Information:
Potential Competing Interests: Dr Buchfuhrer is a speaker for Arbor Pharmaceuticals. Dr Earley receives research support from American Regent . Dr Koo receives research support from the Department of Defense grant W81XWH2010003 . Dr Silber receives royalties from UpToDate . Dr Winkelman is a consultant for Avadel Pharmaceuticals, CVS Health, Eisai Pharmaceuticals, and Noctrix Health and receives research support from American Regent , Merck Pharmaceuticals , and Restless Legs Syndrome Foundation . Dr Manconi reports no relevant financial support or conflict of interest.
Publisher Copyright:
© 2021 Mayo Foundation for Medical Education and Research
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2 or more times a week and causing at least moderate distress. It is important for primary care physicians to be familiar with the disorder and its management. Much has changed in the management of RLS since our previous revised algorithm was published in 2013. This updated algorithm was written by members of the Scientific and Medical Advisory Board of the RLS Foundation based on scientific evidence and expert opinion. A literature search was performed using PubMed identifying all articles on RLS from 2012 to 2020. The management of RLS is considered under the following headings: General Considerations; Intermittent RLS; Chronic Persistent RLS; Refractory RLS; Special Circumstances; and Alternative, Investigative, and Potential Future Therapies. Nonpharmacologic approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation, are outlined. The choice of an alpha2-delta ligand as first-line therapy for chronic persistent RLS with dopamine agonists as a second-line option is explained. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS and describe management approaches, including combination therapy and the use of high-potency opioids. Treatment of RLS in pregnancy and childhood is discussed.
AB - Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2 or more times a week and causing at least moderate distress. It is important for primary care physicians to be familiar with the disorder and its management. Much has changed in the management of RLS since our previous revised algorithm was published in 2013. This updated algorithm was written by members of the Scientific and Medical Advisory Board of the RLS Foundation based on scientific evidence and expert opinion. A literature search was performed using PubMed identifying all articles on RLS from 2012 to 2020. The management of RLS is considered under the following headings: General Considerations; Intermittent RLS; Chronic Persistent RLS; Refractory RLS; Special Circumstances; and Alternative, Investigative, and Potential Future Therapies. Nonpharmacologic approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation, are outlined. The choice of an alpha2-delta ligand as first-line therapy for chronic persistent RLS with dopamine agonists as a second-line option is explained. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS and describe management approaches, including combination therapy and the use of high-potency opioids. Treatment of RLS in pregnancy and childhood is discussed.
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UR - http://www.scopus.com/inward/citedby.url?scp=85108788654&partnerID=8YFLogxK
U2 - 10.1016/j.mayocp.2020.12.026
DO - 10.1016/j.mayocp.2020.12.026
M3 - Review article
C2 - 34218864
AN - SCOPUS:85108788654
VL - 96
SP - 1921
EP - 1937
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
SN - 0025-6196
IS - 7
ER -