Critical Updates to the Treatment of Restless Legs Syndrome: John Winkelman, MD, PhD

WATCH TIME: 8 minutes

"Dopamine agonists are not first line treatments. The reason for that is there’s substantial evidence that dopamine agonists when used for restless legs syndrome are associated with an augmentation of symptoms, a worsening of the underlying disorder."

In 2021, on behalf of the Restless Legs Syndrome Foundation, a group of investigators published updated recommendations for the management of restless legs syndrome (RLS), a condition that impacts between 1.5% and 2.7% of patients in the US. For many patients, RLS is a cause of disabling sleep-onset or maintenance insomnia and may result in reduced quality of life, depression, and increased risk of suicide.

Led by John Winkelman, MD, PhD, some of the topline highlights from the updated recommendations included the need to assess iron status and consider appropriate oral or intravenous iron therapy. Other than for iron, there was no evidence that supplemental minerals or vitamins relieve idiopathic RLS. Additionally, unless contraindicated, the recommendations stated that alpha2-delta ligands should be first-line agents for chronic persistent RLS, with dopamine agonists considered more second-line drugs. Furthermore, low-dose opioid therapy can be an effective approach for refractory RLS, with appropriate precautions.

At the 2023 SLEEP Annual Meeting, held June 3-7, in Indianapolis, Indiana, Winkelman, chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital, gave a presentation on RLS to inform the clinical community on these recent recommendations. In an interview with NeurologyLive^®, Winkelman provided an overview of the major take-home points clinicians should be aware of when treating patients with RLS, the precautions with using dopamine agonists, and why neurologists should be aware of certain iron levels before prescribing certain therapies.

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