Exploring Gaps in RLS Treatment Through New 2024 Guidelines: Andy Berkowski, MD, PhD

WATCH TIME: 3 minutes

"We recommend against a couple of treatments for periodic limb movement disorder and suggest further investigation into how to diagnose it and what its nature is."

After more 10-plus years, In September, the American Academy of Sleep Medicine (AASM) published an updated version of its treatment guidelines for patients with restless legs syndrome (RLS), a sleep-related movement disorder that impacts 5-10% of adults and 2-4% of children. Among the many changes, 3 stand out: the shift away from dopaminergic agents, a greater emphasis on the role of iron in RLS pathophysiology, and the therapeutic potential of alpha-2-delta ligands and intravenous iron as first-line treatments.

Led by Andy Berkowski, MD, PhD, and many others, the guidelines suggest that clinicians should regularly test serum iron studies including ferritin and transferrin saturation, ideally in the morning. The guidelines also offer recommendations for specific populations, including adults vs children, as well as special adult populations such as adults with RLS and end-stage renal disease and those with periodic limb movement disorder (PMLD).

Berkowski, vice chair of the AASM’s Clinical Practice Guidelines Task Force and founder of Relax Health, recently sat down to discuss the guidelines, including some of the finer details clinicians should be aware of. In addition, he spoke on how the guidelines highlight gaps in research, particularly in special populations such as children, individuals and individuals with comorbid neurodegenerative diseases like Parkinson disease (PD). He touched on how there is a need for expanded data in subgroups, including pregnant patients and those with PD, where treatments like levodopa may worsen RLS symptoms. Furthermore, he touched on the need for further research into the biology and diagnostic criteria for PLMD.

REFERENCE
1. Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. Published online September 26, 2024. doi:10.5664/jcsm.11390