Further Advancing the Treatment and Research Field for Restless Legs Syndrome: John Winkelman, MD, PhD

WATCH TIME: 3 minutes

"Certainly, in augmented patients, we need to do some head-to-head trials of different algorithms, whether it be alpha2-delta [ligands] to opioids, or straight to opioids or different alpha2 deltas. We need to have better insight there."

Restless legs syndrome (RLS), characterized by an urge to move the legs, is usually associated with involuntary, rhythmic brief contractions of the legs during sleep known as periodic limb movements. The population prevalence of 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. Over the years, the treatment algorithm for RLS has changed, with the most updated recommendations stating that dopamine agonists, otherwise commonly used agents, should only be used as second-line therapies.

The guidelines, published in 2021 by John Winkelman, MD, PhD, and others, also state that low doses of opioids are effective treatments for patients with RLS when used properly in safe fashion. Additionally, the newly updated algorithm provides clarity for various forms of RLS, including intermittent, chronic persistent, and refractory. In childhood, the guidelines recommend nonpharmacologic approaches, including a consistent bedtime routine, avoidance of sleep deprivation, and elimination of caffeine. Above all, for both adults and children, alpha2-delta ligands should be considered the first-line therapy for RLS.

At the 2023 SLEEP Annual Meeting, held June 3-7, in Indianapolis, Indiana, Winkelman gave a talk on the updated guidelines, and the take-home points clinicians should be aware of. Following his presentation, he sat down to discuss some of the pertinent next steps in advancing the treatment and management of RLS. Winkelman, chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital, spoke specifically about the need to update previous data on standard medications used to treat RLS, as well as conduct studies that compare specific therapeutic approaches and their effectiveness.

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