New Treatment Guidelines for Restless Legs Syndrome and Shifting Away From Dopamine Agonists: John Winkelman, MD, PhD

WATCH TIME: 8 minutes

"Dopamine agonists, once considered the first-line treatment for [restless legs syndrome], are no longer recommended [because of] their long-term complications, particularly augmentation."

Restless legs syndrome (RLS), a movement disorder, is marked by an urge to move the legs or arms, often because of uncomfortable sensations. It can be primary or secondary, with secondary cases associated with iron deficiency, end-stage renal disease, or pregnancy. Many patients with this condition can also experience periodic limb movements during sleep. Studies have shown that RLS can cause sleep disturbances, mood disorders, reduced quality of life, and lower work productivity. Research also provides evidence that augmentation can be a major complication of long-term dopaminergic treatment for RLS, where symptoms worsen as a result of the medication.¹

A task force of experts in sleep medicine commissioned by American Academy of Sleep Medicine (AASM) recently published new clinical practice recommendations for the treatment of RLS in adults and pediatric patients. Established by lead author John Winkelman, MD, PhD, chair of the AASM committee that revised the guidelines, and colleagues, the new recommendations were based on a systematic review of prior studies and an assessment of the literature. Published in Journal of Clinical Sleep Medicine, these guidelines will assist providers for when they are prescribing treatment for their patients with the condition.²

Following the publication, Winkelman, who also serves as the chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital, sat down with NeurologyLive^® to have a deeper discussion of the newly revised guidelines for RLS treatment. During the conversation, he talked about the major risks associated with long-term use of dopamine agonists for treating RLS. He also spoke about how alpha-2-delta calcium channel ligands compare with dopamine agonists in managing RLS symptoms. Furthermore, Winkelman explained the role of iron deficiency in RLS, and how these newer guidelines recommend addressing it for clinicians.

REFERENCES
1. Winkelman JW, Armstrong MJ, Allen RP, et al. 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;87(24):2585-2593. doi:10.1212/WNL.0000000000003388
2. 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

Editor’s Note: Winkelman has disclosed that he receives grant or research support from American Regent, Merck, RLS Foundation, National Institute of Drug Abuse. He has been a consultant for Alexza, Avadel, Azurity, Disc Medicine, Emalex, Genenttec, Haleon, Idorsia, Noctrix, and Psychogenics. Winkelman also gets financial support from the Baszucki Group and has gotten honoraria from UpTo Date and Teledoc.