Overviewing Major Changes to the 2024 Restless Legs Syndrome Guidelines: Andy Berkowski, MD, PhD

WATCH TIME: 9 minutes

"The biggest change in the guidelines is that dopaminergic agents are not recommended in the treatment of restless legs syndrome. Long-term use of these drugs leads to augmentation, making the condition worse than before treatment and creating a new iatrogenic disorder that's hard to reverse or manage. This is a very serious situation, backed by 20 years of accumulating evidence."

Restless legs syndrome (RLS) is a sleep-related movement disorder characterized by an urge to move one or both legs when immobile, which is relieved by movement and is most prominent in the evening or at night. The severity of RLS can vary widely, from occasional symptoms during prolonged sitting or inactivity to daily, nearly constant discomfort and movement. In adults, conditions such as neuropathy, akathisia, spasticity, positional discomfort, joint pain, and nocturnal leg cramps can mimic RLS symptoms. In children, mimics include growing pains, leg cramps, and behavioral issues.

In 2012, the American Academy of Sleep Medicine (AASM) published practice recommendations for the treatment of RLS. More than a decade later, the organization published an updated version of those guidelines, incorporating updated literature and new studies to better reflect appropriate care for patients living with the disorder. In the guidelines, the AASM’s task force provided a summary of the relevant research and certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations that support the recommendations.

Shortly after the newly updated recommendations were published, NeurologyLive^® sat down with Andy Berkowski, MD, PhD, vice chair of the AASM’s Clinical Practice Guidelines Task Force, to discuss the greatest changes treating physicians should be aware of. Berkowski, who’s also the founder of Relax Health, a direct specialty care sleep clinic, covered 3 major updates: moving away from dopaminergic agents, emphasizing the role of iron in RLS pathophysiology, and recommending alpha-2-delta ligands and intravenous iron as first-line treatments. In this conversation, he broke down these major changes and what they could mean for clinical care going forward.

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