๐ Agenda:
- Review diagnostic criteria for Restless Legs Syndrome (RLS).
- Discuss FDA approved medications for RLS, focusing on augmentation.
๐ฆต Diagnostic Criteria:
- Urge to move legs present at rest.
- Symptoms improve with movement.
- Symptoms worsen when sitting or lying down.
- Predominantly occur in the evening or at night.
๐ Prevalence:
- 2.5% of adults have clinically significant RLS.
- RLS is the third most common sleep disorder.
๐งช Workup:
- Check iron levels (ferritin, TIBC).
- Assess for comorbid disorders (e.g., renal failure, pregnancy).
๐ Medications:
- Four classes:
- Calcium channel Alpha 2 Delta ligands (e.g., Gabapentin).
- Dopaminergic agents (e.g., Ropinirole, Pramipexole).
- Opioids (for severe cases).
- Iron supplements (if deficient).
โ ๏ธ Augmentation:
- Iatrogenic worsening of RLS due to dopaminergic medications.
- Symptoms may start earlier in the day and increase in severity.
๐ Management of Augmentation:
- Assess and adjust medications based on symptom timing.
- Consider switching to Alpha 2 Delta agents or opioids.
- Gradually taper off dopaminergic agents.
๐ Study Findings:
- Following guidelines, 84% of patients improved over 2.5 years.
- Only 24% remained moderately to severely ill.
๐ Key Takeaways:
- Assess for underlying contributors (e.g., iron deficiency).
- Start with Alpha 2 Delta agents for treatment-naive patients.
- Gradually reduce dopaminergic medications if augmented.