Youtube Video

Summary published at 9/23/2024

๐Ÿ‘‹ Agenda:

  • Review diagnostic criteria for Restless Legs Syndrome (RLS).
  • Discuss FDA approved medications for RLS, focusing on augmentation.

๐Ÿฆต 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.

๐Ÿ“Š Prevalence:

  • 2.5% of adults have clinically significant RLS.
  • RLS is the third most common sleep disorder.

๐Ÿงช Workup:

  • Check iron levels (ferritin, TIBC).
  • Assess for comorbid disorders (e.g., renal failure, pregnancy).

๐Ÿ’Š 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).

โš ๏ธ Augmentation:

  • Iatrogenic worsening of RLS due to dopaminergic medications.
  • Symptoms may start earlier in the day and increase in severity.

๐Ÿ”„ 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.

๐Ÿ“ˆ Study Findings:

  • Following guidelines, 84% of patients improved over 2.5 years.
  • Only 24% remained moderately to severely ill.

๐Ÿ”‘ 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.

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