Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults

Publication Date: August 1, 2012

RECOMMENDATIONS

Pharmacotherapy

Dopaminergic medications

The dopamine agonist pramipexole is effective in the treatment of moderate-to severe RLS. (High, )
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Clinicians should treat patients with RLS with pramipexole. (STANDARD) (, )
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The dopamine agonist ropinirole is effective in the treatment of moderate-to-very severe RLS.
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Clinicians should treat patients with RLS with ropinirole. (STANDARD) (, )
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Levodopa is effective in the treatment of RLS, but carries the risk of augmentation.
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Clinicians can treat RLS patients with levodopa with dopa decarboxylase inhibitor. (GUIDELINE)
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The dopamine agonist pergolide is effective in the treatment of RLS but has been withdrawn in the U.S. because of the risk of cardiac valvulopathy. (High, )
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Clinicians should not treat RLS patients with pergolide because of the risks of heart valve damage. (STANDARD)
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The dopamine agonist cabergoline is effective in the treatment of moderate-to-severe RLS.
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The dopamine agonist cabergoline is more effective in the treatment of RLS than levodopa, but is not as well tolerated. (Moderate, )
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Given the potential of side effects, including heart valve damage, clinicians can treat RLS patients with cabergoline only if other recommended agents have been tried first and failed, and close clinical follow-up is provided. (GUIDELINE) (, )
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Opioid medications

Opioids are effective in the treatment of RLS, especially for patients with RLS that is not relieved by other treatments. (Low, )
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Clinicians can treat RLS patients with opioids. (GUIDELINE) Values and Trade-Offs. (, )
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Anticonvulsant medications

Gabapentin enacarbil is effective in the treatment of moderate-to-severe RLS.
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Clinicians can treat patients with RLS with gabapentin enacarbil. (GUIDELINE)
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Gabapentin is effective in the treatment of mild-to-moderate RLS. (Low, )
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Clinicians may treat RLS patients with gabapentin. (OPTION) (, )
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Pregabalin is effective in the treatment of moderate-to-severe RLS. (Low, )
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Clinicians may treat patients with RLS with pregabalin (OPTION)
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Carbamazepine is effective in the treatment of RLS. (Low, )
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Clinicians may treat RLS patients with carbamazepine. (OPTION)
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Medications acting on the adrenergic systems

Clonidine is effective in the treatment of RLS. (Low, )
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Clinicians may treat patients with RLS with clonidine (OPTION)
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Iron supplementation

Iron supplementation has not been shown to be effective in the treatment of RLS, except perhaps in patients with iron deficiency or refractory RLS.
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Clinicians may use supplemental iron to treat RLS patients with low ferritin levels. (OPTION)
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Therapies For Which No Recommendations Are Made

Non-ergot-derived dopamine agonists: rotigotine

Rotigotine as a transdermal patch is effective in the treatment of moderate-to-severe RLS, but was withdrawn from the U.S. in 2008. (High, )
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Other dopaminergic medications: lisuride and amantadine

There is insufficient evidence at this time to support the use of lisuride in the treatment of RLS, and it is not FDA-approved.
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Other dopamine agonists There is insufficient evidence at this time to support the use of talipexole, peribedil, and alpha-dihydroergocryptine in the treatment of RLS.
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Benzodiazepines (clonazepam)

There is insufficient information on the effect of benzodiazepines on the treatment of RLS.
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Valproic acid

There is insufficient evidence at present to evaluate the use of valproic acid for RLS.
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Valerian There is insufficient evidence at present to evaluate the use of valerian for RLS.
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Non-pharmacological therapy

There is insufficient evidence at present to evaluate the use of non-pharmacological therapy for RLS, including accommodative strategies, sleep hygiene, behavioral and stimulation therapies, compression devices, exercise, and nutritional considerations. (, )
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Secondary RLS and special patient groups

There is insufficient evidence on the effectiveness of any one therapy or the balance of benefits to harm in the treatment of secondary RLS, children, pregnant women, or other special patient groups for a recommendation to be made.
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THERAPIES FOR PLMD

There is insufficient evidence at present to comment on the use of pharmacological therapy in patients diagnosed with PLMD alone. (NO RECOMMENDATION) (, )
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Recommendation Grading

Disclaimer

Overview

Title

Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults

Authoring Organization

Publication Month/Year

August 1, 2012

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this review is to survey and provide an evidencebased update of the literature and corresponding practice parameters in the area of the treatment of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD).

Target Patient Population

Patients with restless legs syndrome / periodic limb movement disorder

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D012148 - Restless Legs Syndrome, D009069 - Movement Disorders

Keywords

restless legs syndrome, periodic limb movement disorder

Source Citation

SLEEP 2012;35(8):1037.

Supplemental Methodology Resources

Systematic Review Document, Evidence Tables

Methodology

Number of Source Documents
155
Literature Search Start Date
August 12, 2010
Literature Search End Date
June 29, 2011