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Pract Neurol. 2017 Dec;17(6):444-452. doi: 10.1136/practneurol-2017-001762. Epub 2017 Nov 2.

Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management.

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Department of Neurology, University of Texas Health San Antonio, San Antonio, Texas, USA.
Department of Neurology, Weill Cornell Medical School, Methodist Neurological Institute, Houston, Texas, USA.


Restless legs syndrome (RLS) is a chronic neurological disorder that interferes with rest and sleep. It has a wide spectrum of symptom severity, and treatment is started when symptoms become bothersome. Dopamine agonists and calcium channel apha-2-delta antagonists (gabapentin, gabapentin enacarbil and pregabalin) are first-line treatments; calcium channel alpha-2-deltas are preferred over dopamine agonists because they give less augmentation, a condition with symptom onset earlier in the day and intensification of RLS symptoms. Dopamine agonists can still be used as first-line therapy, but the dose should be kept as low as possible. Iron supplements are started when the serum ferritin concentration is ≤75 µg/L, or if the transferrin saturation is less than 20%. For severe or resistant RLS, a combined treatment approach can be effective. Augmentation can be very challenging to treat and lacks evidenced-based guidelines.


augmentation; dopamine agonist; iron; periodic limb movement disorder; restless legs syndrome

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