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Winkelmann, J. ; Allen, R.P.* ; Hoegl, B.* ; Inoue, Y.* ; Oertel, W.* ; Salminen, A.V. ; Winkelman, J.W.* ; Trenkwalder, C.* ; Sampaio, C.*

Treatment of restless legs syndrome: Evidence-based review and implications for clinical practice (Revised 2017)§.

Mov. Disord. 33, 1077-1091 (2018)
Postprint DOI
Open Access Green
The objective of the current review was to update the previous evidence-based medicine review of treatments for restless legs syndrome published in 2008. All randomized, controlled trials (level I) with a high quality score published between January 2007 and January 2017 were reviewed. Forty new studies qualified for efficacy review. Pregabalin, gabapentin enacarbil, and oxycodone/naloxone, which did not appear in the previous review, have accrued data to be considered efficacious. Likewise, new data enable the modification of the level of efficacy for rotigotine from likely efficacious to efficacious. Intravenous ferric carboxymaltose and pneumatic compression devices are considered likely efficacious in idiopathic restless legs syndrome. Bupropion and clonidine were reviewed, but the lack of data determined a rating of insufficient evidence for efficacy. The following interventions continue to be considered efficacious as in 2008: levodopa, ropinirole, pramipexole, cabergoline, pergolide, and gabapentin. Bromocriptine, oxycodone, carbamazepine, and valproic acid are considered likely efficacious. Oral iron is nonefficacious in iron-sufficient subjects, but its benefit for patients with low peripheral iron status has not been adequately evaluated. Restless legs syndrome augmentation has been identified as a significant long-term treatment complication for pramipexole more than pregabalin and possibly for all dopaminergic agents more than alpha 2 delta ligands. Therefore, special monitoring for augmentation is required for all dopaminergic medications as well as tramadol. Other drugs also require special safety monitoring: cabergoline, pergolide, oxycodone, methadone, tramadol, carbamazepine, and valproic acid. Finally, we also highlighted gaps and needs for future clinical research and studies of restless legs syndrome.
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Publication type Article: Journal article
Document type Review
Keywords Restless Legs Syndrome (rls) ; Evidence-based Medicine ; Guidelines ; Mds Recommendations ; Therapy ; Treatment ; Augmentation; Placebo-controlled Trial; Randomized Controlled-trial; Open-label Extension; Double-blind; Gabapentin Enacarbil; Crossover Trial; Parallel-group; Hemodialysis-patients; Syndrome Rls; L-dopa
ISSN (print) / ISBN 0885-3185
e-ISSN 1531-8257
Quellenangaben Volume: 33, Issue: 7, Pages: 1077-1091 Article Number: , Supplement: ,
Publisher Wiley
Publishing Place 111 River St, Hoboken 07030-5774, Nj Usa
Reviewing status Peer reviewed