European guidelines on management of restless legs syndrome: report of a joint task force by the European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society

Abstract

Background: Since the publication of the first European Federation of Neurological Societies (EFNS) guidelines in 2005 on the management of restless legs syndrome (RLS; also known as Willis-Ekbom disease), there have been major therapeutic advances in the field. Furthermore, the management of RLS is now a part of routine neurological practice in Europe. New drugs have also become available, and further randomized controlled trials have been undertaken. These guidelines were undertaken by the EFNS in collaboration with the European Neurological Society and the European Sleep Research Society. Objectives: To provide an evidence-based update of new treatments published since 2005 for the management of RLS. Methods: First, we determined what the objectives of management of primary and secondary RLS should be. We developed the search strategy and conducted a review of the scientific literature up to 31 December 2011 (print and electronic publications) for the drug classes and interventions employed in RLS treatment. Previous guidelines were consulted. All trials were analysed according to class of evidence, and recommendations made according to the 2004 EFNS criteria for rating. Recommendations: Level A recommendations can be made for rotigotine, ropinirole, pramipexole, gabapentin enacarbil, gabapentin and pregabalin, which are all considered effective for the short-term treatment for RLS. However, for the long-term 1385European Journal of Neurology 2012Neurology , 19: 1385Neurology -1396Neurology doi:10.1111Neurology /j.1468Neurology -1331Neurology .2012 treatment for RLS, rotigotine is considered effective, gabapentin enacarbil is probably effective, and ropinirole, pramipexole and gabapentin are considered possibly effective. Cabergoline has according to our criteria a level A recommendation, but the taskforce cannot recommend this drug because of its serious adverse events.

Serum Ferritin Levels in Parkinson's Disease Patients with and without Restless Legs Syndrome

“…8 Augmentation is a major clinical problem that arises with the long-term treatment of dopaminergic agents in RLS. Until now, cases of augmentation have not been described in PD+RLS patients and our clinical experience of several hundred PD patients includes only 1 case.…”

“…7 They are both associated with periodic limb movements in sleep, which are improved with dopaminergic treatment, especially dopamine agonists. 8,9 However, whereas PD patients with (PD+RLS) and without RLS (PD-nonRLS) show increased echogenicity of the SNc on midbrain sonography (supporting the hypothesis of increased iron concentration), patients with idiopathic RLS are often identified with hypoechogenicity (supporting the hypothesis of decreased iron concentration). This suggests a different underlying pathogenesis, 10,11 probably related to iron storage and transport as well as to brain iron concentrations.…”

Treatment of Restless Legs Syndrome

“…There are currently over 30 randomized, placebo-controlled studies and several published evidence-based reviews and meta-analyses of dopaminergic treatments for RLS [34,[69][70][71][72][73][74]. Overall, the direct dopamine agonists have been found to be effective in shortand longer-duration placebo-controlled studies for the treatment of RLS and PLMS.…”

Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome

“…With regard to augmentation, there is a special session for that matter later on this article. However it should be noted that the evidences point to an incidence of up to 30% with the use of pramipexole in three years, up to 3% in 6 months of ropinirole and 13.2% up to 5 years with rotigotina 57 . Assessment of augmentation depends on long-term inquiry.…”

“…Along with pramipexole, ropinirole is recommended for the treatment of RLS by American and European consensus with the same degree of recommendation (A) and level of evidence (1A). This recommendation is endorsed by at least seven randomized, placebo controlled double blind trials 51,57 .…”