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Treatment Options in Intractable Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED)

  • Sleep Disorders (A Iranzo, Section Editor)
  • Published:
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Opinion statement

Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is a common condition characterized by an irresistible urge to move the legs, concomitant with an unpleasant sensation in the lower limbs, which is typically relieved by movement. Symptoms occur predominantly at rest and prevail in the afternoon or evening. Treatment of patients with RLS/WED is indicated for those patients who suffer from clinically relevant symptoms. The management of mild forms of RLS/WED is mainly based on dopamine agonists (DA) therapy (including pramipexole and ropinirole) and α-2-δ calcium-channel ligand. Nevertheless, with passing of time, symptoms tend to become more severe and the patient can eventually develop pharmacoresistance. Furthermore, long-term treatment with dopaminergic agents may be complicated by the development of augmentation, which is defined by an increase in the severity and frequency of RLS/WED symptoms despite adequate treatment. Here, we discuss which are the best therapeutic options when RLS/WED becomes intractable, with a focus on advantages and side effects of the available medications. Prevention strategies include managing lifestyle changes and a good sleep hygiene. Different drug options are available. Switching to longer-acting dopaminergic agents may be a possibility if the patient is well-tolerating DA treatment. An association with α-2-δ calcium-channel ligand is another first-line approach. In refractory RLS/WED, opioids such as oxycodone–naloxone have demonstrated good efficacy. Other pharmacological approaches include IV iron, benzodiazepines such as clonazepam, and antiepileptic drugs, with different level of evidence of efficacy. Therefore, the final decision regarding the agent to use in treating severe RLS/WED symptoms should be tailored to the patient, taking into account the symptomatology, comorbidities, the availability of treatment and the history of the disease.

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Authors and Affiliations

  1. Department of Clinical Neurosciences, Sleep Disorders Centre, San Raffaele Scientific Institute, Milan, Italy

    Fabrizio Rinaldi MD, Andrea Galbiati MSc, Sara Marelli PhD, Luigi Ferini Strambi MD & Marco Zucconi MD

  2. Neurology Clinic, Spedali Civili di Brescia Hospital, University of Brescia, Brescia, Italy

    Fabrizio Rinaldi MD

  3. Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy

    Andrea Galbiati MSc, Sara Marelli PhD & Luigi Ferini Strambi MD

Authors
  1. Fabrizio Rinaldi MD
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  2. Andrea Galbiati MSc
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  5. Marco Zucconi MD
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Correspondence to Marco Zucconi MD.

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Fabrizio Rinaldi, Andrea Galbiati, Sara Marelli, Luigi Ferini Strambi and Marco Zucconi each declare no potential conflicts of interest.

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This article is part of the Topical Collection on Sleep Disorders

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Rinaldi, F., Galbiati, A., Marelli, S. et al. Treatment Options in Intractable Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED). Curr Treat Options Neurol 18, 7 (2016). https://doi.org/10.1007/s11940-015-0390-1

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  • DOI: https://doi.org/10.1007/s11940-015-0390-1

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