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

Mov Disord 2018 07 14;33(7):1077-1091. Epub 2018 May 14.

CHDI Foundation, Princeton, Princeton, NJ, USA, and the Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.

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 α2δ 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. © 2018 International Parkinson and Movement Disorder Society.

Download full-text PDF

Source
http://dx.doi.org/10.1002/mds.27260DOI Listing
July 2018
16 Reads

Publication Analysis

Top Keywords

legs syndrome
20
restless legs
20
considered efficacious
16
cabergoline pergolide
8
valproic acid
8
carbamazepine valproic
8
efficacious
6
review
5
legs
5
syndrome
5
pergolide gabapentin
4
gabapentin bromocriptine
4
ropinirole pramipexole
4
efficacious 2008
4
continue considered
4
2008 levodopa
4
levodopa ropinirole
4
bromocriptine oxycodone
4
pramipexole cabergoline
4
acid considered
4

Similar Publications