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Restless Legs Syndrome and Other Movement Disorders of Sleep—Treatment Update

  • Aaro V. Salminen
  • Juliane WinkelmannEmail author
Movement Disorders (A Videnovic, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Movement Disorders

Abstract

Purpose of review

The purpose of this review article is to summarize and discuss the recent advances in the treatment of restless legs syndrome (RLS), as well as REM sleep behavior disorder (RBD), and periodic leg movement disorder (PLMD).

Recent findings

Traditionally, dopaminergic therapy has been considered the sole option for first-line treatment of RLS due to their impressive acute efficacy. Dopamine agonists such as oral pramipexole and ropinirole, as well as transdermal rotigotine are all effective treatment options. However, augmentation of the RLS symptoms is a major limitation of oral dopaminergic therapy. Recently, gabapentinoid agents such as gabapentin enacarbil and pregabalin have shown comparable short-term efficacy to dopaminergics with lower risk of augmentation of the RLS symptoms. Recent evidence on the efficacy of oxycodone-naloxone in treatment-resistant RLS provides an additional therapeutic avenue. The increasing understanding of the role of iron in RLS pathophysiology has led to new options in iron supplementation therapy in RLS, including treatment with ferric carboxymaltose.

Summary

With emerging evidence of augmentation being a side effect specific to dopaminergic treatment, gabapentinoids are considered a safer option as initial treatment. In severe refractory RLS, oxycodone-naloxone can be used. If iron stores are low, IV iron formulations should be the initial treatment choice. New treatment options are needed to address issues with current therapies.

Keywords

Restless legs syndrome Treatment Dopamine agonist Gabapentinoid Opioid REM sleep behavior disorder 

Notes

Compliance with Ethical Standards

Conflict of Interest

Aaro V. Salminen declares no potential conflict of interest. Juliane Winkelmann has received speaker honoraria from Bayer and UCB, as well as research grants from Else Kröner Foundation and German Research Foundation (DFG). Juliane Winkelmann also has a patent filed related to Thalidomide in RLS pending.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. 1.Institute of NeurogenomicsHelmholtz Zentrum MünchenMunichGermany
  2. 2.Department of NeurologyPhilipps-Universität MarburgMarburgGermany
  3. 3.Lehrstuhl für Neurogenetik und Institut für Humangenetik, Klinikum Rechts der IsarTechnische Universität MünchenMunichGermany
  4. 4.Munich Cluster for Systems Neurology (SyNergy)MunichGermany

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