Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults
Publication Date: August 1, 2012
Last Updated: March 14, 2022
RECOMMENDATIONS
Pharmacotherapy
Dopaminergic medications
The dopamine agonist pramipexole is effective in the treatment of moderate-to severe RLS. (High, )
317067
Clinicians should treat patients with RLS with pramipexole. (STANDARD) (, )
317067
The dopamine agonist ropinirole is effective in the treatment of moderate-to-very severe RLS.
317067
Clinicians should treat patients with RLS with ropinirole. (STANDARD) (, )
317067
Levodopa is effective in the treatment of RLS, but carries the risk of augmentation.
317067
Clinicians can treat RLS patients with levodopa with dopa decarboxylase inhibitor. (GUIDELINE)
317067
The dopamine agonist pergolide is effective in the treatment of RLS but has been withdrawn in the U.S. because of the risk of cardiac valvulopathy. (High, )
317067
Clinicians should not treat RLS patients with pergolide because of the risks of heart valve damage. (STANDARD)
317067
The dopamine agonist cabergoline is effective in the treatment of moderate-to-severe RLS.
317067
The dopamine agonist cabergoline is more effective in the treatment of RLS than levodopa, but is not as well tolerated. (Moderate, )
317067
Given the potential of side effects, including heart valve damage, clinicians can treat RLS patients with cabergoline only if other recommended agents have been tried first and failed, and close clinical follow-up is provided. (GUIDELINE) (, )
317067
Opioid medications
Opioids are effective in the treatment of RLS, especially for patients with RLS that is not relieved by other treatments. (Low, )
317067
Clinicians can treat RLS patients with opioids. (GUIDELINE) Values and Trade-Offs. (, )
317067
Anticonvulsant medications
Gabapentin enacarbil is effective in the treatment of moderate-to-severe RLS.
317067
Clinicians can treat patients with RLS with gabapentin enacarbil. (GUIDELINE)
317067
Gabapentin is effective in the treatment of mild-to-moderate RLS. (Low, )
317067
Clinicians may treat RLS patients with gabapentin. (OPTION) (, )
317067
Pregabalin is effective in the treatment of moderate-to-severe RLS. (Low, )
317067
Clinicians may treat patients with RLS with pregabalin (OPTION)
317067
Carbamazepine is effective in the treatment of RLS. (Low, )
317067
Clinicians may treat RLS patients with carbamazepine. (OPTION)
317067
Medications acting on the adrenergic systems
Clonidine is effective in the treatment of RLS. (Low, )
317067
Clinicians may treat patients with RLS with clonidine (OPTION)
317067
Iron supplementation
Iron supplementation has not been shown to be effective in the treatment of RLS, except perhaps in patients with iron deficiency or refractory RLS.
317067
Clinicians may use supplemental iron to treat RLS patients with low ferritin levels. (OPTION)
317067
Therapies For Which No Recommendations Are Made
Non-ergot-derived dopamine agonists: rotigotine
Rotigotine as a transdermal patch is effective in the treatment of moderate-to-severe RLS, but was withdrawn from the U.S. in 2008. (High, )
317067
Other dopaminergic medications: lisuride and amantadine
There is insufficient evidence at this time to support the use of lisuride in the treatment of RLS, and it is not FDA-approved.
317067
Other dopamine agonists There is insufficient evidence at this time to support the use of talipexole, peribedil, and alpha-dihydroergocryptine in the treatment of RLS.
317067
Benzodiazepines (clonazepam)
There is insufficient information on the effect of benzodiazepines on the treatment of RLS.
317067
Valproic acid
There is insufficient evidence at present to evaluate the use of valproic acid for RLS.
317067
Valerian There is insufficient evidence at present to evaluate the use of valerian for RLS.
317067
Non-pharmacological therapy
There is insufficient evidence at present to evaluate the use of non-pharmacological therapy for RLS, including accommodative strategies, sleep hygiene, behavioral and stimulation therapies, compression devices, exercise, and nutritional considerations. (, )
317067
Secondary RLS and special patient groups
There is insufficient evidence on the effectiveness of any one therapy or the balance of benefits to harm in the treatment of secondary RLS, children, pregnant women, or other special patient groups for a recommendation to be made.
317067
THERAPIES FOR PLMD
There is insufficient evidence at present to comment on the use of pharmacological therapy in patients diagnosed with PLMD alone. (NO RECOMMENDATION) (, )
317067
Recommendation Grading
Overview
Title
Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults
Authoring Organization
American Academy of Sleep Medicine
Publication Month/Year
August 1, 2012
Last Updated Month/Year
January 8, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The purpose of this review is to survey and provide an evidencebased update of the literature and corresponding practice parameters in the area of the treatment of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD).
Target Patient Population
Patients with restless legs syndrome / periodic limb movement disorder
Inclusion Criteria
Male, Female, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D012148 - Restless Legs Syndrome, D009069 - Movement Disorders
Keywords
restless legs syndrome, periodic limb movement disorder
Source Citation
SLEEP 2012;35(8):1037.
Supplemental Methodology Resources
Methodology
Number of Source Documents
155
Literature Search Start Date
August 12, 2010
Literature Search End Date
June 29, 2011