Less is more: pathophysiology of dopaminergic-therapy-related augmentation in restless legs syndrome

@article{Paulus2006LessIM,
  title={Less is more: pathophysiology of dopaminergic-therapy-related augmentation in restless legs syndrome},
  author={Walter Paulus and Claudia Trenkwalder},
  journal={The Lancet Neurology},
  year={2006},
  volume={5},
  pages={878-886}
}
Restless legs syndrome: Diagnostic assessment and the advantages and risks of dopaminergic treatment
TLDR
Dopaminergic agents are currently the agents of first choice to treat RLS, and large multicenter trials support the evidence of efficacy.
Update on the management of restless legs syndrome: existing and emerging treatment options
TLDR
Dopaminergic agents are considered as the first-line therapy for moderate to severe RLS, and gabapentin or other antiepileptic agents, benzodiazepines, or opioids can be used for RLS therapy.
Augmentation of restless leg syndrome (Willis-Ekbom disease) during long-term dopaminergic treatment
TLDR
The clinical features of augmentation, and its differentiation from morning rebound, symptom fluctuations and natural disease progression are discussed, in order to provide clinicians with a comprehensive understanding of this common treatment complication.
Clinical management of restless legs syndrome in end-stage renal disease patients
TLDR
Limited information is available on the effects of dopamine agonists, levodopa, gabapentin, benzodiazepines, and opioids on end-stage renal disease patients, and further clinical studies are still needed to better assess the efficacy, safety, and tolerability of these medications in patients with ESRD.
Restless legs syndrome—current therapies and management of augmentation
Idiopathic restless legs syndrome (RLS) can severely affect quality of life and disturb sleep, so that pharmacological treatment is necessary, especially for elderly patients. Treatment guidelines
Pharmacotherapy of Restless Legs Syndrome with Pramipexole
TLDR
Pramipexole improves subjective symptoms and objective signs of primary RLS even after the first administration and seems to be safe and well tolerated, however, physicians should be aware that augmentation and compulsive behaviours might occur in their RLS patients treated with pramipexoles.
Treatment options for restless legs syndrome
TLDR
The rapid and dramatic improvement of RLS with dopaminergic agents suggests that dopamine system dysfunction may be a basic mechanism, and pharmacological treatment should be limited to those patients who suffer from clinically relevant R LS with impaired sleep quality or quality of life.
Restless legs syndrome: pathophysiology, clinical presentation and management
TLDR
Iron deficiency must be identified and treated by supplementation, both to improve RLS symptoms and to potentially lower the risk of augmentation.
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A previously unreported but far more significant problem of markedly augmented RL symptoms occurred in the afternoon and the evening prior to taking the next nightly dose, and this augmentation was severe enough to require medication change for 50% of the RL patients and 13% of PLMS patients.
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Dopaminergic treatment with levodopa and dopamine agonists is the first choice in idiopathic restless legs syndrome, but augmentation and rebound should be monitored in long-term treatment.
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