Restless Legs Syndrome

Treatment

The goal of treatment for RLS is to eliminate or minimize associated symptoms and increase normal functioning, thereby improving overall quality of life. Treatment is directed toward eliminating troublesome symptoms during rest, sleep, or sedentary activities, with the goal of reducing sleep disturbances, preventing daytime fatigue or somnolence, and improving the patient's ability to participate in work and leisure activities.

The clearly established therapies for RLS and PLMD are all pharmacologic, with pramipexole (Mirapex® from Boehringer Ingelheim, Inc.) and ropinirole (Requip® from GlaxoSmithKline), currently approved by the U.S. Food and Drug Administration for labeling for RLS. Therefore, the use of any other drugs in the treatment of RLS is considered to be off label in the United States.

Before embarking on pharmacotherapy, the treating physician typically explores the possibility that lifestyle changes may alleviate or lessen the symptoms of RLS. In addition, treating any associated conditions that exacerbate the symptoms of RLS may lessen the need for pharmacologic intervention for the RLS.

Two publications provide guidance for the treatment of RLS. The Standards of Practice Committee of the American Academy of Sleep Medicine published practice parameters for the treatment of RLS and PLMD in 1999; in 2004, the Committee updated these guidelines regarding dopaminergic treatment, with recommendations centered upon evidence classified according to study design. Based on a review of the medical literature and expert opinion, the Medical Advisory Board of the Restless Legs Syndrome Foundation developed "An algorithm for the management of restless legs syndrome."144 This algorithm, published in July 2004 in The Mayo Clinic Proceedings, is available in PDF format from the web site of the Proceedings (http://www.mayoclinicproceedings.com/pdf/7907/7907Crc.pdf).