The American Academy of Sleep Medicine (AASM) has released a clinical practice guideline update for the treatment of restless leg syndrome (RLS) and periodic limb movement disorder in adult and pediatric patients. The guidelines, published in the Journal of Sleep Medicine, aim to provide evidence-based recommendations for clinicians.
Restless leg syndrome is a sleep-related movement disorder characterized by uncomfortable sensations in the legs, typically during periods of inactivity at night or early morning. Clinical RLS occurs more than twice per week with moderate distress. Periodic limb movements occur frequently during sleep, exceeding 15 movements per hour in adults and 5 movements per hour in children.
The guidelines task force considered efficacy, sleep quality, and long-term safety when developing recommendations for treating RLS and periodic limb movement disorder. They concluded that dopaminergic medications are no longer suitable for long-term treatment due to increased risk of augmentation.
In contrast, gabapentin enacarbil, gabapentin, and pregabalin are now recommended as strong options for adults with RLS, supported by data from 13 randomized controlled trials and 7 observational studies. These agents have demonstrated clinically significant improvement in disease severity without excessive adverse events.
Routine testing of serum iron indices is also strongly recommended to diagnose brain iron deficiency, which may be contributing to RLS pathophysiology. IV ferric carboxymaltose is suggested for patients with low ferritin levels below 100 μg/L.
Conditionally recommended agents include dipyridamole, extended-release oxycodone, and bilateral high-frequency peroneal nerve stimulation. These interventions showed promise but require further research to inform future guidelines.
The AASM emphasizes that these guidelines serve as best practices rather than requirements or prohibitions. Clinicians are encouraged to collaborate with patients in making decisions about RLS treatment.
Source: https://www.neurologyadvisor.com/features/restless-leg-syndrome-aasm-guidelines-update