The reason that I become interested in the evaluation of augmentation was based upon my own experience with this issue.
When I first joined the discussion board, I had just been diagnosed and had begun treatment with pramipexole. I was still in the "happy" period when pramipexole had completely erased the issues that I had been having with severe WED for about six years. It seemed like a miracle "cure". But in my welcome to the board summary, the moderators suggested that I might be augmenting based upon my description of symptoms before I had taken even my first DA. Unfortunately, after only a few weeks on pramipexole, I had to move from 0.25mg to 0.375 mg to maintain control. After nine months I needed to move up to 0.5 mg and knew that this meant trouble. My doctor (at that time) decided to switch me from pramipexole to a 2mg Neupro patch and gabapentin, which are still working reasonably well.
As I investigated augmentation a but further, I found that my base symptoms before treatment with an AD were going to make diagnosis of augmentation very difficult. The international questionnaire for evaluating augmentation has six questions, which can be summarized as:
1. Loss of effect of medication, evidenced by shorter benefit at night and needing higher doses
2. Symptoms start earlier in the day
3. Symptoms begin to involve other body parts
4. Symptoms develop pain when pain was not present before
5. You start developing sleepiness during the day that is separate from inadequate sleep
6. Increasing loss of control of WED despite use of DA as scheduled.
Since my pre-DA symptoms already involved most of my body and were active 24/7, that meant that I could not use questions 2 and 3 and that question 1 would be more difficult to answer (other than needing higher dose). That only left three or four questions, which invalidating the scoring process for the questionnaire.
So, my take on all this is that diagnosis of augmentation is even less straight forward than the diagnosis of WED, which we all know can be difficult. A diagnosis of augmentation will quite probably involve a give-and-take discussion between you and your physician.
For my part, I know that eventually I am going to start showing signs of augmentation on Neupro. However, as Dr Allen stated in his webinar on augmentation (available to WED Foundation members at http://www.rls.org/members-only%20webinar
), augmentation is something that can develop gradually over time. I have therefore started keeping a WED journal to track both my sleep and my use of medication. I review this and will begin looking for trends before I visit with my doctor so that I will have facts to share with him when the time comes rather than a vague description of my condition that simply leaves too much room from error (his to underestimate my condition and mine to overestimated any seeming increases in my symptoms).