Have you all seen the Mayo clinic RLS study?

[oaklander]

Earlier this year, the Mayo clinic published a comprehensive algorithm for treatment of RLS. The algorithm is intended for patients to give to their doctors as a guide for treating RLS, but it's also invaluable reading for those of us struggling to understand various meds and treatments. If any of you out there still haven't seen it, you can find it either of two ways:
1) it was included in the RLS Nightwalkers newsletter, Summer 2004
2) On this website, under "I Have Restless Legs" menu on home page, choose "Announcements", and it will direct you to the algorithm website pdf file you can read and print out.
Give a copy to your doc, and read it yourself! It's really good information, and has helped me talk to my neurologist and main doc about RLS.

[jumpyowl]

to bring it up again. We were warned about it by HERONAK on this same forum on July 20, 2004.

I got so excited that I abbreviated it for doctors who have no time to read.

I paste it here again:

Heron, but I thought I summarize that Mayo article and post it here for convenience. I really like that work and I added a little.


An Algorithm for the Management of RLS

After M.H. Silber et al. Mayo Clin. Proc. 79(7):916-922, 2004


INTRODUCTION:

Characteristic symptoms: Limb discomfort and urge to move legs which occurs at rest. Symptoms are relieved by movement and are worst in the evening and night.

Associated afflictions: RLS is usually associated with involuntary contraction of leg (muscles) during sleep known as periodic limb movements (PLM). (BTW the reverse is not true).

Severity: ranges from annoying and infrequent to distressing and daily.

Secondary adverse events: Often RLS is a cause of onset or maintenance insomnia.

Prevalence: 5-15% of population.

Pathophysiology: RLS is familial (50%), or idiopathic or related to acquired conditions (iron deficiency/renal failure).

Regulatory status: FDA has not yet approved any medication for the treatment of RLS, so all the drugs discussed here are off label.


Classification of RLS based on severity:

The article distinguishes between three types of RLS:

Intermittent RLS

RLS that is troublesome enough to require treatment but does not necessitate require daily therapy

Daily RLS

RLS that is frequent and troublesome to necessitate daily therapy

Refractory RLS

Daily RLS that is treated with a dopamine agonist with one or more of the following outcomes:

o Inadequate initial response despite adequate doses

o Response that has become inadequate with time despite increasing doses

o Intolerable adverse effect

o Augmentation that is not controllable with additional earlier doses of the drug


TREATMENTS:


INTERMITTENT RLS

Nonpharmacological therapy

• Determine ferritin level and administer iron replacement

• Mental alerting acitivties to reduce boredom

• Abstinence from caffeine, nicotine, and alcohol

• Consider if the use of antidepressants, neuroleptic agents, dopamine-blocking emetics or sedating antihistamines may be contributing and if they can be discontinued.


DAILY RLS

Nonpharmacological therapy

It is the same as for intermittent RLS

Medications

• Dopamine agonists (pramipexole/Mirapex or ropinorole/Requip)

• Gabapentin/Neurontin (anticonvulsive)

• Low potency opioids (propoxyphene/codein, or opioid agonists,
such as tramadol/Ultram



REFRACTORY RLS

Medications

• Change to gabapentin/Neurontine from dopamine agonist

• Change to a different agonist

• Add a second agent such as gabapentin, benzodiazepine, or an opioid

• Change to high potency opioid or tramadol




ALTERNATIVE, INVESTIGATIVE, OR POTENTIAL FUTURE THERAPIES

The management of RLS continues to evolve as new drugs become available and older ones are prescribed less frequently.

Carbamazepine/Tegretol (an anticonvulsive) and clonidine/Catapres (antihypertensive medications) have been successful in clinical trials but are not commonly used in clinical practice..

Among potential new dopamine antagonists Cabergoline/Dostinex (it is also a amtihyperproclactinemic) is of interest because of its long half life of 65 hours, which may result in less augmentation.

Magnesium (ions) has been reported to be effective. In addition to oral iron supplements, treatment of RLS by intravenous iron infusion is presently being investigated in patients with both low and normal ferritin concentration. Such use dates back over 50 years.