Here are some research papers and book and website extracts that deal with augmentation, the link between ferritin (iron) and augmentation, and general diagnosis and treatment of WED/RLS:
NEW in 2018: The International RLS Study Group consensus guidelines on iron treatment for WED/RLS including iron infusions (IV iron treatments)
2016 editorial: Restless legs syndrome (Willis-Ekbom disease): An urgent need for better treatments - Advises against using dopamine agonists to treat
augmentation in WED/RLS patients. From Sleep Medicine journal.
The RLS Foundation's handouts on Augmentation 1. Go to the
RLS Foundation website, click Member Portal at the top, click Publications in the drop-down list, and scroll down to Advanced Information. Download
"What is Augmentation?"2. Become a member, log in, click Member Portal at the top, click Publications in the drop-down list, and and scroll down to Advanced Information. Download
"Augmentation: A quick Guide" and
"Augmentation FAQ"3. For real ammunition, scroll farther to Information for Healthcare Providers and download the
2017 RLS Medical Bulletin.
If you are not a member, go to
http://www.rls.org/ and click Join or Renew - the red box at top right.
If you are broke and the small membership fee, which goes to support research as well as creation of these documents, is too much, you can email the Foundation about getting a scholarship (free) membership:
info@rls.org or (507) 287-6465. It's worth it, to access these and other Foundation publications.
Buchfuhrer's 2012 paper: an excellent review of WED/RLS treatment, including lower recommended
maximum daily doses for dopamine agents (0.25 mg for pramipexole, 1.0 mg for ropinirole), a cautionary note about
impulse control disorder, treatment of
augmentation, benefits of
opioids, use of
IV iron,
combination and
rotation of medications, and a recommendation to keep
ferritin over 75 ng/ml:
Citation: Buchfuhrer, Mark J., Strategies for the Treatment of Restless Legs Syndrome; Neurotherapeutics (2012) 9:776-790
**NEW** A magazine-style summary of Buchfuhrer's views (see above), from a 2015 issue of in Sleep Review Magazine:
The International RLS Study Group's 2015 white paper on augmentation prevention and treatment, with recommendations to keep
ferritin over 50 or 75 ng/ml and
transferrin saturation above 20%, and use of
opioids in severe cases:
Extract from Clinical Management of Restless Legs Syndrome, 2nd edition, Treating Augmentation section, by Lee, H.B., Buchfuhrer, M.J., Allen, R. and Hening, W.A., 2013 (Professional Communications Inc., USA), p.181-183; treating augmentation and the use of potent
opioids:
This book also has the new recommended
maximum daily doses of 0.25 mg for pramipexole on p.161-2 & p. 242, and 1.0 mg for ropinirole on p.164 & p. 242. This mulit-authored book would be a good choice to show your doctor.
From the Johns Hopkins Center for RLS website, a good description of the role of iron in RLS/WED; recommends raising
ferritin to over 100 & trying
iron infusions:
This research paper shows that low ferritin is associated with greater RLS/WED symptom severity and increased risk of augmentation: This report from the International RLS Study Group recommends that serum ferritin be at least 75 ng/ml: This research paper shows that augmentation due to dopamine medications is very common: This research note emphasizes that the incidence of augmentation in people being treated with dopamine agents increases over time: The 2009 paper by Frauscher and others is the one that confirmed the association between low ferritin and greater chance of augmentation on dopamine agonists. A recommendation to get your ferritin levels to over 100 ng/mL can be found in the Johns Hopkins link above.
Edited for readability -Beth Apr 2014
Edited to add Augmentation extract -Beth Jan 2015
Edited to add IRLSSG 2015 white paper & note about free Foundation augmentation brochure -Beth Oct 2015
Edited to update links & improve readability -Beth June 2016
Edited to add 2016 editorial & to accommodate new RLS.org website -Beth Mar 2017
Edited to add Sleep Review Magazine & extra info for other papers - Beth Sep 2017
Edited to add 2018 Iron Guidelines - Beth Oct 2018
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