The objective of the current review was to update the previous evidence-based medicine review of treatments for
restless legs syndrome published in 2008. All randomized, controlled trials (level I) with a high quality score published between January 2007 and January 2017 were reviewed. Forty new studies qualified for efficacy review.
Pregabalin,
gabapentin enacarbil, and
oxycodone/
naloxone, which did not appear in the previous review, have accrued data to be considered efficacious. Likewise, new data enable the modification of the level of efficacy for
rotigotine from likely efficacious to efficacious. Intravenous
ferric carboxymaltose and pneumatic compression devices are considered likely efficacious in idiopathic
restless legs syndrome.
Bupropion and
clonidine were reviewed, but the lack of data determined a rating of insufficient evidence for efficacy. The following interventions continue to be considered efficacious as in 2008:
levodopa,
ropinirole,
pramipexole,
cabergoline,
pergolide, and
gabapentin.
Bromocriptine,
oxycodone,
carbamazepine, and
valproic acid are considered likely efficacious. Oral
iron is nonefficacious in
iron-sufficient subjects, but its benefit for patients with low peripheral
iron status has not been adequately evaluated.
Restless legs syndrome augmentation has been identified as a significant long-term treatment complication for
pramipexole more than
pregabalin and possibly for all
dopaminergic agents more than α2δ
ligands. Therefore, special monitoring for augmentation is required for all dopaminergic medications as well as
tramadol. Other drugs also require special safety monitoring:
cabergoline,
pergolide,
oxycodone,
methadone,
tramadol,
carbamazepine, and
valproic acid. Finally, we also highlighted gaps and needs for future clinical research and studies of
restless legs syndrome. © 2018 International Parkinson and
Movement Disorder Society.