New recommedations in the treatment of restless legs syndrome - dopaminergic drugs on the way out

Restless legs syndrome (RLS) is a common sleep-related movement disorder marked by an urge to move one or both legs (sometimes the arms), especially during periods of immobility. This urge is often accompanied by uncomfortable sensations (dysesthesias) and is typically worse in the evening or at night. Movement provides temporary relief. RLS can significantly disrupt sleep and is frequently associated with periodic limb movement disorder (PLMD), characterized by involuntary muscle contractions during sleep, further impairing sleep quality. The most common causes of RLS are heredity and iron deficiency. New treatment guidelines have introduced major changes. First, dopamine agonists, previously first-line treatment in the 2012 guidelines, are no longer recommended for routine use due to the risk of symptom augmentation. If used, then at low doses for short durations only. Second, iron plays a critical role in the condition's pathophysiology and treatment. Iron therapy, either oral or intravenous, is advised when ferritin levels are below 75 ng/mL, to reach above 100 ng/mL. These recommendations differ from standard guidelines for the general population. Third, if iron levels are sufficient, gabapentin or pregabalin are now recommended as first-line treatment. This article reviews the symptoms, causes, and updated treatment guidelines for RLS.