Article

Dopaminergic agonists, alpha2delta ligands and opioids are, as single-drug
therapy, the first line treatment for restless legs syndrome (RLS/Willis-Ekbom
disease). However, despite treatment efficacy, exacerbations of RLS may occur
with overall worsening in symptoms severity, development of pain and symptoms
spreading to other parts of the body, without meeting augmentation syndrome
criteria. This development of "drug-resistant" RLS can cause pain, severe
insomnia and psychiatric disorders that affect considerably patients' quality of
life. The lack of French recommendations for this form of RLS leave physicians
with few options to help patients with physical and emotional distress. Our group
of neurological experts and sleep specialists proposes a diagnostic and
therapeutic strategy to provide better care and appropriate treatment through
searching for the organic, psychiatric and/or iatrogenic causes of drug
resistance. Once a drug-resistant RLS diagnosis has been confirmed, we recommend
an obligatory work-up including: a video-polysomnogram, a biological evaluation
including iron status, standard numeration and C-reactive protein level.
Treatment will be comorbidity-dependent: dopaminergic agonist would be
recommended in case of depression or associated periodic leg movements,
alpha2delta ligand in case of insomnia, complaint of pain, or general anxiety, in
association with low-dose opioids if necessary. Strong opioids should be
preferred for multiresistant RLS.
CI - Copyright (c) 2018. Published by Elsevier Masson SAS.

Langue : ANGLAIS