The treatment of restless legs syndrome

The objective was to provide an overview of the options for treatment of primary restless legs syndrome (RLS), by analysing the relevant clinical trials for RLS. The patients considered were those affected with primary (or idiopathic) RLS. Levodopa, pramipexole, ropinirole, transdermal rotigotine, pergolide and cabergoline all show clear evidence for efficacy in short-term treatment. Adverse events with these drugs are those usual for dopaminergic agents, and are usually mild and reversible, probably because of the relatively low doses needed. Augmentation, i.e., worsening of RLS symptoms not due to progression of the disease, however, represents a worrisome side effect of dopaminergic drugs, especially levodopa. Ergot-derived dopaminergic agents should also be periodically checked for the possible development of multivalvular heart disease and pleuropulmonary fibrosis. Gabapentin is another drug also having clear evidence for efficacy. In conclusion, dopaminergic agents represent the first line of treatment for idiopathic RLS.