Dopaminergic Augmentation in Restless Legs Syndrome/Willis-Ekbom Disease: Identification and Management

Augmentation is the main clinical complication of long-term dopaminergic treatment of restless legs syndrome (RLS)/Willis-Ekbom disease and also the main reason for treatment failure of this class of drugs. It involves an increase in the severity (or frequency) of RLS symptoms during treatment. There is some preliminary evidence that the incidence of augmentation is higher when short-acting dopamine agonists are used. Prevention strategies include managing lifestyle changes and keeping dopaminergic load low. This might include, whenever feasible, to postpone any dopaminergic medication and perform a treatment trial with nondopaminergic agents (ie, alpha-2 delta ligand) first. Treatment of augmentation might require switching to longer-acting dopaminergic agents, to alpha-2 delta ligands or to opiates.