Medication refractory restless legs syndrome: Real-world experience

Area of Science:

• Neurology
• Sleep Medicine
• Genetics

Background:

• Restless Legs Syndrome (RLS) affects 5-13% of the population, presenting long-term management challenges.
• A significant knowledge gap exists in predicting treatment resistance to first-line therapies for RLS.

Purpose of the Study:

• To identify demographic and clinical factors that predict medication-refractory Restless Legs Syndrome.
• To differentiate characteristics between refractory and non-refractory RLS patient cohorts.

Main Methods:

• Retrospective study at a Movement Disorders Clinic from January 2018 to September 2023.
• Compared clinical and demographic data of medication-refractory RLS patients with a 'benign' cohort.
• Utilized data from 132 RLS patients, with 23 categorized as medication-refractory.

Main Results:

• Refractory RLS cases showed a significantly younger age at onset (39.3 vs. 53.5 years) and longer disease duration (26.7 vs. 14.0 years).
• A positive family history of RLS in first-degree relatives was more prevalent in the refractory group (56.5% vs. 15.5%).
• Dopamine agonists were initiated as primary medication more frequently in the refractory RLS cohort (p=0.006).

Conclusions:

• Younger age at onset, longer disease duration, initial dopamine agonist use, and family history predict refractory RLS.
• Caution is advised regarding dopamine agonist use, particularly in younger RLS patients.
• Botulinum toxin may be a viable second-line treatment for medically-refractory RLS.