Augmentation in restless legs syndrome: a comprehensive observational study of a Spanish cohort

Over the last decades, dopamine agonists (DA) have been widely used in treating restless legs syndrome (RLS). However, long-term use is associated with augmentation-an iatrogenic worsening of symptoms. In light of this risk, current guidelines recommend against using DAs in newly diagnosed patients. Adherence to these guidelines in real-world clinical practice is unclear.

We sought to examine the epidemiology, risk factors, treatment history, and management strategies in RLS patients with augmentation.

In this retrospective observational study, we collected data on RLS characteristics, DA use, treatment modifications, and adherence to clinical recommendations, and compared our findings with previous epidemiological studies.

A total of 93 patients were included (53 % women, 51 % had a family history of RLS, mean age at RLS onset 38.15 ± 16.50 years). Augmentation developed after a mean of 6.25 ± 8.56 years. DAs were the first-line treatment in 86 % of patients and DA doses exceeded recommended limits in 46 % of cases. Despite presenting augmentation, 85 % remained on DAs, of whom only 20 % reduced the dose.

This study highlights a critical gap in AUG management, with persistent DA use despite clear evidence supporting discontinuation. Compared to other epidemiological studies, DA dose reduction and the use of alternative therapies was less frequent. Barriers to treatment modification include inadequate monitoring, reluctance to discontinue DA, and limited access to alternative treatments. Increasing awareness, adherence to updated guidelines, and improving patient access to specialized care are essential to mitigating augmentation and optimizing RLS treatment.