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Review
. 2012 Aug 1;35(8):1039-62.
doi: 10.5665/sleep.1988.

The treatment of restless legs syndrome and periodic limb movement disorder in adults--an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline

R Nisha Aurora  1 , David A Kristo, Sabin R Bista, James A Rowley, Rochelle S Zak, Kenneth R Casey, Carin I Lamm, Sharon L Tracy, Richard S Rosenberg; American Academy of Sleep Medicine
Affiliations
Review

The treatment of restless legs syndrome and periodic limb movement disorder in adults--an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline

R Nisha Aurora et al. Sleep. .

Abstract

A systematic literature review and meta-analyses (where appropriate) were performed to update the previous AASM practice parameters on the treatments, both dopaminergic and other, of RLS and PLMD. A considerable amount of literature has been published since these previous reviews were performed, necessitating an update of the corresponding practice parameters. Therapies with a STANDARD level of recommendation include pramipexole and ropinirole. Therapies with a GUIDELINE level of recommendation include levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline (which has additional caveats for use). Therapies with an OPTION level of recommendation include carbamazepine, gabapentin, pregabalin, clonidine, and for patients with low ferritin levels, iron supplementation. The committee recommends a STANDARD AGAINST the use of pergolide because of the risks of heart valve damage. Therapies for RLS secondary to ESRD, neuropathy, and superficial venous insufficiency are discussed. Lastly, therapies for PLMD are reviewed. However, it should be mentioned that because PLMD therapy typically mimics RLS therapy, the primary focus of this review is therapy for idiopathic RLS.

Keywords: PLMD; RLS; Restless legs syndrome; periodic limb movement disorder; sleep-related movement disorders.

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Figures

Figure 1
Figure 1
Meta-analysis of pramipexole IRLS data, improvement over placebo.
Figure 2
Figure 2
Evidence profile for pramipexole.
Figure 3
Figure 3
Meta-analysis of ropinirole IRLS data, improvement over placebo.
Figure 4
Figure 4
Evidence profile for ropinirole.
Figure 5
Figure 5
Meta-analysis of cabergoline IRLS data, before-after treatment.
Figure 6
Figure 6
Meta-analysis of cabergoline IRLS data, improvement over placebo.
Figure 7
Figure 7
Evidence profile for cabergoline. Patients served as their own controls for before-after treatment effect.
Figure 8
Figure 8
Meta-analysis of gabapentin enacarbil IRLS data, improvement over placebo.
Figure 9
Figure 9
Evidence profile for gabapentin enacarbil.
Figure 10
Figure 10
Evidence profile for gabapentin.
Figure 11
Figure 11
Evidence profile for pregabalin.
Figure 12
Figure 12
Meta-Analysis of rotigotine IRLS data, improvement over placebo.
Figure 13
Figure 13
Evidence profile for rotigotine.
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