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

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


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.

Publication types

  • Meta-Analysis
  • Practice Guideline
  • Review
  • Systematic Review

MeSH terms

  • Academies and Institutes
  • Benzothiazoles / therapeutic use
  • Cabergoline
  • Carbamates / therapeutic use
  • Dopamine Agents / therapeutic use
  • Ergolines / therapeutic use
  • Evidence-Based Medicine*
  • Humans
  • Indoles / therapeutic use
  • Levodopa / therapeutic use
  • Nocturnal Myoclonus Syndrome / therapy*
  • Pergolide / adverse effects
  • Peripheral Nervous System Diseases / drug therapy
  • Pramipexole
  • Restless Legs Syndrome / therapy*
  • Sleep Medicine Specialty*
  • United States
  • Venous Insufficiency / drug therapy
  • gamma-Aminobutyric Acid / analogs & derivatives
  • gamma-Aminobutyric Acid / therapeutic use


  • 1-(((alpha-isobutanoyloxyethoxy)carbonyl)aminomethyl)-1-cyclohexaneacetic acid
  • Benzothiazoles
  • Carbamates
  • Dopamine Agents
  • Ergolines
  • Indoles
  • ropinirole
  • Pergolide
  • Levodopa
  • gamma-Aminobutyric Acid
  • Pramipexole
  • Cabergoline