Diagnostic Standards for Dopaminergic Augmentation of Restless Legs Syndrome: Report from a World Association of Sleep Medicine - International Restless Legs Syndrome Study Group Consensus Conference at the Max Planck Institute

Philipps University of Marburg, Marburg, Hesse, Germany
Sleep Medicine (Impact Factor: 3.15). 09/2007; 8(5):520-30. DOI: 10.1016/j.sleep.2007.03.022
Source: PubMed


Augmentation of symptom severity is the main complication of dopaminergic treatment of restless legs syndrome (RLS). The current article reports on the considerations of augmentation that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored Consensus Conference in April 2006 at the Max Planck Institute (MPI) in Munich, Germany, the conclusions of which were endorsed by the International RLS Study Group (IRLSSG) and the World Association of Sleep Medicine (WASM). The Consensus Conference sought to develop a better understanding of augmentation and generate a better operational definition for its clinical identification.
Current concepts of the pathophysiology, clinical features, and therapy of RLS augmentation were evaluated by subgroups who presented a summary of their findings for general consideration and discussion. Recent data indicating sensitivity and specificity of augmentation features for identification of augmentation were also evaluated. The diagnostic criteria of augmentation developed at the National Institutes of Health (NIH) conference in 2002 were reviewed in light of current data and theoretical understanding of augmentation. The diagnostic value and criteria for each of the accepted features of augmentation were considered by the group. A consensus was then developed for a revised statement of the diagnostic criteria for augmentation.
Five major diagnostic features of augmentation were identified: usual time of RLS symptom onset each day, number of body parts with RLS symptoms, latency to symptoms at rest, severity of the symptoms when they occur, and effects of dopaminergic medication on symptoms. The quantitative data available relating the time of RLS onset and the presence of other features indicated optimal augmentation criteria of either a 4-h advance in usual starting time for RLS symptoms or a combination of the occurrence of other features. A paradoxical response to changes in medication dose also indicates augmentation. Clinical significance of augmentation is defined.
The Consensus Conference agreed upon new operational criteria for the clinical diagnosis of RLS augmentation: the MPI diagnostic criteria for augmentation. Areas needing further consideration for validating these criteria and for understanding the underlying biology of RLS augmentation are indicated.

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    • "While dopamine agonists have a longer duration of action and an estimated 50% decrease in incidence of augmentation in comparison with dopamine precursors, one third of patients will continue to develop progressive worsening of symptoms on therapy.27,28 With augmentation, symptoms start to occur earlier in the day, become more severe in intensity and may affect other parts of the body, including the arms and trunk.29 The pathophysiology of augmentation remains unclear and treatment is challenging, being largely based on clinical consensus and expert opinion.29 Impulse control disorders, including gambling and compulsive shopping, can also occur in up to 17% of patients, much like in Parkinson’s, which can result in serious social consequences. "
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