Augmentation in restless legs syndrome: poor response to sudden withdrawal of dopaminergic therapy

Roger Kurlan, Marcie Rabin

Atlantic Neuroscience Institute, Overlook Medical Center, Summit, NJ, USA

Background: Augmentation is a common complication of long-term dopaminergic therapy for restless legs syndrome (RLS).
Methods: We conducted a retrospective chart review of patients with RLS and augmentation to learn more about the condition, including response to therapy.
Results: We identified 14 patients (nine women, five men; mean age 65.7 years; mean duration of RLS 23.6 years) with augmentation. Thirteen patients were taking a dopamine agonist and one was taking levodopa. Mean duration of dopaminergic therapy was 5.5 years. The dopaminergic drug was withdrawn at one time and replaced by gabapentin (n = 9), tramadol (n = 5), clonazepam (n = 4), propoxyphene (n = 2), or codeine (n = 1). Seven patients required more than one drug to control symptoms. The mean time until augmentation resolved was 12.5 (range 1–43) weeks, shortest when gabapentin was used first (2.6 weeks) and longer when clonazepam (14.9 weeks) or tramadol (22.3 weeks) was the initial replacement drug.
Conclusion: Augmentation was the most common problem associated with referral of a patient with RLS to a movement disorders specialist, yet referring physicians did not appear to know how to treat it. Regaining satisfactory control of symptoms following sudden withdrawal of the offending dopaminergic drug was difficult, taking longer than 3 months on average. The optimum treatment of drug-induced augmentation is unclear and needs further investigation.

Keywords: restless legs syndrome, dopamine agonists, levodopa, augmentation