title: Medication tolerance and augmentation in restless legs syndrome: the need for drug class rotation.
abstract: Restless legs syndrome (RLS) is a common condition characterized by an unpleasant urge to move the legs that usually occurs at night and may interfere with sleep. The medications used most commonly to treat RLS include dopaminergic drugs (levodopa, dopamine agonists), benzodiazepines, and narcotic analgesics. We report the cases of 2 patients with RLS who illustrate the problems of tolerance (declining response over time) and augmentation (a worsening of symptoms due to ongoing treatment) that can complicate the pharmacotherapy of RLS. We discuss the optimal management of RLS and propose strategies to overcome tolerance and augmentation such as a rotational approach among agents from different classes.
authors.affiliation: Movement Disorders Unit, Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Kurlan
authors.forename: Irene Hegeman
authors.initials: IH
authors.lastname: Richard
authors.forename: Cheryl
authors.initials: C
authors.lastname: Deeley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications; D048909:Diabetes Complications; D011307:Drug Prescriptions; D004522:Educational Status; D005260:Female; D006266:Health Education; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D008329:Managed Care Programs; D006278:Medicare; D010349:Patient Compliance; D011446:Prospective Studies; D012148:Restless Legs Syndrome / Q000150:complications / Q000188:drug therapy*