title: Restless legs syndrome (RLS) augmentation associated with dopamine agonist and levodopa usage in a community sample.
abstract: OBJECTIVE
  Assess the rate of augmentation as it occurs during standard long-term dopaminergic treatment of RLS, potential risk factors or predictors of augmentation, the relationship between treatment duration and augmentation, and the clinical impact of augmentation on subjects' health outcomes.
  
  
  METHODS
  Two hundred sixty-six patients with dopamine-treated RLS completed a one-time online survey. All subjects were recruited by their PCP/neurologist and were 18 or older. Augmentation was assessed using NIH guidelines and an augmentation classification system was developed through this research.
  
  
  RESULTS
  Overall, 20% of the patients were classified as having definitive or highly suggestive clinical indications of augmentation. Five factors were considered likely to reflect increased risk of developing augmentation, including more frequent RLS symptoms pre-treatment, greater discomfort with RLS symptoms before treatment, and longer treatment duration. RLS augmentation occurred at a rate of about 8% each year for at least the first 8 years of dopamine treatment. Subjects reporting definite or highly suggestive clinical indicators of augmentation had an average IRLS score of 23.6, indicating generally inadequate treatment with generally poor clinical outcomes. Only 25% of the patients reported no indications of augmentation and they were the only group to show on average a low (<15) IRLS score and good clinical outcomes.
  
  
  CONCLUSIONS
  As currently used, long term dopaminergic treatment for an average ± SD of 2.7 ± 2.4 years produced significant augmentation problems in at least 20% of the patients and only 25% of the patients were totally free of this problem. It is important for physicians to carefully screen patients for changes in RLS symptoms for as long as they are on dopamine agents, with particular attention paid to those patients who present with the most severe RLS symptoms prior to treatment initiation. Given the marked increase in suffering with augmentation, a method for early detection and intervention would be an important contribution to the effective management and treatment of RLS.
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA. richardjhu@mac.com
authors.forename: Richard P
authors.initials: RP
authors.lastname: Allen
authors.forename: William G
authors.initials: WG
authors.lastname: Ondo
authors.forename: Eric
authors.initials: E
authors.lastname: Ball
authors.forename: Michael O
authors.initials: MO
authors.lastname: Calloway
authors.forename: Ranjani
authors.initials: R
authors.lastname: Manjunath
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Higbie
authors.forename: Mechele R
authors.initials: MR
authors.lastname: Lee
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nisbet
mesh_terms: D000328:Adult; D000368:Aged; D052160:Benzothiazoles / Q000008:administration & dosage / Q000009:adverse effects; D003430:Cross-Sectional Studies; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010479:Pergolide / Q000008:administration & dosage / Q000009:adverse effects; D000077487:Pramipexole; D012148:Restless Legs Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D052160:Benzothiazoles; D018491:Dopamine Agonists; D007211:Indoles; C046649:ropinirole; D010479:Pergolide; D007980:Levodopa; D000077487:Pramipexole