Augmentation and impulsive behaviors in restless legs syndrome: Coexistence or association?
To assess the frequency of impulse control disorders (ICDs) in patients with restless legs syndrome (RLS) with and without augmentation under dopaminergic therapy in a case-control study. Augmentation and ICDs are both serious complications of dopaminergic treatment of RLS but little is known about possible associations between these drug-induced disorders.



In total, 58 patients with idiopathic RLS diagnosed according to the International Restless Legs Syndrome Study Group criteria were recruited. Of these, 35 patients had augmentation. The frequency of ICD symptoms was assessed using semi-structural interviews.



Demographic variables did not differ between patients with RLS with and without augmentation but those with augmentation took higher dopaminergic medication than patients without augmentation. Twenty-three patients with RLS (39.7%) had ICD symptoms, with 12 patients (20.7%) having definitive ICDs. Patients with augmentation had an increased risk of expressing ICD symptoms (p = 0.007, odds ratio 5.64, 95% confidence interval 1.59-20.02).



Patients with RLS with augmentation have an almost 6-fold increased risk of exhibiting ICD symptoms. This implies that augmentation and ICDs are related and may share a common pathophysiology. Moreover, our results have clinical implications, suggesting that patients with RLS with augmentation should be screened for ICD symptoms.
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Beatrice
B
Heim
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK. atbin.djamshidian-tehrani@i-med.ac.at.
Atbin
A
Djamshidian
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Anna
A
Heidbreder
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Ambra
A
Stefani
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Laura
L
Zamarian
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Marie-Theres
MT
Pertl
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Elisabeth
E
Brandauer
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Margarete
M
Delazer
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Klaus
K
Seppi
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Werner
W
Poewe
From the Departments of Neurology (B. Heim, A.D., A.H., A.S., L.Z., M.-T.P., E.B., M.D., K.S., W.P., B. Högl) and Psychology (M.-T.P.), Medical University Innsbruck, Austria; and Department of Molecular Neuroscience and Reta Lila Weston Institute for Neurological Studies (A.D.), University of London, UK.
Birgit
B
Högl
D018726:Anti-Dyskinesia Agents / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000150:complications*; D015259:Dopamine Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012148:Restless Legs Syndrome / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D018726:Anti-Dyskinesia Agents; D015259:Dopamine Agents