Too Much of a Good Thing

This chapter covers the diagnostic criteria and epidemiology of restless legs syndrome (RLS) and pharmacotherapy for this highly prevalent disorder. Specifically, the case illustrates a patient with RLS treated with dopaminergic medication and the phenomenon of augmentation. The diagnosis of RLS with augmentation due to dopaminergic medication was based on the history of worsening symptoms in relation to upward titration of a dopaminergic agent that was initially effective, with symptom improvement after the agent was discontinued. The differentiation of augmentation and rebound is discussed. Familial and secondary forms of RLS are viewed. Pharmacotherapy for RLS includes dopaminergic agents, alpha-2-delta ligands, benzodiazepines, and opioids; these are detailed and indications, approval by the U.S. Food and Drug Administration, dosing, and adverse effects are discussed.