Polysomnographic record and successful management of augmentation in restless legs syndrome/Willis-Ekbom disease

Maestri, Michelangelo; Fulda, Stephany; Ferini-Strambi, Luigi; Zucconi, Marco; Marelli, Sara; Staedler, Claudio; Bassetti, Claudio; Manconi, Mauro (2014). Polysomnographic record and successful management of augmentation in restless legs syndrome/Willis-Ekbom disease. Sleep medicine, 15(5), pp. 570-575. Elsevier 10.1016/j.sleep.2014.01.016

[img] Text
Maestri2014_may_SleepRes.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (461kB) | Request a copy

BACKGROUND: Dopamine agonists (DAs) represent the first-line treatment in restless legs syndrome (RLS); however, in the long term, a substantial proportion of patients will develop augmentation, which is a severe drug-related exacerbation of symptoms and the main reason for late DA withdrawal. Polysomnographic features and mechanisms underlining augmentation are unknown. No practice guidelines for management of augmentation are available. METHODS: A clinical case series of 24 consecutive outpatients affected by RLS with clinically significant augmentation during treatment with immediate-release DA was performed. All patients underwent a full-night polysomnographic recording during augmentation. A switchover from immediate-release DAs (l-dopa, pramipexole, ropinirole, rotigotine) to the long-acting, extended-release formula of pramipexole was performed. RESULTS: Fifty percent of patients presented more than 15 periodic limb movements per hour of sleep during augmentation, showing longer sleep latency and shorter total sleep time than subjects without periodic limb movements. In all patients, resolution of augmentation was observed within two to four weeks during which immediate-release dopamine agonists could be completely withdrawn. Treatment efficacy of extended-release pramipexole has persisted, thus far, over a mean follow-up interval of 13 months. CONCLUSIONS: Pramipexole extended release could be an easy, safe, and fast pharmacological option to treat augmentation in patients with restless legs syndrome. As such it warrants further prospective and controlled investigations. This observation supports the hypothesis that the duration of action of the drug plays a key role in the mechanism of augmentation.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Bassetti, Claudio


600 Technology > 610 Medicine & health








Valentina Rossetti

Date Deposited:

14 Oct 2014 08:10

Last Modified:

29 Oct 2015 12:02

Publisher DOI:


PubMed ID:


Additional Information:

Notes: Maestri, Michelangelo Fulda, Stephany Ferini-Strambi, Luigi Zucconi, Marco Marelli, Sara Staedler, Claudio Bassetti, Claudio L Manconi, Mauro Netherlands Sleep Med. 2014 May;15(5):570-5. doi: 10.1016/j.sleep.2014.01.016. Epub 2014 Mar 21. Edition: 2014/04/29 Date: May





Actions (login required)

Edit item Edit item
Provide Feedback