Advances in Motion

[C82021]

advances.massgeneral.org/ne...

[ChrisColumbus]

A good reminder about this. There has been some discussion about Curbside before:healthunlocked.com/rlsuk/po...

[Joolsg]

This is a fantastic resource/initiative for our USA members.To be able to send a patient history and then get advice on how to treat the patient effectively, for free, is just brilliant!

I wonder if UK doctors would be able to use it?

Knowing how obstructive many UK neurologists can be, I suspect they would refuse to use it, even if they could!

[C82021]

If Im not mistaken this article is most current April 29 2024, just a month ago right??

[C82021 in reply to C82021]

Im needing something to provide evidence to my GP, who I will be seeing this coming Friday. My last two neurologist visits being from two separate DR's. One prescribed Pramipexole, the other Ropinirole. Both are "very" perturbed that I don't agree with them. This is in my records that I don't listen to their advice. This does not help me when searching for a DR to agree with my research as I appear problematic, after all who am I to question a professional? Yes, some of you have offered referrals, but for reasons, this is not applicable at the present time, but my GP is. So far my GP has worked best with me.

[ChrisColumbus in reply to C82021]

Good luck! Unfortunately too few doctors and neurologists seem willing to listen to expert advice on RLS. Besides the excellent 2024 article that you linked to, Winkelman raised the issue in this 2022 interview:

“Awareness of augmentation is unfortunately very low in the general medical community and these medications are considered benign by many prescribers in the context of RLS,”

sleepreviewmag.com/sleep-tr...

And back in 2020 the Mayo Algorithm saId:

"Two major problems often limit the use of dopamine agonists, which is why they are not recommended as first-line agents unless there are contraindications to alpha2-delta ligands. The single and by far most common problem is disease augmentation (onset of RLS symptoms earlier in the day after an evening dose of medication, spread of symptoms to the arms, paradoxical worsening of symptoms with dose increase, and shorter effect of each dose of medication... A second common adverse effect of long-term dopamine agonist use is impulse control disorder"

mayoclinicproceedings.org/a...

[C82021 in reply to ChrisColumbus]

Thanks for all this information.

[ChrisColumbus in reply to C82021]

Andy Berkowski in 2021:

"Dopaminergic medications had been the mainstay of first-line pharmacological treatment of RLS for many years, but they have significantly fallen out of favor in the past decade due to high rates of augmentation and, secondarily, impulse-control disorders. Clinical consensus guidelines no longer consider these agents to be first-line treatments"

rlsfoundation.blogspot.com/...

[ChrisColumbus in reply to C82021]

A new clinical practice guideline to update the 2012 American Academy of Sleep Medicine (AASM) Practice Parameter is currently in draft, saying:

"augmentation of RLS symptoms with use of dopamine agonists is a major issue that led to a downgrading of dopamine agonists in this CPG. This updated recommendation represents a substantial change in first-line treatment for RLS, as dopamine agonists constitute the majority of the FDA-approved medications for RLS. Since dopamine agonists remain commonly prescribed treatments for RLS, management of augmentation is an important challenge facing clinicians who treat RLS. Trials are needed to assess an algorithmic approach to the use of alpha-2-delta ligands, opioids, and iron (all recommended treatments in this CPG), combined with dopamine agonist taper and discontinuation."