The horrible nasty side of me would love to hire those russki elements responsible for certain novichok poisonings, to sprinkle a little bit of RLS virus( yeah, I know 😎) into certain medical establishment figures' teatime coffee.
Only then ,we might get a smidgen of sympathy and understanding.☠️😹
Agreed, but at least *some* signs of movement in Newcastle - and they mention pregabalin without saying they are reluctant to prescribe it because of quote "levels of abuse on Tyneside".
That's true. But the usual warning about opioids. Only to be prescribed if RLS presents as painful AND the usual opioid bias about addiction.When DAs are actually the most addictive of all.
I have some depressing news to add to this. Our Professor Walker is still recommending DAs. He did so with me recently, after sorta acknowledging they could be an issue with augmentation.
What's worse? Someone I know is an MS patient at the same trust he works at. This person's MS Neurologist decided to prescribe them DAs based on Prof Walker's recommendation. The result? They nearly had a heart attack, were hospitalized with extremely high blood pressure and heart rate from 1 dose.
This terrified and enraged me! How can they hand this stuff out like candy and it can kill you from a single dose?!
We have such a long way to go to get over this hurdle but we can't give up!
Oh my word. Horrifying.I knew Prof Walker was still prescribing Rotigitone- but I am stunned that he is still prescribing other DAs as first line treatment.
It should be part of ongoing neurological training that neurologists have to read all posts on this forum for a month.
The problem is that they don't see enough RLS patients each year so they don't see the serious side effects happening in real time.
And they NEVER help patients through the hellish withdrawal when augmentation inevitably happens.
Another bad thing is they said the maximum pramipexole is one and a half times what it really is.
And of course" increasing gabapentin/ pregabalin every few days until controls symptoms" is not the best way as it can lead to higher doses than needed.
True! And the first thing on the website is a warning about DAs & in the treatment section confirms RLS-UK follows the Mayo Algorithm and AASM guidance.The reduction schedule of 25% a week is very blasé.
Most people, unless incredibly fit, healthy & resilient could not get off 4mg of Ropinirole in 4 weeks!
Unless they were in a state of the art Rehab facility.
These neurologists need to watch/observe someone going through DA withdrawal!
Hi Joolsg, you wrote "BUT they still advise dopamine agonists as second line treatment ( after gabapentinoids) with a warning about augmentation and ICD". I thought DAs were second line treatment after alpha2-delta ligands? According to Mayo Clinic website.😊
Yes. But not in the new AASM guidance released in January 2025 where all dopamine agonists are now 'NOT RECOMMENDED'. They use examples of when DAs can be prescribed. Where short term benefits outweigh inevitable longer term complications.
So a one off prescription for a long flight. Or end of life where patient has a terminal illness. Or someone who is very old and unlikely to live long enough for augmentation to set in.
I was hoping the UK neurologists would read all available research and treatment protocols and warn against DAs in the same way that the AASM has.
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Daily Mail on RLS today
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New book on RLS 
Augmentation with DAs in RLS but what about Parkinson's - A question I've pondered...
