Dopamine Agonists and the Worsening of RLS Symptoms

Augmentation, as many with restless legs syndrome know, is one of the most common and least understood problems with current RLS treatment. This phenomenon occurs after a patient starts a dopaminergic medication to treat their RLS - and over time it can make symptoms much worse.

Unfortunately, many who initially start on dopaminergic medications say that it is extremely effective in alleviating symptoms, at first. It may take years for augmentation to kick in, or just mere months. Warning signs of augmentation include an increase in symptom intensity, a shorter period of rest or inactivity before symptoms begin, an appearance of symptoms earlier in the day, or a return to what symptoms were like prior to starting treatment (worsening of symptoms). Many also report experiencing RLS symptoms that spread to their arms, trunk or even the face.

"Augmentation is a condition where RLS symptoms start to worsen after initially improving, while on dopamine agonist treatments such as pramipexole, ropinirole, rotigotine, and levodopa," said Dr. William Ondo, director of the Houston Methodist Neurological Institute RLS Quality Care Center. "Since most patients with an urge to move initially respond to properly dosed dopaminergic medicines, augmentation is arguably the biggest practical impediment to successful chronic management of RLS."

In 2015, to combat this gap in information and awareness, the RLS Foundation rolled out a far-reaching "Year of Augmentation" awareness and education program. This included distributing and promoting an augmentation consensus white paper, a collaboration between the International Restless Legs Study Group, the European Restless Legs Study Group and the RLS Foundation. The white paper was distributed by the RLS Foundation to nearly 50,000 US healthcare providers. Foundation volunteer support group leaders were provided with informational "augmentation toolkits" for their meetings. The RLS Foundation also released its first ever long-form video, RLS and Augmentation , which has been viewed by over 10,000 people.

If you think you may be experiencing augmentation, there is help. The Foundation's free What is Augmentation? handout discusses several approaches used to manage augmentation. Prior to making any changes in your treatment plan, it is important consult your healthcare provider to determine if you have augmentation and the treatment approach best suited for you. If you think that your doctor may lack an understanding of RLS, you can find an RLS Quality Care Center or RLS healthcare provider near you. You can also view and share the "Prevention and Treatment of Augmentation" webinar, presented by Dr. Mark Buchfuhrer of Stanford Sleep Medicine Center (an RLS Quality Care Center), from the Foundation's 2017 Webinar Series, available for free on our YouTube channel.

In the days since augmentation first surfaced, significant strides have been made. In 2016, Dr. William Ondo was awarded a $37,000 grant from the RLS Foundation's Research Grant Program to study a new treatment modality for RLS patients who are augmenting. His research team is currently recruiting subjects in Houston, Texas, to study the effectiveness of a new therapy specifically to RLS patients who are currently suffering from augmentation while still taking dopamine agonist medications. Learn more about how to participate here.

If you need additional information on augmentation, please call the RLS Foundation at 512-366-9109 or email info@rls.org and we will be happy to assist you. You are not alone!