April 1, 2026

RLS Foundation Certifies Chase Family Movement Disorders Center as a QCC

As an RLS Quality Care Center, the Chase Family Movement Disorders Center is certified to provide expert care to patients with restless legs syndrome, a chronic neurological sleep disorder.

AUSTIN, TEXAS, April 1, 2026 – The Restless Legs Syndrome (RLS) Foundation announces it has certified Hartford Healthcare’s Chase Family Movement Disorders Center as an RLS Quality Care Center.

An estimated 2%-3% of adults need daily clinical treatment for RLS, a chronic neurological disease that disrupts sleep and can have a devastating impact on overall quality of life. As an RLS Quality Care Center, the Chase Family Movement Disorders Center will serve as a destination for RLS patients who need expert medical care.

“We are pleased to be recognized with this designation,” says Duarte Machado, MD, director of the Quality Care Center at the Chase Family Movement Disorders Center. “We are honored to be recognized as an RLS Quality Care Center and proud to help elevate national awareness of the significant needs within this patient community. By integrating our strengths and expertise in movement disorders and sleep medicine, we are uniquely equipped to deliver innovative, patient-driven care for all. Through our collaboration with the RLS Foundation, we aim to continue to advance clinical excellence, broaden access to our specialized care, and foster greater understanding of patient care needs through our affiliation with the Connecticut RLS Support Group,” says Dr. Machado.

The Chase Family Movement Disorders Center joins a network of 16 other institutions in the US and Europe that are certified by the RLS Foundation as Quality Care Centers. Through this program, the Foundation aims to improve the diagnosis and treatment of the disease worldwide.

RLS Quality Care Centers:

• Provide expert care to RLS patients
• Serve as information and referral resources for healthcare providers who treat patients with RLS and regional support groups
• Support patients and families through educational offerings and literature
• Share information with other centers to improve clinical best practices
• Partner with the RLS Foundation on quality improvement projects to raise the standard of care for RLS patients everywhere

“We are delighted to welcome the Chase Family Movement Disorders Center to the RLS Foundation Quality Care Center network,” says RLS Foundation Executive Director Karla Dzienkowski. “Individuals with RLS face significant challenges in finding healthcare providers who are informed in the management of moderate to severe forms of RLS. The Chase Family Movement Disorders Center provides access to knowledgeable and skilled healthcare providers who can provide personalized treatment plans to improve quality of life for those living with RLS.”

Dzienkowski adds, “The goal of the Quality Care Center network is to provide RLS patients access to healthcare providers proficient in RLS management. We look forward to our partnership with the Chase Family Movement Disorders Center to provide treatment access, management and quality of life improvement for RLS patients.”

The contact information for USC is listed on the RLS Foundation website. Other certified RLS Quality Care Centers are:

• Johns Hopkins Center for Restless Legs Syndrome
• Mayo Clinic Center for Sleep Medicine
• Houston Methodist Neurological Institute
• Stanford Sleep Medicine Center
• Emory Sleep Center
• Yale Center for Restless Legs Syndrome
• Vanderbilt University Medical Center
• Scripps Clinic Viterbi Family Sleep Center
• Neurocenter of Southern Switzerland
• Innsbruck Medical University
• Massachusetts General
• University of Pittsburgh
• University of Virginia at Charlottesville
• Barrow Neurological Institute
• Thomas Jefferson University Hospital

To learn more about the RLS Quality Care Center Program, visit www.rls.org/quality-care-centers.

About the RLS Foundation

The Restless Legs Syndrome Foundation is dedicated to improving the lives of all who live with restless legs syndrome (RLS). Founded in 1992, the Foundation’s goals are to increase awareness, improve treatments and advance research to find a cure. The Foundation serves healthcare providers, researchers, over 6,000 members, and an estimated 12 million individuals in the United States who have the disease. The Foundation’s Research Grant Program has awarded over $2 million in funding for medical research on RLS causes and treatments. For more information, visit www.rls.org.

CONTACT
Adrianna Colucci
Communications and Marketing Coordinator
adrianna@rls.org
512-366-9109

April 11, 2024

When Should I Visit an RLS Quality Care Center?

This article is based on the QA from the webinar titled “When to Visit an RLS Quality Care Center,” presented by Avinash Aggarwal, MD. Dr. Aggarwal is the Quality Care Center Director at the University of Pittsburgh Medical Center in Pittsburgh, PA. The complete webinar recording can be found in the Member Portal on www.rls.org.

1. What is the desired outcome of a visit to a Quality Care Center? Reduced symptoms? Lifestyle changes? Dietary changes? Exercise?

When visiting a QCC, all of these issues are addressed. A thorough medical history of past and present medications, including supplements and over-the-counter medications, will identify potential RLS triggers. Physicians and patients work together to determine the desired outcome of their visit.

2. How do you ensure you will get assigned to the expert who can treat your severity of RLS?

Only the providers listed on the RLS Foundation website at www.rls.org/treatment/quality-care-centers are certified RLS experts. Patients should thoroughly research each physician on the Foundation website and ask for an appointment with the provider that is close in proximity and is a fit for all healthcare needs.

3. Which medical records do you bring to your first appointment?

Bring all medical records available and send them ahead of time, if possible. Medical records include physician notes, a list of previous medications and their side effects, current medications, and test results, specifically results from a complete iron panel.

4. What does a QCC offer me if I have a local doctor and have already tried all known classes of medications?

QCC providers think outside of the box, considering the patient’s complete history and a comprehensive neurological examination. All patients are administered the International Restless Legs Syndrome Study Group Rating Scale (IRLSSG) on both their initial and subsequent visits. With adequate treatment, the severity rating can decrease from high to extremely low, sometimes zero. As experts in the RLS field, QCC certified providers can identify triggers and treat patients based on the latest guidelines.

5. What should I expect from the first visit, and can follow-up visits be done remotely?

The first visit is typically about an hour long. A QCC provider performs a thorough history and examination, reviews the current treatment plan, and discusses available therapies. The International Restless Legs Syndrome Study Group Rating Scale (IRLSSG) is also administered on the first visit to gauge RLS symptoms. A tailored treatment plan is developed for the patient utilizing a shared decision-making process. Follow-up visits can be done remotely.

6. How can we find the QCC closest to where we live? Is there a list of locations?

There are 10 QCCs in the United States and two in Europe. A list of all centers as well as contact and appointment information is available on RLS Foundation website. If you need assistance, contact the RLS Foundation at info@rls.org.

7. How long is the wait time for an appointment?

Every center is different and wait times are variable. At the QCC in Pittsburgh, there is a cancellation list that reduces waiting time.

8. What training and expertise do the QCCs have that sets them apart?

QCC physicians are board-certified in sleep medicine and many are neurologists. All QCC providers abide by the latest RLS treatment guidelines and provide comprehensive care. QCC physicians undergo a rigorous process to be credentialed.

8. If I have visited a QCC in the past, are there any reasons I should visit one again?

If symptoms are not controlled, if there are significant side effects, or if a patient is not satisfied with disease control, another visit to a QCC may be considered.

10. Are Canadians able to visit the QCCs?

QCCs welcome patients from around the world. Patients should speak to their insurance company to determine if there is coverage or if there will be out-of-pocket expenses.

11. Can out-of-state quality care centers continue with opioid therapy?

Opioid therapy coverage depends on individual state and insurance company regulations.

12. Is there a QCC available for consultations and treatment for out-of-state patients who are not able to travel?

Since COVID, some out-of-state appointments are available. Coverage will depend on the insurer and out-of-pocket expenses may apply.

April 24, 2023

Help! I Think I Have Augmentation and Don’t Know What to Do!

Each day at the RLS Foundation we receive calls from individuals seeking support, information and help with augmentation, a distressing challenge to their RLS treatment.

The good news is that, thanks to ongoing research, augmentation is manageable and treatment options are available. This article provides an overview of augmentation that will help you to understand this unfortunate side effect of treatment and the available strategies to manage it.

What is Augmentation?

Augmentation is a worsening of RLS symptoms that occurs after starting a medication that increases dopamine levels in the brain. These dopaminergic medications include levodopa/carbidopa, ropinirole, pramipexole and the rotigotine patch. At first, medications in this category are very effective, but over time, in a period from six months to several years, RLS symptoms worsen from what they were prior to initiating therapy. The rate of augmentation in people taking dopamine drugs for RLS is 5%- 10% per year; in eight years nearly half of individuals taking dopaminergic medication will experience augmentation.

If an individual with RLS notices symptoms progressively worsening after starting treatment with a dopaminergic drug, then augmentation may be occurring. Simply put, the treatment initially prescribed to alleviate symptoms is worsening the disease.

What are the Symptoms of Augmentation?

Augmentation is an insidious process, and symptoms often go unnoticed. The first indication of an underlying problem is when a patient feels the need to request an increase in medication dose.

All individuals with RLS should recognize the symptoms of augmentation, which include:

• Earlier onset of symptoms, beginning in the afternoon and evening, rather than at bedtime
• Increase in the intensity of symptoms compared to their level prior to starting treatment
• Spread of symptoms to other body parts (trunk, arms or face), rather than being limited solely to the legs
• Shorter period of rest or inactivity before symptoms begin, and treatment medication is not working as long as it did previously
• Loss of effectiveness of the medication at the dose that previously managed symptoms
• Paradoxical response to the medication; in other words, the prescribed medication triggers symptoms rather than alleviating them

Three factors predispose an individual with RLS to developing augmentation:

• Daily administration of carbidopa/levodopa to treat RLS
• Exceeding the maximum dosages approved by the Food and Drug Administration (FDA) for dopaminergic drugs used to treat RLS
• Low body iron stores as measured by a laboratory test of serum ferritin

When someone is experiencing augmentation, aggressive iron supplementation is extremely important. Intravenous formulations effective in raising blood iron storage levels in RLS patients include: Ferumoxytol (Feraheme); low molecular iron dextran (INFeD); ferric derisomaltose (Monoferric) and ferric carboxymaltose (Injectafer). Ferrous sulfate 365 mg pills taken once daily can be used for ferritin levels higher than 75–100 mcg/L or transferrin saturation less than 20%. However, RLS patients with deteriorating symptoms need rapid iron repletion, and oral iron takes months to improve iron status.

If you, as a patient, suspect augmentation, the first course of action is to make an appointment with your healthcare provider; do not stop taking the medications, as prescribed, to manage your RLS.

How is Augmentation Diagnosed?

Before a diagnosis of augmentation can be made, the first step is to schedule an appointment with your RLS healthcare provider for a thorough medical examination to rule out any underlying medical conditions that can exacerbate RLS symptoms. Two additional aspects of RLS that are often confused with augmentation are night-to-night variability of symptoms and exacerbation of symptoms for several days; neither is indicative of augmentation.

Factors that can worsen RLS include the use of sedating antihistamines; all antidepressants except for bupropion or trazadone; low body iron stores or unexpected blood loss due to surgery or undiagnosed gastrointestinal bleeding (ulcers, polyps); commonly reported triggers of symptoms such as caffeine, alcohol, sugar, salt or nicotine; a secondary undiagnosed sleep disorder such as sleep apnea; or rebound (the prescribed medication is not lasting as long as it did previously and disrupts sleep at the end of the sleep cycle in the early morning hours). Two additional factors that can cause an increase in RLS symptoms are stress and changes in activity level, such as immobility due to surgery or changes in exercise, activity or routines.

Augmentation Diagnosis: What’s Next?

RLS is a chronic progressive disease, and it is often difficult to distinguish between disease progression (natural worsening of the disease) and augmentation. Healthcare providers need to be aware of the key indicators of augmentation, which include:

• The patient requests a dose increase of a dopaminergic medication.
• The prescribed dose currently exceeds FDA maximums for the dopaminergic medication.
• The patient reports breakthrough RLS symptoms with an accompanying increase in symptom intensity.
• The RLS involves other body parts (trunk, arms, face).
• Symptoms occur 24/7.
• Symptoms previously appearing only in the evening or nighttime now present earlier in the day, and the patient requests additional medication doses earlier in the day.

There is no test for the diagnosis of RLS augmentation. A thorough medical examination by your healthcare provider who reviews current medications (over-the-counter medications, supplements, prescriptions) to look for drugs that can worsen RLS symptoms, along with a comprehensive history of symptom progression, will help to determine if augmentation is present.

How is Augmentation Managed?

There are four treatment strategies to manage RLS augmentation. Working with your doctor you can determine the approach that best works for you.

The first approach involves changing the dosing schedule to “split-dose” the dopaminergic medication. Half the dose of the medication is given earlier in the day, and the second half is given at the regularly scheduled time; the total dose is not to exceed FDA maximums. If this approach does not resolve symptoms, a second medication from another medication class is added to the treatment regimen. Alpha-2-delta ligand drugs such as gabapentin, gabapentin enacarbil, and pregabalin are added to the treatment plan while reducing the dose of the dopaminergic agent. This approach may be effective, but the alpha-2-delta ligands may not be sufficient to control RLS symptoms in the absence of the dopaminergic agents.

A second treatment option to manage augmentation is to switch from a short-acting dopamine agonist to a long-acting one, but this approach is not recommended by RLS experts. The FDA approved the Neupro (rotigotine) patch for the treatment of RLS, and the oral medications pramipexole ER and ropinirole XL are also available. There are no studies to determine if the change to a long-acting dopamine agonist will reduce or mask RLS symptoms. RLS experts have found that tapering off long- acting dopamine agonists with preexisting augmentation is considerably more difficult. Although symptoms improve in the short term, the underlying augmentation remains, and in time symptoms will return.

The third approach involves adding an opioid medication such as buprenorphine, suboxone, methadone or oxycodone to the dopamine agonist, then tapering down the dopamine agonist. Once the transition from dopamine agonist to opioids has occurred, the dose of the opioid is reduced. If symptoms persist, an alpha-2-delta ligand can be added to the treatment protocol, or it can be used to decrease the dose of opioid used.

The final approach to address augmentation is to slowly decrease the dose of the dopamine medication, without any other RLS treatment, followed by 12 drug-free nights before reassessing the need for further treatment. The RLS Foundation handout Drug Holidays and RLS provides a thorough outline of this approach to the treatment of augmentation.

For patients with severe augmentation who have taken high dopamine medication doses, it may be difficult to completely eliminate these drugs, due to the worsening of RLS upon withdrawal. A small dose of a dopamine drug in combination with an alpha-2-delta ligand and/or opioid may be necessary to manage symptoms. However, it is important to note that, once a dopamine drug is successfully discontinued, reintroducing any drug in the dopamine class will lead to a rapid reappearance of augmentation. In other words, all drugs in the dopamine class are no longer a treatment option.

How Do I Find a Provider to Manage RLS Augmentation?

A provider who is knowledgeable and experienced in treating RLS can be found at an RLS Foundation Quality Care Center. The doctors who practice at these centers are certified RLS providers who treat patients with augmentation and are familiar with the available treatment options. There are 10 RLS Foundation Quality Care Centers in the United States and two in Europe; travel to receive expert care is an option available to individuals with RLS, though not all patients can afford to do so. For a list of RLS Foundation Quality Care Centers, visit www.rls.org/QCC or contact the Foundation.

A second option is to work with the healthcare provider managing your RLS treatment. You will want to determine that they have experience in managing augmentation and are willing to work with you through the entire process. Finding a treatment plan to manage your RLS augmentation is not a one- size-fits-all approach, so finding a provider who is willing to work with you is essential.

The RLS Foundation maintains a list of providers who have expressed an interest in treating RLS, and this may be an option for you. To view this list, visit www.rls.org/Find-a-doc or contact the Foundation. However, these healthcare providers are not certified RLS experts like those practicing at an RLS Quality Care Center.

I Think I Have Augmentation. What Can I Do to Help Myself?

You can do several things before an appointment with your healthcare provider that will give them insight into the state of your RLS. Below is a helpful checklist of items to prepare you for your appointment:

1. Resist the urge to make any changes to your current treatment plan. Your healthcare provider needs to get a clear picture of your RLS symptoms under your current treatment plan; any changes could make this more difficult.
2. Schedule an appointment with your healthcare provider as soon as possible. Because scheduling delays are common, ask whether your name can be added to a cancellation list when you book your appointment. That way, if there is a cancellation, you may be called to fill the slot in the schedule.
3. Make a list of all medications that you currently take (prescriptions, over-the-counter medications, supplements).
4. Make a chronological list of all medications that you have taken in the past for RLS and note why you stopped taking them.
5. Gather copies of all laboratory test results for iron, and any other recent laboratory test results for your provider to review.
6. Complete an RLS Sleep Diary, included in this issue of NightWalkers. The Sleep Diary will provide your healthcare provider with an overview of your sleep patterns and RLS symptoms.
7. Make and bring copies of the following open-access articles from Mayo Clinic Proceedings: “The Management of Restless Legs Syndrome: An Updated Algorithm” (2021) and “The Appropriate Use of Opioids in the Treatment of Refractory Restless Legs Syndrome” (2018). For copies of these articles, visit www.mayoclinicproceedings.org or contact the Foundation.

For more information about augmentation and RLS, visit the RLS Foundation’s Member Portal on www.rls.org to find educational resource materials. We invite you to attend the Foundation’s monthly webinar series presented by RLS experts and to watch past webinars online to become more knowledgeable about RLS. The Foundation also sponsors four monthly online Virtual Support Group Meetings, so you can connect with others in the RLS community for support, tips and helpful information.

Finding Hope

I’ve tried to describe emotional aspects of having severe or refractory RLS. The word “refractory” in medicine means “not treatable” or “resistant to treatment.” Those of us in this RLS category have horrible symptoms at any time of day OR night. The symptoms and pain will disturb any facet of daily living. RLS does not discriminate. I’ve had feelings of not “fitting in” in social settings, especially knowing that I could have an uncontrollable bout of restlessness. Or worse yet, my sheer terror of having an episode of RLS just when I have to be calm and quiet -- I’ve lied to get out of such situations. I feel very angry at being powerless over such an invasive illness. RLS is a monster that is all-consuming. I came to realize that I had lost the power of choice physically, and was close to losing the one most valuable of feelings: hope. Realizing that hope is a huge part of living happily, I aggressively sought help.

In one year, three neurologists and four more attempts at medication adjustments resulted in three visits to emergency rooms and two calls to “crises on-call” telephone services, as I was having horrible medication reactions. I was exhausting all avenues for relief from RLS insanity. There are several RLS Quality Care Centers and it seemed to make sense to contact one and hope for admission. There was one neurologist I wanted to contact as I had seen him years ago regarding a medication. Why see him now? I didn’t know, but it was significant. No, it was life-changing. My physician, it turns out, is very familiar with RLS and has treated refractory cases successfully. His knowledge and treatment skills are based on sound, demonstrated and practical RLS treatment protocols. And, he is a really great guy. Within two days after my first visit, I started my journey into wellness. That was three months ago.

Resignation is understandable. But, now I know that relief is possible. Basic things have changed in my life. It was just a month ago that I bought a book; A simple mystery novel written by an author that I loved to read when I could sit quietly, empty my mind, and enjoy fiction as fact without disturbances from my RLS. What a joy it was to go to a bookstore and actually feel like I had a purpose, a reason in being there! That was groundbreaking.

My RLS was an imposition on my wife. She would see me walk for hours during the night doing my “circle 8” in the kitchen, living room and dining room. And she felt it. She felt the pain of not going to movies or plays or concerts. Felt the pain of being uncertain about gatherings because “my legs hurt.” And she felt the pain of hopelessness, because that is what she saw at every failed attempt for a remedy. Two weeks ago we went to a movie that I would not have chosen because of content and appeal. I was able to sit through the movie, and was able to ask questions about it later sitting in our living room. Sitting. Quietly.

And now, there is the beauty of sleeping when I want to rather than reach the point of deathly exhaustion. I still have troublesome and unfortunate sleep behaviors learned over 25 years of illness that may not be corrected. I have already found the wonder of regular sleep versus desperation naps. A different world. So now, I’m positive I will be able to come close to experiencing a far better sense of being normal. It’s already started, and my accounts of health and really good rest are noticed by friends and family. I’m told that I look and sound different. Now, I again have hope. I have great hope that the rest of my life will be truly peaceful. I hope that at least one reader will try “just one more” physician or go to a recognized RLS Quality Care Center. There is a solution under some rock – don’t stop turning them over.

Awareness and Education

The RLS Foundation Surpasses Goals for the Year

Nearly 25 years ago, the Foundation began as a tiny group of dedicated individuals meeting around a kitchen table in Raleigh, North Carolina. We grew to become a bustling organization located in Austin, Texas, with an expansive network of nearly 5,000 dedicated members.

Since its inception, the Foundation has provided over $1.6 million in support of RLS research, and we are still the leading organization for science-based education and patient services for those suffering from RLS.

Just consider what we have accomplished over the past 12 months alone:

1. Certified five additional RLS Quality Care Centers

2. Reinvigorated our research grant program by committing to award up to eight new pilot grants totaling $200,000

3. Developed a teen guide and children’s booklet to help our youth manage the challenges of RLS

4. Created a multidisciplinary Scientific and Medical Advisory Board

5. Launched research into the economic impact of RLS and its treatment

6. Rolled out a far-reaching Year of Augmentation awareness and education program – distributing and promoting an augmentation white paper research summary to nearly 50,000 healthcare providers

The Foundation also created a support group leader "RLS and Augmentation" tool kit, and released our RLS and Augmentation video, which has already been watched by thousands.



The Foundation has also been active in educating the medical community this year by attending SLEEP, a joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society, in Denver, Colorado. We were also present in November at the annual conference for the Society of Neuroscience in San Diego. Both events attract thousands of researchers and healthcare providers that are eager to learn more about RLS and other sleep disorders.


We are so proud of all we have accomplished this year on behalf of the RLS community, but we could not have done any of it without the generous donations given by both members and nonmembers alike. Together, we have hit incredible milestones - big achievements executed by a small staff and a network of dedicated volunteers.

To everyone who has helped us get to where we are, we thank you!

• Recognition of Quality Care Centers as leaders in the field and as specialty clinics for patients who are traveling or in search of knowledgeable healthcare providers
•  Availability of Quality Care Center staff as resources for referring primary care providers
•  Patient educational offerings, print materials and connection with RLS Foundation local support groups

Yale Centers for Restless Legs Syndrome and Houston Methodist Neurological Institute

•        Recognition of Quality Care Centers as leaders in the field and as specialty clinics for patients who are traveling or in search of knowledgeable healthcare providers
•       Availability of Quality Care Center staff as information resources for referring primary care providers
•        Patient educational offerings, print materials and connections with RLS Foundation local support groups