#3-21E. Redefining RLS Management: The Shift to Gabapentinoids (JAMA, 2026)

Do you still prescribe dopamine agonists as the first-line treatment for Restless Legs Syndrome (RLS)? It is time to update that practice. This episode explores a 2026 comprehensive review in JAMA concerning RLS, a sleep-related movement disorder affecting approximately 3% of adults. The authors detail the pathophysiology involving iron deficiency and genetic predisposition, emphasizing that diagnosis is clinical—based on the "URGED" criteria—and requires screening for iron deficiency (ferritin ≤100 ng/mL). The most critical clinical takeaway is the decisive shift in pharmacotherapy: gabapentinoids (alpha-2-delta ligands) are now the recommended first-line agents, while dopamine agonists are no longer preferred for daily use due to the high risk of augmentation—an iatrogenic worsening of symptoms. While the paper provides a clear treatment algorithm, it is important to critically note that high-quality data regarding non-pharmacologic interventions remain limited. This review is essential for physicians to align with current standards, ensuring they treat the underlying iron deficiency and avoid long-term complications associated with older dopaminergic protocols.

Citation: Winkelman JW, Wipper B. Restless Legs Syndrome: A Review. JAMA. 2026. DOI: 10.1001/jama.2025.23247

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.