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Restless legs syndrome — SCE Neurology MCQ

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HardMovement DisordersRestless legs syndromeSCE Neurology

A patient taking pramipexole nightly for restless legs syndrome develops symptoms progressively earlier in the day, spread to the arms and shorter relief after each dose increase. Ferritin is 120 micrograms/L and transferrin saturation is normal. What is the best management strategy?

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Correct answer: B — Introduce a non-dopaminergic treatment and gradually taper pramipexole

Earlier onset, anatomical spread and diminishing duration of benefit after dose escalation define dopaminergic augmentation. Current guidance favours moving to a different mechanism, commonly an alpha-2-delta ligand when appropriate, while tapering the dopamine agonist gradually to limit severe rebound. Increasing or splitting the dose tends to perpetuate augmentation, levodopa can reproduce it, and abrupt withdrawal without cover can cause marked transient worsening.

Reference: AASM clinical practice guideline for restless legs syndrome (Published January 2025): https://pmc.ncbi.nlm.nih.gov/articles/PMC11701286/