Restless legs syndrome治療アルゴリズム

抄録

RLS treatment guidelines were first published in 2012 following the approval of dopaminergic drugs. These guidelines were subsequently revised in 2024 to incorporate new treatment options. The main feature of the RLS treatment algorithm (2024) is that a systematic review and meta–analysis were conducted using the MINDs method. While adhering to the basic concept of treatment strategy aimed at achieving goals. A new algorithm was developed, taking into account the background of RLS treatment drugs and treatment augmentation in Japan. In RLS, treatment is started after diagnosis, neurological examination, evaluation of the pathology, including iron metabolism, presence or absence of coexisting conditions, etc., is conducted before initiating treatment, and are essential in the treatment of RLS. For intermittent or mild cases, non–pharmacological therapy or on–demand treatment is performed. If there is no iron deficiency, and the disease is moderate to severe, the aim is to improve neurological function and symptoms by correcting the imbalance between dopaminergic nerves, glutamatergic nerves, and adenosine nerves, and α2δ ligands or dopamine receptor agonists are considered as the first–line therapy. If augmentation occurs, reduce the dose of dopamine agonists and divide the treatment into smaller doses, switch to a long–acting dopamine receptor agonist, discontinue dopamine receptor agonists or use them in combination with secondary therapy, and recheck %TSAT, ferritin, and aggravating factors. In cases of resistance, low–dose opioids may be used. Further research is needed to strengthen the evidence base for RLS treatment. It is expected that this algorithm will be used as a starting point for further revisions by future generations of researchers based on new evidence.