DeCure for Restless legs syndrome

Restless legs syndrome is a chronic neurological disorder diagnosed by four clinical criteria from the International RLS Study Group, but misdiagnosis remains routine because its vague symptoms resemble other disorders. A 2018 literature review notes that primary care clinicians struggle to properly diagnose and manage RLS, leaving patients without proper management. A 2005 update on RLS in Switzerland confirms that even after dopaminergic drugs became official first-line treatment, correct diagnosis is still delayed in some patients, prolonging discomfort or painful symptoms for years. The 2005 paper emphasises the need to search systematically for treatable causes and to treat comorbidities such as depression or polyneuropathy separately.

Medication treatment began with opioids in the 17th century, followed by benzodiazepines as the first "modern" treatment. A 1999 review states that Sinemet (levodopa) and dopamine agonists are first-line treatments, with studies showing 90–100% initial efficacy. However, continued use of Sinemet can produce augmentation of symptoms. To combat augmentation, a dopamine agonist like Permax is typically introduced, which has a much lower incidence of augmentation but must be built up slowly. Two newer dopamine agonists, Mirapex and Requip, show therapeutic benefits but are not efficacious enough to replace the tested agonists. The 1999 review concludes that no single therapy can effectively treat RLS patients over the long term without fear of augmentation and undesirable side effects. The 2005 update adds that therapy resistance and severe side effects, particularly augmentation and fibrosis, can be minimised by understanding treatment details and optimal follow-up.

Non-pharmacological approaches are also used. A 2018 paper states that the basis of RLS treatment is combination therapy including medication and non-drug approaches. It systematises directive non-drug approaches with evidence-based effectiveness: body-mind approach, behavioural and cognitive-behavioural second- and third-wave psychotherapy, and rational-emotive-behavioural therapy. The American Academy of Neurology published evidence-based recommendations in 2016 for treating RLS in adults, summarised in a 2017 review, which states that treatment should be considered if symptoms lead to sleep disturbances or significantly affect daytime functions.

What is still missing is research on the genetic basis of RLS, on pathogenetic mechanisms in dopaminergic and other neurotransmitter systems, on iron metabolism in the brain and spinal cord, and on the socioeconomic burden of the disease, as noted in 2005. Neuroanatomical, neurophysiological, neuropharmacological, and neurogenetic findings still need to be merged to reveal the pathophysiology of RLS, according to a 2008 review. No trial has yet identified a single long-term therapy without augmentation or undesirable side effects, and patient stratification by treatable causes or comorbidities remains underdeveloped.