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• • significant reduction of periodic limb movements during sleep and wakefulness
  • relief from sensory symptoms and leg discomfort
  • reduction of motor symptoms
  • may be effective for patients who failed to respond to other dopaminergic medications.

• Ropinirole (Requip) - In May 2005, the U.S. Food and Drug Administration (FDA) approved ropinirole (Requip) for the treatment of moderate to severe restless legs syndrome and it is now recommended by the AASM. There was a 55% improvement of symptom severity and sleep disturbance noted on a restless legs syndrome questionnaire filled out by a group of patients taking ropinirole after 4 months of use. This drug was first approved for the treatment of Parkinson's disease in 1997.

• Bromocriptine (Parlodel) - This medication is often effective for patients with restless legs syndrome who have not responded to therapy with levodopa/carbidopa.

• Rotigotine (Neupro) - A novel transdermal delivery system (Neupro patch) has recently emerged for the treatment of patients with restless legs syndrome with a dopamine receptor agonist drug called rotigotine . The patch is applied once a day to the skin and continuously releases the drug through the skin for a period of 24-hours.

In March 2008, the manufacturer of Neupro (Schwarz Pharma) informed healthcare professionals and patients of the recall of Neupro because of the formation of rotigotine crystals in the patches. When the rotigotine crystalizes, less drug is available to be absorbed through the skin and, therefore, the efficacy of the product may vary. Neupro will not be available in the U.S. by the end of April 2008. Healthcare professionals should not initiate any new patients on Neupro and should begin to gradually down-titrate all patients currently using the product per the guidelines in the product labeling. Patients should not abruptly discontinue therapy because abrupt withdrawal of dopamine agonists has been associated with a syndrome resembling neuroleptic malignant syndrome or akinetic crises.

Benzodiazepines

Benzodiazepines do not act directly upon restless leg syndrome but may be used to alleviate related symptoms. They reduce communication between nerve cells by interfering with chemical activity and are used for:

• Relaxing muscles
• Relieving anxiety
• Reducing restlessness
• Promoting sleep

This class of drugs is usually used for the treatment of restless legs syndrome symptoms that are mild or intermittent and occur primarily during sleep. Benzodiazepines are also used as adjunctive therapy in patients with restless legs syndrome who are being treated with other medications but who are still experiencing sleep disturbances even while on medication. For patients with severe symptoms, benzodiazepines are effective when used together with Sinemet or dopamine agonists.

Benzodiazepines are effective on a long term basis and have a low incidence of side effects or buildup of tolerance over time. Benzodiazepines may be used to help with insomnia but must be used with caution especially in older people. They are not particularly effective for paresthesia related to restless legs syndrome or for PLMS. Side-effects of benzodiazepines may include:

• Drowsiness especially in the morning
• Dizziness, unsteadiness and elevated risk of falling
• Reduced libido (sexual desire)