Restless legs syndrome: diagnostic assessment and the advantages and risks of dopaminergic treatment.

In the past few years, major advances have been made in the field of restless legs syndrome (RLS). New tools have been developed to assess the presence and severity of RLS and its complications. Furthermore new concepts of the phenotype are emerging.With a high likelihood a slight dopaminergic hypofunction contributes essentially to the pathophysiology of most phenotypes of RLS. Dopaminergic substitution either with L-DOPA or with dopamine agonists ameliorates symptoms in the large majority of patients. Too high of doses of either type of drug may be involved in the development of augmentation caused by treatment-induced alterations in dopaminergic neurotransmission. Dopaminergic agents are currently the agents of first choice to treat RLS, and large multicenter trials support the evidence of efficacy. Very careful tailoring of the dose is required to avoid the development of treatment complications, specifically augmentation.