August 3, 2026

@michaelokun

One of the most practical discussions at the 36th Annual Aspen Movement Course centered on a terrific new JAMA review of restless legs syndrome (RLS). What really resonated with our faculty was the simplicity of the diagnostic and treatment flow charts, which translate a complex disorder into a stepwise approach clinicians can use immediately. The review reinforces starting with the essential diagnostic criteria while carefully considering common mimics, risk factors, and associated conditions, then emphasizes checking serum ferritin and transferrin saturation early because iron deficiency remains one of the most treatable contributors to RLS. We especially liked the updated treatment algorithm: replenish iron first when stores are low, transition to gabapentinoids (gabapentin, gabapentin enacarbil, or pregabalin) as preferred first-line therapy for patients with bothersome, frequent symptoms, reserve as-needed levodopa or dopamine agonists for those with only infrequent symptoms, and thoughtfully escalate to combination strategies, low-dose opioids, peroneal nerve stimulation, or carefully monitored dopamine agonists for refractory disease. If you use an agonist be ready for augmentation. This paper provides an outstanding example of how a well-designed clinical flow chart can help clinicians deliver evidence-based, individualized care while minimizing complications such as augmentation.