January 26, 2026

@michaelokun

Do you know all the updates on restless legs syndrome (RLS) 2026? Are we getting the diagnosis right and the treatment smarter. Spoiler alert: ‘Gabapentinoids’ now take center stage. What does RLS mean? RLS or restless legs syndrome is a movement disorder marked by an urge to move the legs that worsens at rest, improves w/ movement and is strongest in the evening or night. Winkelman and Wipper describe in a just dropped paper in JAMA what is new in understanding, diagnosing and treating RLS in 2026. Key points: - RLS affects about 3 percent of adults and frequently disrupts sleep mood and quality of life. - Abnormal brain iron handling, genetic risk and dopamine system changes appear central to RLS biology. - Gabapentinoids are now first line therapy, while dopamine agonists are no longer preferred due to augmentation risk. My take: RLS is frequently misdiagnosed or treated in ways that make symptoms worse over time. This review provides a clear practical reset. The message is simple, but powerful. Get the diagnosis right, check iron thoughtfully and treat in a way that protects folks long-term, rather than chasing short term relief. In our MDS Aspen course, the experts have been chirping for 3-5 years to shift away from dopamine agonists and to ‘gabapentinoids.’ The time has come! Here are 5 points that resonated w/ me: 1- RLS is a clinical diagnosis and sleep studies are not required for most folks. 2- Iron deficiency in the brain can exist even when blood iron looks normal. 3- Gabapentinoids help many folks and avoid the long term risks seen w/ dopamine agonist and dopaminergic drugs. 4- Augmentation is a real and a frequently underrecognized complication of dopamine agonists. 5- Thoughtful stepwise care by health care providers can markedly improve sleep and daily function for folks living w/ RLS. https://jamanetwork.com/journals/jama/fullarticle/2844112 #michaelokun #parkinson #rls #restlesslegs #fixelinstitute