Objective: To describe the outcome of a patient with restless legs syndrome (RLS) and augmentation phenomena that was treated with Duodopa in continuous infusion.

Background: Restless legs syndrome (RLS) treatment in people with chronic obstructive pulmonary disease (COPD) is a challenge due to the contraindication of many medications, especially if augmentation phenomena is present.

Methods: Case report of a 70 years-old male patient with severe RLS and augmentation phenomena. Symptoms of RLS started 3 years before, with a good initial response to dopaminergic medication. Augmentation started a year after dopaminergic exposure with the RLS present all the day and worsening at nights. The patient has COPD GOLD-IV with domiciliary oxygen therapy. There was a contraindication for benzodiazepines, opioids, and Alpha-2-delta ligands (gabapentin, pregabalin) because these treatments provoked respiratory decompensations that required 9 hospitalizations in less than a year. The RLS difficult the patient to accomplish nocturnal CPAP treatment leading to hypercapnic respiratory failure. Finally, we proposed to the patient the treatment with 24-hour Duodopa infusion to avoid the pulsatile effect of dopaminergic formulations that provoked the augmentation. To evaluate the efficacy of this treatment we measured the intensity of symptoms with the Restless Legs Syndrome Rating Scale (RLSRS), the quality of life with the Restless Legs Syndrome Quality of Life Questionnaire (RLS-QOL), and the clinical impact with the clinical global impression (CGI) before the initiation of the infusion and three months and a year after the intervention.

Results: Patient was on treatment with levodopa/carbidopa 150 mg five times per day and levodopa/carbidopa retard 200 mg at night before the intervention. The punctuations in RLSRS was 36 -very severe- and in the RLS-QOL was 22. We initiated the treatment with Duodopa infusion 24 hours with a dose of 1.8 ml/hr. and 9 ml of nocturnal dose. Three months after the intervention RLSRS was 9 -mild- and RLS-QOL 74. A year after intervention RLSRS was 4-mild- and RLS-QOL was 100. The CGI-Improvement was very much improved. Only 1 hospitalization has been required and no side effects or complications of the dispositive have been reported along this year.

Conclusions: Duodopa can be a good option for refractory RLS with augmentation phenomena in patients that other therapies are ineffective or contraindicated.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/duodopa-for-the-treatment-of-severe-restless-legs-syndrome/