S03: Treatment options and mechanisms in pediatric RLS
Saturday, April 28 | 9:40am-11:10am | Room 342B
Chair: Rosalia Silvestri (Italy)
Dopaminergic drugs: Efficacy, limitations and concerns
Arthur Walters (USA)
The role of iron supplementation in pediatric RLS
Rosalia Silvestri (Italy)
Looking to non-dopaminergic treatment for pediatric RLS
Diego Garcia-Borreguero (Spain)
Challenges in treating RLS within comorbid developmental disorders
Osman Ipsiroglu (Canada)
Summary of symposium:
In most countries throughout the world recommended drugs for the treatment of RLS are off-label in children and sleep specialists’ experience with pediatric therapy is often scanty and anecdotal. The possibility of undesired long- term effects on brain development and difficulties to handle possible side effects limits de facto conventional drug approaches in this age range. The nutriceutical and behavioral approach to pediatric RLS offering iron and vitamin supplementation, with ad hoc diet and exercise programs within a correct sleep hygiene, is instead less controversial and more conventionally accepted.
Dopaminergic mechanisms responsible for RLS will be discussed and explored to see whether they may support the indication to early dopaminergic treatment in children. The pro and cons of early dopaminergic treatment in view of the available literature reports on clinical trials will be critically addressed.
The role of iron depletion among the causing mechanisms of early RLS will be discussed. The major clinical trials with oral or IV iron supplementation in children will be critically reviewed according to the new international guidelines for iron supplementation therapy in RLS.
The role of additional drugs, especially the alpha-2 delta drugs such as gabapentin, vitamin D and other therapeutic approaches will be discussed in view of the existing clinical trials and several anecdotal experiences. Specific indications linked to comorbidities or insufficient dietary intake will be critically addressed.
Finally, the challenge of diagnosing and treating children with neurodevelopmental disorders that require per se other therapeutic planning will be presented. Relevant topics will include how and when to consider additional therapy for RLS in the context of a well-known therapeutically addressed comorbidity and how and when to discard previously recommended drugs that may prove deleterious by aggravating RLS within the context of neurodevolpmental disorders.
Upon Completion of this CME activity, participants should be able to:
• Be aware of the current limitations for RLS treatment in pediatrics
• Better understand biological brain mechanisms responsible for the syndrome
• Implement the best possible therapy according to specific dietary indications, vitamin and iron status, and children daytime schedule of activity
• Be aware of specific recommendations for children who have RLS comorbid neurodevelopmental disorders
Sleep experts, pediatricians, pediatric neurologists, nutritionists, basic scientists, pharmacologists, pediatric psychologists