Italian adaptation of international recommendations for the management of restless legs syndrome: A consensus statement by the scientific committee of RLS-Italia

BACKGROUND: Recent international recommendations have substantially changed the management of restless legs syndrome (RLS), emphasizing systematic iron assessment, earlier use of iron therapy and α2δ ligands, and greater caution with chronic dopaminergic treatment because of augmentation. Their implementation requires adaptation to national healthcare organization, regulatory indications, reimbursement, and access to specialist services. METHODS: The Scientific Committee of RLS-Italia conducted a structured, non-Delphi consensus process based on the 2025 American Academy of Sleep Medicine clinical practice guideline and systematic review, the 2026 RLS Foundation algorithm, the World Sleep Society partial endorsement, and selected supporting evidence. Successive drafts were circulated, discussed, and approved by all authors. RESULTS: The proposed Italian framework prioritizes clinical diagnosis, exclusion of mimics, correction of exacerbating factors, systematic assessment of iron status, and iron treatment when indicated. α2δ ligands are preferred for most adults with chronic persistent RLS, whereas dopamine agonists should be restricted to selected patients and monitored for augmentation. Refractory or augmented disease should be managed by clinicians with specific RLS expertise, with consideration of intravenous iron, opioids, or device-based treatment. Dipyridamole is not included in the standard pathway, and periodic limb movement disorder should not be diagnosed or treated solely on the basis of polysomnographic findings. CONCLUSIONS: This consensus statement provides a nationally coherent framework that can support regional implementation through locally appropriate organizational and clinical protocols.