Restless legs syndrome (RLS) is an awake phenomenon characterised by an intense, irresistible urge to move the legs, sensory complaints, and motor restlessness. RLS is usually associated with periodic limb movements in sleep (PLMS). Clinical evidence suggests that dopaminergic agents are the treatment of first choice. Dopaminergic treatment is usually effective, but many patients develop augmentation.¹ Augmentation is the worsening of RLS symptoms attributable to a specific therapeutic intervention; its primary feature is a shift of RLS symptoms to an earlier time than was typical at symptom onset during the initial course of beneficial stable treatment.² Augmentation requires the withdrawal of dopaminergic agents. Anticonvulsants may be used if the response to dopaminergic agents is not adequate or if augmentation occurs.¹

We describe two patients affected by RLS with PLMS who became unresponsive to the traditional dopaminergic agents and developed augmentation. Both patients were treated with the antiepileptic drug levetiracetam and showed a clear and persistent clinical improvement of both RLS symptoms and PLMS. The clinical assessment and follow up included: subjective evaluation of symptoms and their impact on everyday life by means of the International Restless Legs Syndrome Study Group (IRLSSG) rating scale; evaluation of daytime sleepiness with the Epworth sleepiness scale; a suggested immobilisation test …