Differential diagnosis of augmentation

	Augmentation	End-of-dose rebound	Tolerance	Natural progression	Exacerbating factors*
Worse than before treatment	Yes	Yes, in early morning	No	Yes	Yes
Earlier onset	Yes	Yes, in early morning	No	Yes	Yes
Spread to arms	Yes	No	No	Yes	Yes
Breakthrough at night	Yes	Yes, in early morning	Yes	Yes	Yes
Worse with increased dose	Yes, but not immediately	No	No	No	No
Improved with decreased dose	Yes, but not always^¶	No	No	No	No

* For example, low serum ferritin, medications, increased immobility.
¶ Eventually augmentation is overcome when the dose is decreased; while augmentation symptoms can improve within 72 hours on levodopa, it can take several weeks to several months to see an improvement with dopamine agonists.

Reproduced from: Garcia-Borreguero D, Silber MH, Winkelman JW, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Med 2016; 21:1. Table used with the permission of Elsevier Inc. All rights reserved.

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