Real-world outcomes with Nidra® TOMAC for refractory RLS

Millions of adults with restless legs syndrome (RLS) are becoming refractory to medication, largely due to augmentation to dopamine agonists. The groundbreaking 2025 AASM guidelines for restless legs syndrome (RLS) recommend against dopamine agonists and suggest alternative treatment options including high-frequency peroneal nerve stimulation. The Nidra® tonic motor activation (TOMAC) system is the only commercially available device that delivers high-frequency peroneal nerve stimulation. Here, we review real-world outcomes for patients prescribed Nidra® TOMAC as part of standard of care in the United States between 2024 and 2025. Dr. Jonathan Charlesworth presents interim clinical outcomes data from the THRIVE real-world registry demonstrating the long-term safety and effectiveness of TOMAC. Dr. Andrew Spector provides his clinical experience as a sleep neurologist who has prescribed TOMAC to dozens of his patients.