Restless Legs Syndrome Clinical Presentation

  • Author: Ali M Bozorg, MD; Chief Editor: Selim R Benbadis, MD   more...
 
Updated: Apr 4, 2012
 

History and Physical Examination

History

The diagnosis of restless legs syndrome (RLS) is based primarily on the patient’s clinical history. Often, patients do not bring RLS symptoms to the attention of the physician; therefore, including a few general sleep questions in the review of systems can be helpful. RLS patients typically report dysesthetic sensations described as "pins and needles," an "internal itch," or a "creeping or crawling" sensation.

The criteria for diagnosis of RLS are based on those developed by the International RLS Study Group in 1995. The following 4 basic elements must be present to make the diagnosis[15, 4, 18, 19] :

  • A compelling urge to move the limbs - Usually associated with paresthesias/dysesthesias
  • Motor restlessness - As seen in activities such as floor pacing, tossing and turning in bed, and rubbing the legs
  • Symptoms that worsen or are exclusively present at rest (ie, lying, sitting), with variable and temporary relief on activity
  • Circadian variation of symptoms that are present in the evening and at night - Often, symptoms are relieved after 5:00 am, but in more severe cases, symptoms can be present throughout the day without circadian variation

Approximately 85% of patients with RLS have periodic movements of sleep, usually involving the legs (periodic leg movements of sleep [PLMS]).[5] PLMS is characterized by involuntary, forceful dorsiflexion of the foot lasting 0.5-5 seconds and occurring every 20-40 seconds throughout sleep.

A large majority of patients (85%) with RLS report difficulty falling asleep at night because of RLS, and they may experience excessive daytime somnolence because of poor sleep quality due to multiple PLMS-induced arousals. PLMS noted on polysomnography alone do not warrant treatment. Clinicians should consider treating PLMS if they are causing frequent arousals.

Other features commonly associated with RLS but not required for diagnosis include sleep disturbances, daytime fatigue, and involuntary, repetitive, periodic, jerking limb movements (either during sleep or while awake and at rest). A positive family history also aids in the diagnosis of RLS, especially in children.

RLS in children

RLS can be difficult to diagnose in children, especially younger children.[20] In order to make a definite diagnosis of RLS, patients must endorse the 4 criteria of RLS and be able to describe leg symptoms in their own language.[21]

Alternatively, patients must have the 4 essential criteria and have sleep disturbances, a sibling or parent with RLS, and a PLMS index of greater than 5 on polysomnography.[20] For a possible diagnosis of RLS, a PLMS index of greater than 5 on polysomnography and a first-degree family member with RLS are required. These strict criteria are intended to prevent overdiagnosis of RLS in children.

Physical examination

The physical examination is usually normal in patients with RLS; it is performed to identify secondary causes and to exclude other disorders. In particular, the patient should be evaluated for neuropathy, radiculopathy, and parkinsonism.

Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Ali M Bozorg, MD  Assistant Professor, Comprehensive Epilepsy Program, Department of Neurology, University of South Florida College of Medicine

Ali M Bozorg, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, and American Epilepsy Society

Disclosure: Cyberonics Honoraria Speaking and teaching; UCB, Inc. Honoraria Speaking and teaching

Chief Editor

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Additional Contributors

Jose E Cavazos, MD, PhD, FAAN Associate Professor with Tenure, Departments of Neurology, Pharmacology, and Physiology, Program Director of the Clinical Neurophysiology Fellowship, University of Texas School of Medicine at San Antonio; Co-Director, South Texas Comprehensive Epilepsy Center, University Hospital System; Director of the San Antonio Veterans Affairs Epilepsy Center of Excellence and Neurodiagnostic Centers, Audie L Murphy Veterans Affairs Medical Center

Jose E Cavazos, MD, PhD, FAAN is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, and American Neurological Association

Disclosure: GXC Global, Inc. Intellectual property rights Medical Director - company is to develop a seizure detecting device. No conflict with any of the eMedicine articles that I wrote or edited.

William G Irr, MD Consulting Staff, Department of Neurology Service, St Luke's Episcopal Hospital of Houston

William G Irr, MD is a member of the following medical societies: American Academy of Neurology.

Disclosure: Nothing to disclose.

Juan Latorre, MD Research Fellow, Department of Physical Medicine and Spinal Cord Injury Medicine, The Institute for Rehabilitation and Research

Juan Latorre, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Erasmo A Passaro, MD, FAAN Director, Comprehensive Epilepsy Program/Clinical Neurophysiology Lab, Bayfront Medical Center, Florida Center for Neurology

Erasmo A Passaro, MD, FAAN is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association, and American Society of Neuroimaging

Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; UCB Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Forest Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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