Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Restless Legs Syndrome Differential Diagnoses

  • Author: Ali M Bozorg, MD; Chief Editor: Selim R Benbadis, MD  more...
 
Updated: Apr 15, 2016
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of restless legs syndrome (RLS) include the following:

  • Akathisia
  • Neuropathy
  • Nocturnal leg cramps
  • Painful legs and moving toes
  • Vascular disease
  • Radiculopathy

Akathisia is characterized by an inner urge to move all or part of the body, without a focal sensory complaint in the limbs. Often, it does not correlate with rest or show circadian variation, and it usually results from medications such as selective serotonin reuptake inhibitors (SSRIs), neuroleptics, or other dopamine-blocking agents.[23]

Patients with neuropathy can have symptoms similar to those of RLS.[24] Typical sensory complaints include numbness, tingling, and pain. However, neuropathic symptoms also differ from RLS symptoms in that they usually are not associated with motor restlessness or helped by movement, nor do they worsen in the evening or at night. Neuropathy and RLS may coexist. RLS occurs more frequently in patients with hereditary neuropathies but not in patients with acquired neuropathies, such as diabetic neuropathy.[24]

Nocturnal leg cramps are typically unilateral, painful, palpable, involuntary muscle contractions that are often local with a sudden onset. Like RLS, they may have a circadian pattern and often occur at rest. However, nocturnal leg cramps are associated with physical changes, including a muscle hardening not seen in RLS.

Patients with painful legs and moving toes exhibit involuntary, spontaneous flexion and extension of the toes, which is usually secondary to spinal cord injury or root lesions.[20] Unlike RLS, this condition is not associated with a focal urge to move the limbs, and it does not show a clear circadian pattern.

Vascular disease (including deep vein thrombosis and claudication) must be considered. Patients with RLS have intact peripheral pulses and typically do not have edema or cool extremities. Also, vascular disease does not exhibit a circadian pattern and usually worsens with activity, not with rest.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

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

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

Disclosure: Received honoraria from Cyberonics for speaking and teaching; Received honoraria from UCB, Inc. for 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 Medical Association, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cyberonics; Eisai; Lundbeck; Sunovion; UCB; Upsher-Smith<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cyberonics; Eisai; Glaxo Smith Kline; Lundbeck; Sunovion; UCB<br/>Received research grant from: Cyberonics; Lundbeck; Sepracor; Sunovion; UCB; Upsher-Smith.

Acknowledgements

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 Medscape Reference 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

References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th. Arlington, VA: American Psychiatric Association; 2013. 410-3.

  2. Krueger BR. Restless legs syndrome and periodic movements of sleep. Mayo Clin Proc. 1990 Jul. 65(7):999-1006. [Medline].

  3. Gamaldo CE, Earley CJ. Restless legs syndrome: a clinical update. Chest. 2006 Nov. 130(5):1596-604. [Medline].

  4. Hening WA. Restless Legs Syndrome. Curr Treat Options Neurol. 1999 Sep. 1(4):309-319. [Medline].

  5. Ferreri F, Rossini PM. Neurophysiological investigations in restless legs syndrome and other disorders of movement during sleep. Sleep Med. 2004 Jul. 5(4):397-9. [Medline].

  6. Restless legs syndrome. detection and management in primary care. National Heart, Lung, and Blood Institute Working Group on Restless Legs Syndrome. Am Fam Phys. 2000 Jul 1. 62(1):108-14. [Medline].

  7. Evidente VG, Adler CH. How to help patients with restless legs syndrome. Discerning the indescribable and relaxing the restless. Postgrad Med. 1999 Mar. 105(3):59-61, 65-6, 73-4. [Medline].

  8. Silber MH. Restless legs syndrome. Mayo Clin Proc. 1997 Mar. 72(3):261-4. [Medline].

  9. Takaki J, Nishi T, Nangaku M, et al. Clinical and psychological aspects of restless legs syndrome in uremic patients on hemodialysis. Am J Kidney Dis. 2003 Apr. 41(4):833-9. [Medline].

  10. Walters AS, LeBrocq C, Dhar A, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003 Mar. 4(2):121-32. [Medline].

  11. Weinstock LB, Walters AS, Paueksakon P. Restless legs syndrome - Theoretical roles of inflammatory and immune mechanisms. Sleep Med Rev. 2012 Jan 16. [Medline].

  12. Winkelman JW. Considering the causes of RLS. Eur J Neurol. 2006 Oct. 13 Suppl 3:8-14. [Medline].

  13. Allen RP, Earley CJ. Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol. 2001 Mar. 18(2):128-47. [Medline].

  14. Jhoo JH, Yoon IY, Kim YK, Chung S, Kim JM, Lee SB. Availability of brain serotonin transporters in patients with restless legs syndrome. Neurology. 2010 Feb 9. 74(6):513-8. [Medline].

  15. Trenkwalder C, Hogl B, Winkelmann J. Recent advances in the diagnosis, genetics and treatment of restless legs syndrome. J Neurol. 2009 Apr. 256(4):539-53. [Medline].

  16. Cesnik E, Casetta I, Turri M, Govoni V, Granieri E, Strambi LF, et al. Transient RLS during pregnancy is a risk factor for the chronic idiopathic form. Neurology. 2010 Dec 7. 75(23):2117-20. [Medline].

  17. Berger K, Luedemann J, Trenkwalder C, et al. Sex and the risk of restless legs syndrome in the general population. Arch Intern Med. 2004 Jan 26. 164(2):196-202. [Medline].

  18. Kutner NG, Zhang R, Huang Y, Bliwise DL. Racial differences in restless legs symptoms and serum ferritin in an incident dialysis patient cohort. Int Urol Nephrol. 2012 Jan 5. [Medline].

  19. Abetz L, Allen R, Follet A, et al. Evaluating the quality of life of patients with restless legs syndrome. Clin Ther. 2004 Jun. 26(6):925-35. [Medline].

  20. Ekbom K, Ulfberg J. Restless legs syndrome. J Intern Med. 2009 Nov. 266(5):419-31. [Medline].

  21. Simakajornboon N, Kheirandish-Gozal L, Gozal D. Diagnosis and management of restless legs syndrome in children. Sleep Med Rev. 2009 Apr. 13(2):149-56. [Medline].

  22. Kotagal S, Silber MH. Childhood-onset restless legs syndrome. Ann Neurol. 2004 Dec. 56(6):803-7. [Medline].

  23. Lane RM. SSRI-induced extrapyramidal side-effects and akathisia: implications for treatment. J Psychopharmacol. 1998. 12(2):192-214. [Medline].

  24. Hattan E, Chalk C, Postuma RB. Is there a higher risk of restless legs syndrome in peripheral neuropathy?. Neurology. 2009 Mar 17. 72(11):955-60. [Medline].

  25. Montplaisir J, Nicolas A, Denesle R. Restless legs syndrome improved by pramipexole: a double-blind randomized trial. Neurology. 1999 Mar 23. 52(5):938-43. [Medline].

  26. Ondo W. Ropinirole for restless legs syndrome. Mov Disord. 1999 Jan. 14(1):138-40. [Medline].

  27. Giorgi L, Asgharian A, Hunter B. Ropinirole in Patients With Restless Legs Syndrome and Baseline IRLS Total Scores =24: Efficacy and Tolerability in a 26-Week, Double-Blind, Parallel-Group, Placebo-Controlled Study Followed by a 40-Week Open-Label Extension. Clin Ther. 2013 Aug 9. [Medline].

  28. Baldwin CM, Keating GM. Rotigotine transdermal patch: in restless legs syndrome. CNS Drugs. 2008. 22(10):797-806. [Medline].

  29. Bogan RK, Bornemann MA, Kushida CA, Trân PV, Barrett RW. Long-term maintenance treatment of restless legs syndrome with gabapentin enacarbil: a randomized controlled study. Mayo Clin Proc. 2010 Jun. 85(6):512-21. [Medline]. [Full Text].

  30. Garcia-Borreguero D, Kohnen R, Silber MH, Winkelman JW, Earley CJ, Högl B, et al. The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group. Sleep Med. 2013 Jul. 14(7):675-84. [Medline].

  31. Grote L, Leissner L, Hedner J, Ulfberg J. A randomized, double-blind, placebo controlled, multi-center study of intravenous iron sucrose and placebo in the treatment of restless legs syndrome. Mov Disord. 2009 Jul 30. 24(10):1445-52. [Medline].

  32. Shinno H, Yamanaka M, Ishikawa I, Danjo S, Nakamura Y, Inami Y. Successful treatment of restless legs syndrome with the herbal prescription Yokukansan. Prog Neuropsychopharmacol Biol Psychiatry. 2010 Feb 1. 34(1):252-3. [Medline].

  33. Oscroft NS, Smith IE. Oral glucocorticosteroids: effective in a case of restless legs syndrome resistant to other therapies. Sleep Med. 2010 Jun. 11(6):596. [Medline].

  34. Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, Maridaki MD, Koutedakis Y, Founta P, et al. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome. Nephrol Dial Transplant. 2013 Aug 8. [Medline].

  35. Anderson P. Restless Legs Syndrome Linked to Higher Mortality. Available at http://www.medscape.com/viewarticle/805712. Accessed: Jun 19 2013.

  36. Li Y, Wang W, Winkelman JW, Malhotra A, Ma J, Gao X. Prospective study of restless legs syndrome and mortality among men. Neurology. 2013 Jun 12. [Medline].

  37. Jeffrey S. FDA Okays First Device for Restless Legs Syndrome. Medscape Medical News. May 30 2014. [Full Text].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.