Restless Legs Syndrome Workup
- Author: Ali M Bozorg, MD; Chief Editor: Selim R Benbadis, MD more...
All patients with symptoms of restless legs syndrome (RLS) should be tested for iron deficiency.[3, 4] At a minimum, a ferritin level should be obtained. A complete iron panel, including iron levels, ferritin, transferrin saturation, and total iron binding capacity, is preferable because the ferritin level can be falsely elevated in acute inflammatory states.
Patients whose RLS is well controlled but who develop reemergence or augmentation of symptoms should undergo repeat evaluation of their iron status. Augmentation is defined the presence of 1 or more of the following:
Earlier onset of symptoms during the evening or after assumption of a restful position
Increased intensity of symptoms in the morning
Extension of symptoms to the upper part of the body
If a secondary cause of RLS is suspected on the basis of the history, abnormal findings on neurologic examination, or a poor response to treatment, other laboratory tests should be done. These include a complete blood count (CBC) and measurement of levels of the following:
Blood urea nitrogen (BUN)
Fasting blood glucose
Thyroid-stimulating hormone (TSH)
Needle electromyography (EMG) and nerve conduction studies should be considered if polyneuropathy or radiculopathy is suspected on clinical grounds, even if the results of the neurologic examination are apparently normal.
Polysomnography (PSG) may be necessary to quantify periodic leg movements of sleep (PLMS) or to characterize sleep architecture, especially in children and in patients who continue to have significant sleep disturbances despite relief of RLS symptoms with treatment. PSG should also be used in patients with other suspected sleep comorbidities.
Imaging studies are not routinely used in the diagnosis of patients with RLS and are currently investigational in this setting.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th. Arlington, VA: American Psychiatric Association; 2013. 410-3.
Krueger BR. Restless legs syndrome and periodic movements of sleep. Mayo Clin Proc. 1990 Jul. 65(7):999-1006. [Medline].
Gamaldo CE, Earley CJ. Restless legs syndrome: a clinical update. Chest. 2006 Nov. 130(5):1596-604. [Medline].
Hening WA. Restless Legs Syndrome. Curr Treat Options Neurol. 1999 Sep. 1(4):309-319. [Medline].
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].
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].
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].
Silber MH. Restless legs syndrome. Mayo Clin Proc. 1997 Mar. 72(3):261-4. [Medline].
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].
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].
Weinstock LB, Walters AS, Paueksakon P. Restless legs syndrome - Theoretical roles of inflammatory and immune mechanisms. Sleep Med Rev. 2012 Jan 16. [Medline].
Winkelman JW. Considering the causes of RLS. Eur J Neurol. 2006 Oct. 13 Suppl 3:8-14. [Medline].
Allen RP, Earley CJ. Restless legs syndrome: a review of clinical and pathophysiologic features. J Clin Neurophysiol. 2001 Mar. 18(2):128-47. [Medline].
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].
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].
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].
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].
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].
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].
Ekbom K, Ulfberg J. Restless legs syndrome. J Intern Med. 2009 Nov. 266(5):419-31. [Medline].
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].
Kotagal S, Silber MH. Childhood-onset restless legs syndrome. Ann Neurol. 2004 Dec. 56(6):803-7. [Medline].
Lane RM. SSRI-induced extrapyramidal side-effects and akathisia: implications for treatment. J Psychopharmacol. 1998. 12(2):192-214. [Medline].
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].
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].
Ondo W. Ropinirole for restless legs syndrome. Mov Disord. 1999 Jan. 14(1):138-40. [Medline].
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].
Baldwin CM, Keating GM. Rotigotine transdermal patch: in restless legs syndrome. CNS Drugs. 2008. 22(10):797-806. [Medline].
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].
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].
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].
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].
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].
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].
Anderson P. Restless Legs Syndrome Linked to Higher Mortality. Available at http://www.medscape.com/viewarticle/805712. Accessed: Jun 19 2013.
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].
Jeffrey S. FDA Okays First Device for Restless Legs Syndrome. Medscape Medical News. May 30 2014. [Full Text].