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Restless Legs Syndrome Workup

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

Laboratory Studies

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)
  • Creatinine
  • Fasting blood glucose
  • Magnesium
  • Thyroid-stimulating hormone (TSH)
  • Vitamin B-12
  • Folate

Other Studies

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.[5]

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.

Contributor Information and Disclosures

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.


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

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