Restless Legs Syndrome Differential Diagnoses

Updated: Jan 06, 2022
  • Author: Ali M Bozorg, MD; Chief Editor: Selim R Benbadis, MD  more...
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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. [24]

Patients with neuropathy can have symptoms similar to those of RLS. [25] 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. [25]

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. [21] 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