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Living With RLS

Many people with RLS bear a constant physical and mental burden due to the broad range of RLS symptoms that may have an impact on their lives. Apart from unusual sensations and leg restlessness, RLS may cause sleep disturbance, daytime fatigue, and mood disturbance that can have a significant impact on general health, vitality, and day-to-day living.4

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Diagnostic Criteria:     Diagnosis   Differential Diagnosis

Due to the lack of a specific diagnostic laboratory test, patient history is the primary means of diagnosing restless legs syndrome (RLS). Often RLS goes undiagnosed or misdiagnosed due to a lack of clinician awareness combined with patient difficulty in describing RLS symptoms. In the primary care section of the RLS Epidemiology, Symptoms, and Treatment (REST) study, only 12.9% (46 out of 357) of patients consulting a physician about RLS symptoms reported being given a diagnosis for RLS.1 Some potential misdiagnoses that may be associated with RLS symptoms are impaired circulation, nocturnal leg cramps, and osteoarthritis.3

Due to the unusual sensory experiences associated with RLS, patients often have difficulty describing their symptoms.

Terms often used to describe RLS symptoms3-5

  • Burning
    		•
  • Searing
    		•
  • Creeping
    		•
  • Pulling
    		•
  • Crawling
    		•
  • Water flowing
    		•
  • Electric
    		•
  • Bugs under the skin
    		•
  • Tingling
    		•
  • Soda in the veins
    		•
  • Tugging
    		•
     

    The essential clinical criteria for RLS diagnosis were developed in 1995 by the International RLS Study Group (IRLSSG) and updated in 2003 through collaboration between the IRLSSG and the National Institutes of Health.3 Combined with a physical examination and a careful patient history, an initial diagnosis can be made by adapting diagnostic questions around these 4 essential criteria for RLS diagnosis.4

    Essential Criteria for RLS Diagnosis*

    1. An urge to move the legs, usually accompanied or caused by uncomfortable sensations in the legs
    2. The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting
    3. The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues
    4. The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night
    *Adapted with permission from Allen RP, et al.3

    Supportive clinical features that can further define an RLS diagnosis include positive family history for RLS, response to dopaminergic treatment, and evidence of periodic limb movements in sleep (PLMS).3 While not essential for diagnosis, these additional clinical features occur frequently enough to aid in the resolution of any diagnostic ambiguities.3

    When evaluating a patient with RLS, it is essential to rule out underlying conditions associated with secondary RLS with a thorough drug history and laboratory tests (eg, serum ferritin, serum folate, serum glucose, serum creatinine, urea, electrolytes, complete blood count).4,14