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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

Differential Diagnosis

Various conditions that can mimic the sensorimotor disturbances of RLS must be excluded before a conclusive diagnosis can be made.

Disorders to be excluded during evaluation

  • Nocturnal leg cramps
    Leg cramps are a common sleep-related problem characterized by palpable knotting of the muscle in the presence of localized, involuntary muscle contractions.5
  • Akathisia
    Often a side effect of neuroleptics and dopaminergic blocking agents, this condition is characterized by excessive movement and an inner sense of restlessness.18 While sharing some symptoms with RLS, there are notable differences between the 2 conditions. For example, the circadian patterns of RLS symptom amplification are not present in akathisia.5 Also, akathisia only presents when a patient is seated, while RLS occurs whenever a patient is at rest. Lastly, akathisia does not cause sleep disturbance, a major factor in RLS.16
  • Vesper's curse
    A transient lumbar stenosis caused by an increase in right atrial filling pressure that results in leg pain, lumbosacral discomfort, and paresthesias that can result in sleep disturbance.18
  • Periodic limb movements in sleep (PLMS)
    This condition is associated with periodic episodes of highly repetitive limb movements during sleep. These repetitive episodes of muscle contraction are usually grouped into series, with one 0.5- to 5-second long contraction occurring every 20 to 40 seconds.3 While over 80% of patients with RLS have PLMS, the latter is an independent condition linked to other disorders, such as sleep apnea, narcolepsy, and certain drug treatments.3,17,18 In the absence of the essential clinical features of RLS, other disorders or idiopathic PLMS should be considered.
  • Vascular disease
    Certain venous vascular issues, such as deep venous thrombosis, intermittent claudication, and varicose veins may cause sensations that have some similarity to RLS symptoms.4,5
  • Peripheral neuropathy
    This condition is characterized by nerve damage that results in sensory complaints of numbness, tingling, or pain. Neuropathies are usually not associated with motor restlessness and do not follow the normal circadian pattern of RLS symptom amplification. Often small fiber sensory neuropathies seen in diabetes are confused with RLS symptoms.5
  • Other conditions
    Some other conditions that can mimic specific RLS symptoms include3,4,18:
    • Generalized anxiety disorder
    • Agitated depression
    • Leg pain or irritation from osteoarthritic conditions, sciatica, or pruritus
    • Sleep-onset myoclonus