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Diagnosis of RLS

Background

The diagnosis of restless legs syndrome is symptomatic. An international study group set diagnostic criteria in a workshop at the NIH.


Reference

RA Allen et al. Restless legs: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Medicine 2003 4: 101-119.

RLS in adults

The essential diagnostic criteria developed in 2003 is slightly different from previous criteria, with question 3 relating to relief with movement instead of motor restlessness. The criteria are in Table 1.

Table 1: Essential diagnostic criteria for RLS

1 An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs (Sometimes the urge to move is present without the uncomfortable sensations and sometimes the arms and other body parts are involved in addition to the legs)
2 The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying 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 (When symptoms are very severe, the worsening at night may be noticeable but must have been previously present)

Descriptive terms for restless legs syndrome include the following (though they have a particular US bent):

Supportive features of RLS include:

Associated features of RLS include:

RLS in the cognitively impaired

Essential criteria for the diagnosis of probable RLS in the cognitively impaired elderly are shown in Table 2, and all five are necessary for diagnosis.

Table 2:RLS in the cognitively impaired

1 Signs of leg discomfort such as rubbing or kneading the legs and groaning while holding the lower extremities are present
2 Excessive motor activity in the lower extremities such as pacing, fidgeting, repetitive kicking, tossing and turning in bed, slapping the legs on the mattress, cycling movements of the lower limbs, repetitive foot tapping, rubbing the feet together, and inability to remain seated are present
3 Signs of leg discomfort are exclusively present or worsen during periods of rest or inactivity
4 Signs of leg discomfort are diminished with activity
5 Criteria 1 and 2 occur only in the evening or at night or are worse at those times than during the day

RLS in children

Criteria for the diagnosis of definite RLS in children are shown in Table 3. They are intended for children aged two to 12 years, with adult criteria for those aged 13 or older. There are separate, lesser criteria for the diagnosis of probable or possible RLS in children.

Table 3: Definite RLS in children

1 The child meets all four essential adult criteria for RLS and
2 The child relates a description in his or her own words that is consistent with leg discomfort
or
1 The child meets all four essential adult criteria for RLS and
2 Two of the following supportive criteria are present:
 

Sleep disturbance for age

 

A biologic parent or sibling has definite RLS

 

The child has polysomnographically documented periodic limb movement index of 5 or more per hour of sleep

Questions for use in epidemiological studies

A positive diagnosis requires that respondents answer yes to the first three questions in Table 4.

Table 4: Questions for epidemiological diagnosis

1 Do you have unpleasant sensations in your legs combined with an urge or need to move your legs? Yes or No
2 Do these feelings occur mainly or only at rest and do they improve with movement? Yes or No
3 Are these feelings worse in the evening or night than in the morning? Yes or No
4

How often do these feelings occur?

Less than one time a year

At least once a year but less than once a month

One time per month

2-4 times per month

2-3 times per week

4-5 times per week

6-7 times per week

 

 

Comment

This is a really useful paper, if for no other reason that it explains each item, and supports each item with a host of references (140 of them). It makes for essential reading for anyone studying or interested in RLS.