Restless Legs Syndrome Presenting with Typical Symptoms

Primary-care health professionals are in a good position to diagnose Restless Legs Syndrome (RLS) because most patients will initially present to them. Diagnosis is relatively simple and can be made on the clinical history alone using published diagnostic criteria. The International Restless Legs Syndrome Study Group (IRLSSG) has developed four diagnostic criteria for Restless Legs Syndrome that confirm or rule out a diagnosis of Restless Legs Syndrome.1

The urge to move the legs is irresistible and may be temporarily or partially relieved by movement, such as walking, rocking, shaking, stretching, or bending.1 Patients may describe disruptions to their everyday lives, including activities that require sitting for extended periods of time, such as travel by plane or car.1

Due to the subjective nature of Restless Legs Syndrome symptoms, many patients find it difficult to describe symptoms in a precise and uniform way. The lack of specific language to describe Restless Legs Syndrome clearly also increases the risk of misdiagnosis. Most patients describe symptoms in terms such as twitching, crawling, creeping, tingling, itching, aching, or burning.1,7 Although these descriptions may sound trivial, the healthcare professional should not underestimate the impact that the symptoms can have on patients with Restless Legs Syndrome.

The symptoms begin or worsen during the evening or night and typically abate in the morning, although a small proportion of patients do experience symptoms during the day.1

Primary vs Secondary Restless Legs Syndrome

It is important to rule out secondary Restless Legs Syndrome, which may be related to other underlying conditions, eg, pregnancy, renal failure, or iron deficiency.1

Periodic Leg Movements in Sleep

Although periodic leg movements in sleep are not essential for diagnosis, about 80% of patients with Restless Legs Syndrome do experience these leg symptoms,1 which are viewed as the motor component of this sensorimotor disorder. Periodic leg movements in sleep are repetitive movements of the big toe, ankle and sometimes knee and hip lasting 0.5 to 5 seconds that occur at 20- to 40-second intervals during non-REM sleep. Sometimes the patient's bed partner reports the presence of these leg symptoms even before the individual experiences sensory symptoms of Restless Legs Syndrome.10 It is important to note that people who suffer from periodic leg movements in sleep may not know it.

Restless Legs Syndrome Presenting as Sleep Disturbance

Sleep disturbance is a major consequence of Restless Legs Syndrome. People with Restless Legs Syndrome may present sleep complaints, such as difficulty falling asleep, resulting in daytime fatigue.

Patients with Restless Legs Syndrome have sleep-onset difficulty because:

• Their symptoms, such as the urge to move their legs or periodic limb movements in wakefulness (PLMW), are activated when they lie down and try to relax.9
  
  
• The discomfort of Restless Legs Syndrome is more problematic during the evening and at night when the patient is trying to sleep.1