Genetics and medical history

RLS is diagnosed clinically, using a combination of the patient's family and medical history and a thorough physical examination. Currently, there are no laboratory tests that can diagnose RLS; however, they can help rule out other causes of symptoms. Although primary RLS frequently runs in families, the condition may be specific to the individual or secondary to other conditions.1-3

Patients often have difficulty describing the sensations of RLS, making diagnosis challenging. They may use terms such as “creepy-crawly,” “electricity in my legs,” and “bugs crawling in my muscles.”4

In an RLS study conducted in a primary care setting, 357 patients consulted their doctor about their RLS symptoms, and 58% of patients reported receiving a diagnosis—13% for RLS and 45% for other conditions.* A thorough medical history and physical examination are crucial to avoid misdiagnosis and a delay in treatment.1,5

*Study DesignQuestionnaire survey matched patients and primary care physicians (PCPs) in the United States, France, Germany, Spain, and the United Kingdom. To avoid bias, PCPs asked to participate were not told it was a study of RLS. In total, 2223 patients who completed the survey reported weekly RLS symptoms. Of these, 1557 had follow-up questionnaires completed by both themselves and their physician, with an RLS sufferers subgroup of 551 patients, defined as reporting at least twice-weekly symptoms with negative impacts on quality of life. Of the total patients, 357 consulted their PCPs about their RLS symptoms, with 46 (12.9%) reporting an RLS diagnosis.
creepy-crawly electricity in my legs bugs crawling in my muscles

Differential diagnosis

Other conditions can produce symptoms similar to those of RLS. These conditions, often referred to as RLS mimics, include nocturnal leg cramps, leg shaking, foot tapping, claudication, peripheral neuropathy, and akathisia. The International Restless Legs Syndrome Study Group recommends excluding RLS mimics as a primary source of symptoms as part of the diagnostic process.1,4,6

RLS essential diagnostic criteria

The following criteria are required to support a diagnosis of RLS4:

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Irresistible urge to move the legs

This is usually accompanied by uncomfortable or painful sensations in the legs. Arms or other parts of the body are sometimes also involved.

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Onset or exacerbation of symptoms with rest

Motor and sensory symptoms typically start during periods of inactivity.

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Circadian pattern

Symptoms typically begin or worsen in the evening or at bedtime.

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Relief with movement

Symptoms are partially or totally relieved by movement, for as long as the activity continues.

Supportive clinical features

Although not essential criteria, the presence of the following features can help support an RLS diagnosis4:

  • Periodic limb movements (PLMs). About 80% of patients with RLS experience PLMs
  • Positive family history. Primary RLS has a strong genetic component. People with RLS are 3 to 7 times more likely to have a first-degree relative with RLS than people without RLS
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Download Guide

For additional information on diagnosing RLS, consult our disease guide

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RLS Overview

Review the latest findings on this often debilitating condition

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