Restless Legs Syndrome:

Classification, Diagnosis and

Approaches to Treatment

Part 1 of 3

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RLS Slide Library Version 1.0 - All Contents Copyright © WE MOVE 2001
 Restless Legs Syndrome (RLS)
Characterized by...
• Desire to move in association with
paresthesias/dysesthesias of the limbs
• Motor restlessness

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 Restless Legs Syndrome, cont’d
Characterized by...
• Provocative factor of rest
• Improved by movement
• Evening and nighttime accentuation

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RLS Diagnosis: Minimal Criteria

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 ICSD Criteria: RLS
• Unpleasant sensations in legs at night
• Sensations of “creeping” in the calves
• Relief with movement
• PSG shows limb movement
• No medical or psychiatric disorder
• Other sleep disorder may be present

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 Sensory Abnormalities
Desire to move limbs associated with...
• Paresthesias
• Dysesthesias

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 Motor Abnormalities
• Restlessness...Irresistible urge to move
• Relief with Movement

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 Provocative Factor of Rest
• Symptoms worse or exclusively present at
rest, such as while lying down or sitting
• Partial or temporary relief with motor
activity

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Evening and Nighttime Accentuation

• Worsening symptoms during the evening

or night
• Symptoms typically peak near midnight
• Seem to follow a Circadian pattern

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 RLS: Associated Findings
• Periodic Limb Movements in Sleep (PLMS)
• Sleep disturbances
• Dyskinesias While Awake (see next slide)

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 Dyskinesias While Awake
• Involuntary and occur at rest
• Flexion jerk of lower extremities
• Sporadic, aperiodic, periodic, or in clusters
• Higher frequency than PLMS
• Perhaps a “waking counterpart” of PLMS

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 Two Forms of RLS
• Idiopathic or primary RLS
– Familial
– Sporadic
• Symptomatic or secondary RLS
– Renal failure – Iron deficiency
– Neuropathy – Radiculopathy
– Diabetes – Pregnancy
– Rheumatoid arthritis

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 Positive Family History
In idiopathic RLS...
Fifty to 60% report a close relative or
relatives with RLS-associated symptoms

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 Disease Course
• Idiopathic RLS: variable age of onset
• Symptoms may present during late
adulthood
• Symptoms tend to increase with age
• Some patients experience remissions

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 Clinical Characteristics
• Mean age of onset is 27 years
• Unilateral onset in 42%
• Arm involvement in 25% to 50%

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 Clinical Features of RLS
• Affects females more than males
• Sleep disturbance in about 94%
– Sleep latency insomnia
– Fragmented or nonrestorative sleep
– Excessive daytime sleepiness in 22%

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