Diagnosis of Restless Legs Syndrome

How is Restless Legs Syndrome Diagnosed?

The diagnosis of RLS is based upon a thorough medical and neurologic evaluation as well as a detailed patient history. Some physicians may use a clinical assessment scale to aid in the diagnosis of RLS and help to determine disease severity. Diagnostic indicators include the following:

• Desire to move the limbs usually in association with paresthesias/dysesthesias.
• Motor restlessness.
• Symptoms are worse or exclusively present at rest (i.e. lying, sitting) with at least partial and temporary relief by activity.
• Symptoms are worse in the evening/night.

Are there other factors that physicians consider when confirming a diagnosis of RLS?

Additional features that may suggest RLS may include the following:

• Difficulty initiating and maintaining sleep.
• Involuntary movements of the legs (or arms) that occur during sleep or while at rest.
• Absence of associated neurologic findings as revealed during a complete neurologic evaluation. Most cases of RLS are idiopathic and, upon examination, there are typically no unusual neurologic findings. However, when RLS occurs in association with other disorders, such as diabetes or peripheral neuropathy, etc., it is possible that abnormal neurologic findings may be discovered during the course of evaluation. These findings may include loss of tendon reflexes, an abnormal electrical impulse conduction study (electromyography or EMG), and an abnormal nerve conduction velocity test.
• Family history of RLS.
• Disease onset at any age with a clinical course that is typically chronic and progressive with an increase in severity with advancing age.

Are there any tests to confirm the diagnosis of RLS and assess its severity?

The diagnosis of RLS is based solely on a thorough medical assessment using the criteria described above. Physicians should check blood levels of ferritin, a measure of iron storage. An overnight sleep or an ambulatory monitor of leg activity for several nights may be suggested to document the potential occurrence and frequency of periodic limb movements during sleep (PLMS). During a specialized test known as a polysomnogram episodes of PLMS are documented. More than 80% of people with RLS also have PLMS. Documentation of PLMS during a sleep study (i.e., a PLMS index of >5 episodes per hour) is strongly suggestive of RLS since PLMS occurs only rarely outside of restless legs syndrome. In addition, a higher PLMS index correlates with more severe RLS symptoms. Complaints of sleep disturbances (i.e., difficulty falling asleep and maintaining sleep throughout the night) may also be documented during an overnight sleep study.

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