Characterized by a compulsive urge to move the legs.
Accompanied by dysesthesias described as creeping, crawling, tingling, cramping, or aching of the extremities.
Symptoms are usually worse during rest and in the evening, and are temporarily improved with movement.
Lower extremities are affected more than upper extremities.
Treatment includes nonpharmacologic interventions, dopamine agonists, opioids, benzodiazepines, or neuroleptic agents.
Restless legs syndrome (RLS) is an urge to move the legs accompanied by symptoms of dysesthesias, such as creeping, crawling, tingling, cramping, or aching of the extremities, primarily in the lower extremities. The dysesthesias occur more often at rest and in the evening, and are temporarily improved with movement. This can cause initiation and maintenance insomnia resulting in excessive daytime sleepiness.
History and exam
Key diagnostic factors
- evening symptoms
- relieving factors (movement, stretching, massage)
- location in lower extremities, less commonly upper extremities and torso
Other diagnostic factors
- alcohol use
- caffeine use
- female sex
- conditions associated with iron deficiency
- family history of RLS
- use of antidepressants, antihistamines, and metoclopramide
- increased age
- female sex
- diabetes mellitus
1st investigations to order
- clinical diagnosis
Investigations to consider
- serum ferritin
- Periodic limb movement disorder (PLMD)
- Peripheral neuropathy
- Guidelines for the first-line treatment of restless legs syndrome/Willis–Ekbom disease, prevention and treatment of dopaminergic augmentation
- Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer