Summary
Definition
History and exam
Key diagnostic factors
- urge to move the legs
- dysesthesias
- evening or night 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
Risk factors
- conditions associated with iron deficiency
- pregnancy
- family history of RLS
- use of antidepressants, antihistamines, and metoclopramide
- female sex
- increased age
- obesity
- diabetes mellitus
- Parkinson disease
- multiple sclerosis
- peripheral neuropathy
Diagnostic tests
1st tests to order
- clinical diagnosis
- iron studies
Treatment algorithm
intermittent RLS: nonpregnant
intermittent RLS: pregnant
chronic persistent RLS: nonpregnant
chronic persistent RLS: pregnant
refractory RLS: nonpregnant
refractory RLS: pregnant
Contributors
Authors
Nitun Verma, MD, MBA
Sleep Physician
AC Wellness
Cupertino
CA
Disclosures
NV declares that he has no competing interests.
Clete A. Kushida, MD, PhD, RPSGT
Acting Medical Director
Stanford Sleep Medicine Center
Director
Stanford Center for Human Sleep Research
Associate Professor
Stanford University Medical Center
Stanford Sleep Medicine Center
Redwood City
CA
Disclosures
CAK has received research grant support from XenoPort, the manufacturer of gabapentin enacarbil, and is an author of a number of references cited in this topic.
Peer reviewers
Magdolna Hornyak, MD
Associate Professor
Interdisciplinary Pain Center and Department for Psychiatry and Psychotherapy
University Medical Center Freiburg
Freiburg
Germany
Disclosures
MH declares that she has no competing interests.
K Ray Chaudhuri, MD, FRCP, DSc, FEAN
Professor of Movement Disorders and Neuroscience and Clinical Director
Parkinson Foundation International Centre of Excellence
King's College Hospital and King's College
Campus Research Director and Assistant Medical Director
King's College Hospital NHS Foundation Trust
London
UK
Disclosures
KRC declares that he has no competing interests.
Brian Koo, MD
Associate Professor of Neurology
Yale University
New Haven
CT
Disclosures
BK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Winkelman JW, Armstrong MJ, Allen RP, et al. Practice guideline summary: treatment of restless legs syndrome in adults - report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2016 Dec 13;87(24):2585-93.Full text Abstract
Silber MH, Buchfuhrer MJ, Earley CJ, et al. The management of restless legs syndrome: an updated algorithm. Mayo Clin Proc. 2021 Jul;96(7):1921-37.Full text Abstract
Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018 Jan;41:27-44.Full text Abstract
Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults - an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep. 2012 Aug 1;35(8):1039-62.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Periodic limb movement disorder (PLMD)
- Akathisia
- Peripheral neuropathy
More DifferentialsGuidelines
- International classification of sleep disorders, 3rd edition, text revision (ICSD-3-TR)
- Management of restless legs syndrome: an updated algorithm
More Guidelines
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