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Restless legs syndrome

Last reviewed: 4 Sep 2023
Last updated: 25 May 2023



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
More key diagnostic factors

Other diagnostic factors

  • alcohol use
  • caffeine use
  • female sex
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
  • iron studies
More 1st investigations to order

Treatment algorithm


intermittent RLS: nonpregnant

intermittent RLS: pregnant

chronic persistent RLS: nonpregnant

chronic persistent RLS: pregnant


refractory RLS: nonpregnant

refractory RLS: pregnant



Nitun Verma, MD, MBA

Sleep Physician

AC Wellness




NV declares that he has no competing interests.

Clete A. Kushida, MD, PhD, RPSGT

Acting Medical Director

Stanford Sleep Medicine Center


Stanford Center for Human Sleep Research

Associate Professor

Stanford University Medical Center

Stanford Sleep Medicine Center

Redwood City



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




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




KRC declares that he has no competing interests.

Brian Koo, MD

Associate Professor of Neurology

Yale University

New Haven



BK declares that he has no competing interests.

  • Differentials

    • Periodic limb movement disorder (PLMD)
    • Akathisia
    • Peripheral neuropathy
    More Differentials
  • Guidelines

    • Management of restless legs syndrome: an updated algorithm​
    • Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children
    More Guidelines
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