Restless legs syndrome (RLS) is a
condition characterized by discomfort at rest and urge to move focused on the
legs. RLS may occur as an idiopathic, often hereditary condition (primary RLS),
or in association with medical conditions (secondary RLS) including iron
deficiency, uremia, and polyneuropathy. Current understanding of the
pathophysiology of RLS points to the involvement of three interrelated
components: dopaminergic dysfunction, impaired iron homeostasis, and genetic
mechanisms.
NIH diagnostic criteria of RLS
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Essential criteria
- An urge to move the legs, usually accompanied
or caused by uncomfortable or unpleasant sensations in the legs.
- The urge to move or unpleasant sensations begin
or worsen during periods of rest or inactivity such as lying or sitting.
- The urge to move or unpleasant sensations are
partially or totally relieved by movement, such as walking or
stretching, at least as long as the activity continues.
- The urge to move or unpleasant sensations are
worse in the evening or night than during the day or only occur in the
evening or night.
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Supportive clinical features
- Positive family history of RLS.
- Response to dopaminergic therapy.
- Periodic limb movements during wakefulness or
sleep (PLMs)*.
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Associated features
- Natural clinical course:
Onset age is variable, in patients with earlier onset (<50 years) the
symptoms are insidious, while patients with later onset have a more
aggressive course. RLS is usually a chronic disease with progressive
clinical course; in mildest forms of RLS the clinical course can be
static or intermittent.
- Sleep disturbances:
disturbed sleep is usually associated to RLS, this morbidity is however
aspecific.
- Medical evaluation/Physical examination:
physical and neurological examination is generally normal (except for
secondary RLS). Medical evaluation should be addressed to possible
causes for secondary RLS.
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Abbreviations: NIH, National Institutes of Health;
PLMs, periodic limb movements; PLMW, periodic limb movement during wakefulness;
RLS, restless legs syndrome.
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