RLS description and diagnosis

RLS is described by the RLS foundation as a neurological condition that is characterized by the irresistible urge to move the legs. Patients will describe an uncomfortable itching or "creepy-crawling" sensation on the legs in the evenings and report that it feels like "bugs crawling under the skin." The IRLSSG has listed 4 essential criteria to clinically diagnose RLS. Physical examination is usually normal. There is no single test used which will make the diagnosis although many patients suffer from iron deficiency with low ferritin levels. While overnight polysomnography (PSG) in a sleep laboratory is helpful to assess periodic limb movements of sleep (PLMS), a PSG is not necessary to make the clinical diagnosis of RLS. PLMS are defined as a repetitive or periodic bursts of leg (or arm) electromyographic (EMG) activity during sleep associated with discrete, stereotypical movements of the legs or arms. PLMS are felt to be a related but separate disease from RLS. Although most (80%) patients with RLS with have PLMS on PSG testing, approximately 12-20% of RLS patients will not have evidence for PLMS (Montplaisir J et al., 1997). Approximately 30% of patients with PLMS will have RLS symptoms. The revised 2003 IRLSSG essential criteria include 1) An urge to move the legs accompanied or caused by uncomfortable sensations in the legs, 2) The urge to move or unpleasant sensations beginning or worsening during periods or rest or inactivity such as lying or sitting, 3) The urge to move or unpleasant sensations are partially or totally relieved by movements such as walking or stretching, at least as long as the activity continues, 4) 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 (Allen RP et al., 2003). Despite these revised guidelines, there are still difficulties in excluding mimics such as leg cramps that can confound the diagnosis and the specificity of the 4 diagnostic criteria is 84% (Hening WA et al., 2009). It has been suggested that the validated self-completed Cambridge-Hopkins RLS questionnaire (CH-RLSq) is more useful with a sensitivity of 87.2% and a specificity of 94.4%. (Allen RP et al., 2008). In addition to the diagnostic criteria, the IRLSSG developed a validated, patient-completed 10 item severity rating scale called the IRLS severity scale or IRLSSS (Walters AS et al., 2003).

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