RLS Slide Library Version All Contents Copyright © WE MOVE 2001 Restless Legs Syndrome: Classification, Diagnosis and Approaches to Treatment Part 1 of 3

Restless Legs Syndrome (RLS) Characterized by... Desire to move in association with paresthesias/dysesthesias of the limbs Motor restlessness

Restless Legs Syndrome, cont’d Characterized by... Provocative factor of rest Improved by movement Evening and nighttime accentuation

RLS Diagnosis: Minimal Criteria

ICSD Criteria: RLS Unpleasant sensations in legs at night Sensations of “creeping” in the calves Relief with movement PSG shows limb movement No medical or psychiatric disorder Other sleep disorder may be present

Sensory Abnormalities Desire to move limbs associated with... Paresthesias Dysesthesias

Motor Abnormalities Restlessness...Irresistible urge to move Relief with Movement

Provocative Factor of Rest Symptoms worse or exclusively present at rest, such as while lying down or sitting Partial or temporary relief with motor activity

Evening and Nighttime Accentuation Worsening symptoms during the evening or night Symptoms typically peak near midnight Seem to follow a Circadian pattern

RLS: Associated Findings Periodic Limb Movements in Sleep (PLMS) Sleep disturbances Dyskinesias While Awake (see next slide)

Dyskinesias While Awake Involuntary and occur at rest Flexion jerk of lower extremities Sporadic, aperiodic, periodic, or in clusters Higher frequency than PLMS Perhaps a “waking counterpart” of PLMS

Two Forms of RLS Idiopathic or primary RLS –Familial –Sporadic Symptomatic or secondary RLS –Renal failure – Iron deficiency –Neuropathy – Radiculopathy –Diabetes – Pregnancy –Rheumatoid arthritis

Positive Family History In idiopathic RLS... Fifty to 60% report a close relative or relatives with RLS-associated symptoms

Disease Course Idiopathic RLS: variable age of onset Symptoms may present during late adulthood Symptoms tend to increase with age Some patients experience remissions

Clinical Characteristics Mean age of onset is 27 years Unilateral onset in 42% Arm involvement in 25% to 50%

Clinical Features of RLS Affects females more than males Sleep disturbance in about 94% –Sleep latency insomnia –Fragmented or nonrestorative sleep –Excessive daytime sleepiness in 22%