History and exam

Key diagnostic factors

common

urge to move the legs

Usually, but not always, accompanied by uncomfortable and unpleasant sensations in the legs (dysesthesias). Begins or worsens during periods of rest or inactivity, such as lying down or sitting.[1]

dysesthesias

Patients often complain of unpleasant sensations that are poorly characterized but can be described as creeping, crawling, tingling, cramping, or aching of the extremities.[1][22]

evening or night symptoms

Symptoms usually worsen later in the day, often in the hours preceding sleep. In more severe cases, symptoms can occur in the afternoon or morning.[1][22]

relieving factors (movement, stretching, massage)

Symptoms decrease, if only momentarily, with movement, stretching, or massage.[1][22]

location in lower extremities, less commonly upper extremities and torso

Lower extremities are primarily affected, but in more severe cases, the torso or upper extremities can also be affected.[1][22]

Other diagnostic factors

common

alcohol use

Especially near bedtime, can worsen symptoms.[23]

caffeine use

Can worsen symptoms.[23]

female sex

RLS prevalence is higher in women than in men.[6]

Risk factors

strong

conditions associated with iron deficiency

Low circulating iron stores (e.g., in end-stage renal disease, undernutrition, malabsorption, or occult bleeding) are identified in some people with RLS symptoms and reversed with iron supplementation.[22]

pregnancy

Can increase the total circulating blood volume and reduce the concentration of iron, which can temporarily or permanently start the symptoms of RLS.[17] Transient RLS during pregnancy confers an approximately fourfold increased risk of developing chronic RLS.[6]

family history of RLS

Primary RLS often occurs in a familial pattern with strong penetrance and is thought to follow an autosomal-dominant inheritance in many families.[4] However, linkage and genome-wide studies suggest a more complex pattern. Several different gene loci have been associated with RLS, but no specific gene mutations have been identified.[5] Patients with familial RLS show an earlier onset of the disease compared with those with sporadic RLS.[6]

use of antidepressants, antihistamines, and metoclopramide

Antidepressants (except bupropion), sedating antihistamines, neuroleptic agents, and dopamine-blocking antiemetics such as metoclopramide can cause or worsen RLS.[23]

female sex

RLS prevalence is higher in women than in men.[6] This is thought to be predominantly due to the higher prevalence of RLS in pregnancy.[12]

weak

increased age

Studies have shown that the prevalence of RLS increases steadily with age up to 65 years for both men and women living in North America or Europe: the prevalence appears to double every 20 years and peak around 65 years. Studies on Asian patients show a less prominent age-dependency.[6]

obesity

Obesity has been associated with an increased likelihood of having RLS in many studies. However, other studies have shown no association.[6]

diabetes mellitus

Studies have demonstrated an increased prevalence of RLS in patients with type 1, type 2, and gestational diabetes.[20]

Parkinson disease

RLS appears to be more common in patients with Parkinson disease.[24] This may be due to reduced serum ferritin levels, but further studies are needed to explore this.[25]

multiple sclerosis

One systematic review found that the odds of RLS among patients with multiple sclerosis (MS) are fourfold higher compared with people without MS.[18]

peripheral neuropathy

RLS is thought to be more common in patients with peripheral neuropathy, with prevalence estimates ranging from 5.2% to 53.7%.[20]

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