Diagnosing Restless Leg Syndrome

You’ve all seen the ads.  You might have even heard about the charges of “disease mongering” that have been bandied about, specifically about this disorder.  We are going to start covering the topic of restless legs syndrome (RLS).  (By the way, disease mongering is when someone with a financial interest in a disease, like a pharmaceutical company with an effective medicine, publicizes a disorder with the sole intention of convincing people that they are sick and therefore in need of medical treatment.)

First, let’s talk about the medical aspects and then return to some of the controversy (in later blogs).  RLS sufferers have a variety of unpleasant sensations that they describe, but often have a hard time putting a finger on exactly what they feel.  The typical description is that there is an almost irresistible sensation that causes the sufferer to move their legs. 

These unpleasant sensations are rarely described as being painful, but are definitely bothersome.  Some of the descriptive terms are “creepy-crawly” sensations, itching, “soda bubbling”, burning, or “pins and needles”.  The uncomfortable feelings occur only when relaxing and are relieved by movement, but return as the patient begins to relax again.  Since they occur during relaxing, the often cause problems with sleep, leading to insomnia.  The discomfort typically occurs in both legs, below the knees, but can be limited to one and occasion can even involve the arms.  To make matters worse RLS often coexists with a condition that causes involuntarily jerking movements of the legs during sleep, known as periodic limb movements of sleep (PLMS).

An expert group of doctors came up with 4 specific criteria that need to be present to diagnose RLS.

1. An urge to move the legs, usually accompanied by an uncomfortable or unpleasant sensation in the legs.  This should not be confused with fidgeting or habitual repetitive movements, such as foot tapping.
2. The urge to move begins or worsens during periods of rest or inactivity.  Both the physical immobility and the decreased alertness of the brain probably contribute to the symptoms.  RLS is not triggered by any specific body position, but positions that are more restful may be more prone to RLS.
3. Symptoms may be partially or totally relieved by movement (e.g., walking or stretching), at least during the actual activity.  Patients often get immediate, but short-lived relief when they are active.  As the disease progresses, sufferers may need more movement to get the relief they need.  This is why some severe RLS patients have such discomfort that they need to pace around and can’t go to sleep.
4. Symptoms occur exclusively at night or worsen at night.  A number of studies have pointed out a peak in RLS restlessness in the hours after midnight, with drop in the late morning hours.