Diagnostic criteria for restless legs syndrome

RLS, a neurologic sensorimotor disease often profoundly disturbing sleep and quality of life, has variable expression influenced by genetic, environmental, and medical factors. The symptoms vary considerably in frequency from less than once a month or year to daily and severity from mildly annoying to disabling. Symptoms may also remit for various periods of time. RLS is diagnosed by ascertaining symptom patterns that meet the following 5 essential criteria, adding clinical specifiers where appropriate.

Essential diagnostic criteria (all must be met):

1. An urge to move the legs usually but not always accompanied by, or felt to be caused by, uncomfortable and unpleasant sensations in the legs*^¶.

2. The urge to move the legs and any accompanying unpleasant sensations begin or worsen during periods of rest or inactivity, such as lying down or sitting.

3. The urge to move the legs and any accompanying unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues^Δ.

4. The urge to move the legs and any accompanying unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day^◊.

5. The occurrence of the above features is not solely accounted for as symptoms primary to another medical or a behavioral condition (eg, myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort, habitual foot tapping)^§.

Specifiers for clinical course of RLS:^¥

A. Chronic-persistent RLS – Symptoms when not treated would occur on average at least twice weekly for the past year.

B. Intermittent RLS – Symptoms when not treated would occur on average <2/week for the past year, with at least 5 lifetime events.

Specifier for clinical significance of RLS:

The symptoms of RLS cause significant distress or impairment in social, occupational, educational, or other important areas of functioning by their impact on sleep, energy/vitality, daily activities, behavior, cognition, or mood.

RLS: restless legs syndrome.
* Sometimes the urge to move the legs is present without the uncomfortable sensations, and sometimes the arms or other parts of the body are involved in addition to the legs.
¶ For children, the description of these symptoms should be in the child's own words.
Δ When symptoms are very severe, relief by activity may not be noticeable but must have been previously present.
◊ When symptoms are very severe, the worsening in the evening or night may not be noticeable but must have been previously present.
§ These conditions, often referred to as "RLS mimics," have been commonly confused with RLS, particularly in surveys, because they produce symptoms that meet or at least come very close to meeting criteria 1 to 4. The list here gives some examples that have been noted as particularly significant in epidemiologic studies and clinical practice. RLS may also occur with any of these conditions, but the RLS symptoms will then be more in degree, conditions of expression, or character than those usually occurring as part of the other condition.
¥ The clinical course criteria do not apply for pediatric cases nor for some special cases of provoked RLS, such as pregnancy or drug-induced RLS, where the frequency may be high but limited to duration of the provocative condition.

Graphic 86837 Version 11.0