What is restless legs syndrome (RLS)?

Updated: Oct 09, 2018
  • Author: Sufen Chiu, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
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Restless legs syndrome (RLS)

Leg discomfort in patients with RLS is associated with a strong urge to move the legs, and the relief with movement may ultimately reveal a pathophysiology similar to that of akathisia. The response to dopaminergic agents and the association with ADHD indicate that RLS is associated with dopaminergic dysfunction. Most patients with RLS have periodic limb movement disorder in sleep (PLMS). The pediatric population with RLS often experiences inattention, overactivity, and mood lability from the associated disruption or fragmentation of sleep.

According to DSM-5, the urge to move the legs must also include all of the following: begins/worsens during periods of rest or inactivity, partially or totally relieved by movement, and is worse in the evening or at night than during the day. The symptoms can delay sleep onset and awaken the individual from sleep. Onset of RLS is usually in the second or third decade of life.

Diagnosis in children may be challenging because children have difficult reporting an "urge." Children and adolescents also report restlessness during the day from prolonged sitting, so a reported increase in restless at night is key to diagnosis. The International Restless Legs Syndrome Study Group published a detailed review regarding the difficulty of diagnosing RLS in the pediatric population. [9] They highlighted the need to rule out common mimics such as positional discomfort, sore leg muscles, sprains/strains, positional ischemia, dermatitis, bruises, and growing pains.

RLS may be precipitated by iron deficiency and/or genetic risk. Several genetic markers have been identified to be associated with RLS. African Americans and Asians appear to be less at risk. Serotonergic antidepressants can induce or aggravate RLS.

Other DSM-5 sleep disorders that are not discussed here include Substance/Medication-Induced Sleep Disorder, Other Specified Insomnia Disorder, Unspecified Insomnia Disorder, Other Specified Hypersomnolence Disorder, Unspecified Hypersomnolence Disorder, Other Specified Sleep-Wake Disorder, and Unspecified Sleep-Wake Disorder

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