Melody Ryan; John T. Slevin

Disclosures

Am J Health Syst Pharm. 2006;63(17):1599-1612. 

In This Article

Signs and Symptoms

Most patients with RLS who seek medical treatment will describe the urge to move and uncomfortable sensations. Because these are apparently difficult to adequately describe, a host of descriptive terms have been reported (Appendix A), including pain. Typically, patients simply state that they can only describe the sensations as uncomfortable and being deep within the leg rather than on the surface. Despite the name, RLS symptoms may also involve the arms or other body parts. As the symptoms of RLS increase in severity, these other areas may become involved, but the legs must be affected and are usually affected first and more severely than the other body parts. The urge to move or unpleasant sensations begin or worsen during rest or inactivity such as lying or sitting.[3] The more restful the position and the longer the duration, the more likely it becomes that symptoms will occur, although it appears that immobility and decreased alertness must come into play. Montplaisir et al.[4] demonstrated that motor manifestations of RLS are synchronous to the slowing of cerebral cortical activity as measured by spectral analysis of the electroencephalogram (EEG). Furthermore, patients report that activities to maintain alertness, such as engaging in conversations or playing video games, can reduce the severity of symptoms.

Early in the course of the illness, relief of the urge to move or unpleasant sensations occurs immediately or very soon after the activity begins and the effect continues as long as the activity persists. Alternatively, some patients have learned that a counterstimulus, such as rubbing their legs, may provide similar relief. As many as 82% of patients were reported by Winkelmann et al.[5] to use temperature change (e.g., taking hot or cold baths) as a coping strategy. As their RLS becomes more severe, patients may find that more and continuous movement provides progressively less relief. Although individuals with severe RLS may have apparently uniform symptoms throughout a 24-hour day, it is more characteristic that symptoms are at their worst in the evening or night. Using polysomnography for EEG-determined sleep and leg movements, Hening et al.[6] demonstrated a peak in RLS restlessness in the hours immediately after midnight.

Periodic limb movements of sleep (PLMS) were first documented in patients with RLS in 1965.[7] PLMS were originally described as a rhythmic extension of the big toe and dorsiflexion of the ankle, with occasional flexion at the knee and hip, but they may vary considerably in their motor patterns. They tend to occur during sleep and are grouped into series with a periodic pattern of one movement usually occurring every 20-40 seconds.[3] The quantification of PLMS is routinely performed in the sleep laboratory (Appendix B). PLMS are not specific to RLS and can occur in several other sleep disorders, including narcolepsy and obstructive sleep apnea, as well as in isolation.

Symptoms of RLS make sleeping difficult for many patients, and a recent population poll confirms the presence of significant daytime difficulties resulting from this condition. These problems included being late to work, making errors at work, and missing work or events because of drowsiness. Respondents with RLS also reported driving while drowsy more frequently than respondents without RLS.[11] These daytime difficulties can translate into safety, social, and economic issues for the individual and for society.

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