Diagnosis of Restless Legs Syndrome

Differential Diagnosis or Restless Legs Syndrome

Several other conditions may produce signs/symptoms that are similar to those of restless legs syndrome including:

• Muscle cramps
• Prolonged sitting or standing in one position
• Peripheral neuropathy
• Arthritis
• Insomnia
• Akathisia (motor restlessness) due to antipsychotic or neuroleptic medications
• Radiculopathy (disorder of the spinal nerve roots)
• "Painful legs and moving toes" syndrome - In this condition, pain is usually the primary symptom, not restlessness and abnormal movements are usually in the toes.
• REM (rapid eye movement) sleep disorder - Individuals with this disorder often have a history of nightmares and vocalization during sleep.

Of these conditions, peripheral neuropathy and sleep disorders are the most common conditions which may be confused with restless legs syndrome. Akathisia associated with restless legs syndrome may be distinguished from akathisia from other conditions by seeing if the patient responds to dopaminergic medication. Often, patients with akathisia have been taking dopamine blocking medication and, when the medication is discontinued, the symptoms resolve. If sleep disorder is prominent for the patient, the physician will want to rule out sleep apnea although both conditions can coexist.

Periodic leg movements may also be associated with other conditions including:

• Sleep apnea syndrome
• Neurodegenerative diseases
• Stroke
• Narcolepsy - a sleep disorder characterized by recurring episodes of sleep during the day
• An MRI of the lumbar spine may be requested to rule out cauda equina or nerve root compression

If PLMS impacts sleep to the point of causing insomnia or extreme daytime sleepiness that impacts on daily functioning and is not related to any other medical condition, then periodic limb movement disorder (PLMD) may be considered in the differential diagnosis.