Clinical diagnosis, investigation & management of restless legs syndrome

Restless legs syndrome (RLS) is a condition which is defined by disordered nocturnal movements of the lower limbs. It is a clinical diagnosis based on symptoms; patients tend to have difficulty describing the sensation and “patients may say things like pins and needles, Coca Cola veins, jumpity legs, aching legs.”

Diagnosis involves the description of an urge to move the legs, often accompanied by aforementioned uncomfortable sensations. Symptoms are typically present at night, are worse with rest or inactivity, and are relieved with movement. Given the classic nocturnal presentation, there is a disruption in sleep and resulting daytime somnolence. This is often when patients come to seek medical input. Other supportive factors indicating a RLS diagnosis include a response to dopaminergic therapy. Studies suggest RLS is associated with dopamine and iron transport dysregulation, and given iron is a cofactor of dopamine, this supports this theory. A strong family history is also another flag for a RLS diagnosis.