Depth and Distribution of Symptoms in Restless Legs Syndrome/ Willis-Ekbom Disease

Abstract

Study Objectives: To determine the depth and distribution of sensory discomfort in idiopathic restless legs syndrome/Willis-Ekbom disease (RLS) and RLS concurrent with other leg conditions, specifically peripheral neuropathy, sciatica, leg cramps, and arthritis. Methods: RLS subjects (n = 122) were divided into 71 idiopathic RLS and 51 RLS-C, or Comorbid, groups. All subjects were examined by an RLS expert, answered standardized RLS questionnaires, and received a body diagram to draw the location and depth of their symptoms. Results: Age was 63.04 ± 12.84 years, with 77 females and 45 males. All patients had lower limb involvement and 43/122 (35.25%) also had upper limb involvement. Of the 122 subjects, 42.62% felt that the RLS discomfort was only deep, 9.84% felt that the discomfort was only superficial, and 47.54% felt both superficial and deep discomfort. There were no defining characteristics in depth or distribution of RLS sensations that differentiated those patients with idiopathic RLS from those patients with RLS associated with other comorbid leg conditions. The sensation of arthritis was felt almost exclusively in the joints and not in the four quadrants of the leg, whereas the exact opposite was true of RLS sensations. Conclusions: Depth and distribution cannot be used as a discriminative mechanism to separate out idiopathic RLS from RLS comorbid with other leg conditions. Although seen in clinical practice, the total absence of patients with non-painful RLS only in the joints in the current study attests to the rarity of this presentation and raises the possibility of misdiagnosis under these circumstances. We recommend that such patients not be admitted to genetic or epidemiological studies.

Restless Legs Syndrome: clinical features, diagnosis and a practical approach to management

“…The symptoms occur after a period of relative inactivity. The key clinical feature of RLS is the irresistible urge to move the legs, either by itself or in response to uncomfortable paraesthesia of the legs 6. Moving the legs or walking improves the urge.

International Restless Legs Syndrome Study Group consensus diagnostic criteria for restless legs syndrome

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

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

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

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

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

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“…Most patients report that the paraesthesia appear to arise deep inside the leg such as the bones or the muscles and less commonly superficially near the skin 6. Symptoms typically involve both legs but commonly alternate between the legs and are rarely purely unilateral.…”

Prevalence and Clinical Characteristics of the Restless Legs Syndrome (RLS) in Patients Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in Antioquia

“…Additionally, the frequency of the symptoms may vary from occurring daily to being occasional (Wijemanne & Ondo, 2017). In untreated patients, a gradual but irregular progression of the symptoms has been observed over time (Yeh et al, 2016). The symptoms usually affect both legs and the movements are not necessarily symmetrical or synchronous: they vary from day to day, may alternate between legs, and are rarely purely unilateral (Montplaisir et al, 1997;Rinaldi et al, 2016).…”

The Effectiveness of Foot Reflexology in the Severity of Restless Legs Syndrome in Female Patients Undergoing Dialysis: A Randomized Controlled Trial

“…Patients with RLS usually experience several complications including problems with doing daily tasks and sleep deprivation, excessive daytime sleepiness, chronic insomnia, daytime drowsiness, fatigue during the day, stress, anxiety, depression, driving problems, and disruption of the social activities and family life, which can impair the quality of life (3,6). Moreover, RLS may cause problems with the dialysis process (7).…”

“…RLS is a sensorimotor disorder that is accompanied by an uncomfortable sensation of paresthesia and involuntary and continuous movement of legs. The signs of RLS are aggregated during the periods of rest and lack of activity and are relieved by moving the involved leg (2,3). Approximately, 20% -30% of patients with hemodialysis experience RLS (4) while the prevalence of RLS is 2% -15% in the general population (5).…”