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RLS/WED: Criteria, Differential Diagnosis and Prevalence of Occurrence

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Restless Legs Syndrome/Willis Ekbom Disease

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Abstract

Restless legs syndrome (RLS), also known as Willis–Ekbom disease (WED), is a common neurosensorimotor disorder. The clinical importance of RLS/WED is underlined by epidemiological studies showing that one in 100 people may experience RLS/WED symptoms which seriously impact quality of life [1]. The diagnosis is based primarily on patient self-report and history. However, a number of diseases have symptoms that are often confused with those of RLS/WED, and other conditions are associated with higher rates of RLS/WED. The first official operational diagnostic criteria for RLS/WED became available in 1990 when the American Sleep Disorder Association published the International Classification of Sleep Disorders (ICSD). The ICSD classified RLS/WED as one of the “Intrinsic Sleep Dorders” under the subgroup of “dyssomnias” and defined RLS/WED by “disagreeable leg sensations, usually prior onset, that causes an almost irresistible urge to move the legs.

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References

  1. Earley CJ, Silber MH. Restless legs syndrome: understanding its consequences and the need for better treatment. Sleep Med. 2010;11:807–15.

    Article  PubMed  Google Scholar 

  2. Ondo WG. Common comorbidities and differential diagnosis of restless legs syndrome. J Clin Psychiatry. 2014;75(3):e06.

    Article  PubMed  Google Scholar 

  3. Ekbom KA. Restless legs. Acta Med Scand. 1945;Suppl 158:1–123.

    Google Scholar 

  4. Ekbom KA. Restless legs syndrome. Neurology. 1960;10:868–73.

    Article  CAS  PubMed  Google Scholar 

  5. American Sleep Disorders Association. Diagnostic Classification Steering Committee. The International classification of sleep disorders: diagnostic and coding manual. Rochester, MN, U.S.A.: ASDA; 1990.

    Google Scholar 

  6. Walters AS. Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group. Mov Disord. 1995;10:634–42.

    Article  CAS  PubMed  Google Scholar 

  7. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisir J. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4:101–19.

    Article  PubMed  Google Scholar 

  8. Allen RP, Burchell BJ, MacDonald B, Hening WA, Earley CJ. Validation of the self-completed Cambridge-Hopkins questionnaire (CH-RLSq) for ascertainment of restless legs syndrome (RLS) in a population survey. Sleep Med. 2009;10:1097–100.

    Article  PubMed  Google Scholar 

  9. Popat RA, Van Den Eeden SK, Tanner CM, Kushida CA, Rama AN, Black JE, et al. Reliability and validity of two self-administered questionnaires for screening restless legs syndrome in population-based studies. Sleep Med. 2010;11:154–60.

    Article  PubMed  Google Scholar 

  10. Allen RP, Stillman P, Myers AJ. Physician-diagnosed restless legs syndrome in a large sample of primary medical care patients in western Europe: Prevalence and characteristics. Sleep Med. 2010;11:31–7.

    Article  PubMed  Google Scholar 

  11. Ferini-Strambi L. RLS-like symptoms: differential diagnosis by history and clinical assessment. Sleep Med. 2007:S3–6.

    Google Scholar 

  12. Hening WA, Allen RP, Washburn M, Lesage SR, Earley CJ. The four diagnostic criteria for Restless Legs Syndrome are unable to exclude confounding conditions (“mimics”). Sleep Med. 2009;10:976–81.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Holmes R, Tluk S, Metta V, Patel P, Rao R, Williams A, et al. Nature and variants of idiopathic restless legs syndrome: observations from 152 patients referred to secondary care in the UK. J Neural Transm. 2007;114:929–34.

    Article  CAS  PubMed  Google Scholar 

  14. Winkelman J, Gagnon A, Clai AG. Sensory symptoms in restless legs syndrome: the enigma of pain. Sleep Med. 2013;14:934–42.

    Article  PubMed  Google Scholar 

  15. Karroum EG, Leu-Semenescu S, Arnulf I. Topography of the sensations in primary restless legs syndrome. J Neurol Sci. 2012;320:26–31.

    Article  PubMed  Google Scholar 

  16. Buchfuhrer MJ. Restless legs syndrome (RLS) with expansion of symptoms to the face. Sleep Med. 2008;9:188–90.

    Article  PubMed  Google Scholar 

  17. Shukla G, Gupta A, Pandey RM, Kalaivani M, Goyal V, Srivastava A, Behari M. What features differentiate unilateral from bilateral restless legs syndrome? A comparative observational study of 195 patients. Sleep Med. 2014;15(6):714–9.

    Article  PubMed  Google Scholar 

  18. Michaud M, Lavigne G, Desautels A, Poirier G, Montplaisir J. Effects of immobility on sensory and motor symptoms of restless legs syndrome. Mov Disord. 2002;17:112–5.

    Article  PubMed  Google Scholar 

  19. Birinyi PV, Allen RP, Lesage S, Dean T, Earley CJ. Investigation into the correlation between sensation and leg movement in restless legs syndrome. Mov Disord. 2005;20:1097–103.

    Article  PubMed  Google Scholar 

  20. Garcia-Borreguero D, Kohnen R, Boothby L, Tzonova D, Larrosa O, Dunkl E. Validation of the multiple suggested immobilization test: a test for the assessment of severity of restless legs syndrome (Willis-Ekbom Disease). Sleep. 2013;36:1101–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tzonova D, Larrosa O, Calvo E, Granizo JJ, Williams AM, de la Llave Y, et al. Breakthrough symptoms during the daytime in patients with restless legs syndrome (Willis-Ekbom disease). Sleep Med. 2012;13:151–5.

    Article  CAS  PubMed  Google Scholar 

  22. Hening WA, Walters AS, Wagner M, Rosen R, Chen V, Kim S, et al. Circadian rhythm of motor restlessness and sensory symptoms in the idiopathic restless legs syndrome. Sleep. 1999;22:901–12.

    Article  CAS  PubMed  Google Scholar 

  23. Trenkwalder C, Hening WA, Walters AS, Campbell SS, Rahman K, Chokroverty S. Circadian rhythm of periodic limb movements and sensory symptoms of restless legs syndrome. Mov Disord. 1999;14:102–10.

    Article  CAS  PubMed  Google Scholar 

  24. Michaud M, Dumont M, Selmaoui B, Paquet J, Fantini ML, Montplaisir J. Circadian rhythm of restless legs syndrome: relationship with biological markers. Ann Neurol. 2004;55:372–80.

    Article  CAS  PubMed  Google Scholar 

  25. Michaud M, Dumont M, Paquet J, Desautels A, Fantini ML, Montplaisir J. Circadian variation of the effects of immobility on symptoms of restless legs syndrome. Sleep. 2005;28:843–6.

    Article  PubMed  Google Scholar 

  26. Allen RP, Dean T, Earley CJ. Effects of rest-duration, time-of-day and their interaction on periodic leg movements while awake in restless legs syndrome. Sleep Med. 2005;6:429–34.

    Article  PubMed  Google Scholar 

  27. Moller C, Wetter TC, Koster J, Stiasny-Kolster K. Differential diagnosis of unpleasant sensations in the legs: prevalence of restless legs syndrome in a primary care population. Sleep Med. 2010;11:161–6.

    Article  PubMed  Google Scholar 

  28. Benes H, Kohnen R. Validation of an algorithm for the diagnosis of restless legs syndrome: The Restless Legs Syndrome-Diagnostic Index (RLS-DI). Sleep Med. 2009;10:515–23.

    Article  PubMed  Google Scholar 

  29. Kushida C, Martin M, Nikam P, Blaisdell B, Wallenstein G, Ferini-Strambi L, et al. Burden of restless legs syndrome on health-related quality of life. Qual Life Res. 2007;16:617–24.

    Article  PubMed  Google Scholar 

  30. Happe S, Reese JP, Stiasny-Kolster K, Peglau I, Mayer G, Klotsche J, et al. Assessing health-related quality of life in patients with restless legs syndrome. Sleep Med. 2009;10:295–305.

    Article  PubMed  Google Scholar 

  31. Wesstrom J, Nilsson S, Sundstrom-Poromaa I, Ulfberg J. Health-related quality of life and restless legs syndrome among women in Sweden. Psychiatry Clin Neurosci. 2010;64:574–9.

    Article  PubMed  Google Scholar 

  32. McCrink L, Allen RP, Wolowacz S, Sherrill B, Connolly M, Kirsch J. Predictors of health-related quality of life in sufferers with restless legs syndrome: a multi-national study. Sleep Med. 2007;8:73–83.

    Article  PubMed  Google Scholar 

  33. Trenkwalder C, Garcia-Borreguero D, Montagna P, Lainey E, de Weerd AW, Tidswell P, et al. Ropinirole in the treatment of restless legs syndrome: results from the TREAT RLS 1 study, a 12 week, randomised, placebo controlled study in 10 European countries. J Neurol Neurosurg Psychiatry. 2004;75:92–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Oertel WH, Benes H, Garcia-Borreguero D, Hogl B, Poewe W, Montagna P, et al. Rotigotine transdermal patch in moderate to severe idiopathic restless legs syndrome: a randomized, placebo-controlled polysomnographic study. Sleep Med. 2010;11:848–56.

    Article  PubMed  Google Scholar 

  35. Montplaisir J, Boucher S, Poirier G, Lavigne G, Lapierre O, Lesperance P. Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 patients diagnosed with new standard criteria. Mov Disord. 1997;12:61–5.

    Article  CAS  PubMed  Google Scholar 

  36. Ferri R, Zucconi M, Manconi M, Bruni O, Ferini-Strambi L, Vandi S, et al. Different periodicity and time structure of leg movements during sleep in narcolepsy/cataplexy and restless legs syndrome. Sleep. 2006;29:1587–94.

    Article  PubMed  Google Scholar 

  37. Ferri R, Manconi M, Plazzi G, Bruni O, Cosentino FII, Ferini-Strambi L, et al. Leg movements during wakefulness in restless legs syndrome: Time structure and relationships with periodic leg movements during sleep. Sleep Med. 2012;13:529–35.

    Article  PubMed  Google Scholar 

  38. Ferini-Strambi L, Walters AS, Sica D. The relationship among restless legs syndrome (Willis-Ekbom Disease), hypertension, cardiovascular disease, and cerebrovascular disease. J Neurol. 2014;261(6):1051–68.

    Article  PubMed  Google Scholar 

  39. Pennestri MH, Montplaisir J, Colombo R, Lavigne G, Lanfranchi PA. Nocturnal blood pressure changes in patients with restless legs syndrome. Neurology. 2007;68:1213–8.

    Article  CAS  PubMed  Google Scholar 

  40. Dauvilliers Y, Rompre S, Gagnon JF, Vendette M, Petit D, Montplaisir J. REM sleep characteristics in narcolepsy and REM sleep behavior disorder. Sleep. 2007;30:844–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Fulda S, Rusakova I, Ferri R, Bassetti CL, Pisarenco I, Colamartino E, et al. P6. Leg movements during sleep in patients with obstructive sleep apnea. Clin Neurophysiol. 2012;123:e104.

    Article  Google Scholar 

  42. Hoque R, Chesson AL Jr. Pharmacologically induced/exacerbated restless legs syndrome, periodic limb movements of sleep, and REM behavior disorder/REM sleep without atonia: literature review, qualitative scoring, and comparative analysis. J Clin Sleep Med. 2010;6:79–83.

    PubMed  PubMed Central  Google Scholar 

  43. Pennestri MH, Whittom S, Adam B, Petit D, Carrier J, Montplaisir J. PLMS and PLMW in healthy subjects as a function of age: prevalence and interval distribution. Sleep. 2006;29:1183–7.

    Article  PubMed  Google Scholar 

  44. Stiasny-Kolster K, Kohnen R, Carsten Möller J, Trenkwalder C, Oertel WH. Validation of the “L-DOPA test” for diagnosis of restless legs syndrome. Mov Disord. 2006;21:1333–9.

    Article  PubMed  Google Scholar 

  45. Winkelman JW, Sethi KD, Kushida CA, Becker PM, Koester J, Cappola JJ, et al. Efficacy and safety of pramipexole in restless legs syndrome. Neurology. 2006;67:1034–9.

    Article  CAS  PubMed  Google Scholar 

  46. Trenkwalder C, Benes H, Poewe W, Oertel WH, Garcia-Borreguero D, de Weerd AW, et al. Efficacy of rotigotine for treatment of moderate-to-severe restless legs syndrome: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2008;7:595–604.

    Article  CAS  PubMed  Google Scholar 

  47. Allen RP, La Buda MC, Becker P, Earley CJ. Family history study of the restless legs syndrome. Sleep Med. 2002;3(Suppl):S3–7.

    Article  PubMed  Google Scholar 

  48. Ondo WG, Vuong KD, Wang Q. Restless legs syndrome in monozygotic twins: clinical correlates. Neurology. 2000;55:1404–6.

    Article  CAS  PubMed  Google Scholar 

  49. Xiong L, Jang K, Montplaisir J, Levchenko A, Thibodeau P, Gaspar C, et al. Canadian restless legs syndrome twin study. Neurology. 2007;68:1631–3.

    Article  CAS  PubMed  Google Scholar 

  50. Gamaldo C, Benbrook AR, Allen RP, Oguntimein O, Earley CJ. Evaluating daytime alertness in individuals with Restless Legs Syndrome (RLS) compared to sleep restricted controls. Sleep Med. 2009;10:134–8.

    Article  PubMed  Google Scholar 

  51. Allen RP, Barker PB, Horska A, Earley CJ. Thalamic glutamate/glutamine in restless legs syndrome: increased and related to disturbed sleep. Neurology. 2013;80:2028–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165:1286–92.

    Article  PubMed  Google Scholar 

  53. Pantaleo NP, Hening WA, Allen RP, Earley CJ. Pregnancy accounts for most of the gender difference in prevalence of familial RLS. Sleep Med. 2010;11:310–3.

    Article  PubMed  Google Scholar 

  54. Allen RP, Earley CJ. Defining the phenotype of the restless legs syndrome (RLS) using age-of-symptom-onset. Sleep Med. 2000;1:11–9.

    Article  CAS  PubMed  Google Scholar 

  55. Saletu B, Gruber G, Saletu M, Brandstatter N, Hauer C, Prause W, et al. Sleep laboratory studies in restless legs syndrome patients as compared with normals and acute effects of ropinirole. 1. Findings on objective and subjective sleep and awakening quality. Neuropsychobiology. 2000;41:181–9.

    Article  CAS  PubMed  Google Scholar 

  56. Winkelman JW, Finn L, Young T. Prevalence and correlates of restless legs syndrome symptoms in the Wisconsin Sleep Cohort. Sleep Med. 2006;7:545–52.

    Article  PubMed  Google Scholar 

  57. Winkelman JW, Redline S, Baldwin CM, Resnick HE, Newman AB, Gottlieb DJ. Polysomnographic and health-related quality of life correlates of restless legs syndrome in the Sleep Heart Health Study. Sleep. 2009;32:772–8.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Allen RP, Earley CJ. Validation of the Johns Hopkins restless legs severity scale. Sleep Med. 2001;2:239–42.

    Article  PubMed  Google Scholar 

  59. Earley CJ, Allen RP. Pergolide and carbidopa/levodopa treatment of the restless legs syndrome and periodic leg movements in sleep in a consecutive series of patients. Sleep. 1996;19:801–10.

    Article  CAS  PubMed  Google Scholar 

  60. Neau JP, Marion P, Mathis S, Julian A, Godeneche G, Larrieu D, et al. Restless legs syndrome and pregnancy: follow-up of pregnant women before and after delivery. Eur Neurol. 2010;64:361–6.

    Article  PubMed  Google Scholar 

  61. Manconi M, Ulfberg J, Berger K, Ghorayeb I, Wesstrom J, Fulda S, et al. When gender matters: restless legs syndrome. Report of the “RLS and woman” workshop endorsed by the European RLS Study Group. Sleep Med Rev. 2012;16:297–307.

    Article  PubMed  Google Scholar 

  62. Cesnik E, Casetta I, Turri M, Govoni V, Granieri E, Strambi LF, et al. Transient RLS during pregnancy is a risk factor for the chronic idiopathic form. Neurology. 2010;75:2117–20.

    Article  CAS  PubMed  Google Scholar 

  63. Allen RP, Auerbach S, Bahrain H, Auerbach M, Earley CJ. The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia. Am J Hematol. 2013;88:261–4.

    Article  PubMed  Google Scholar 

  64. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.

    Google Scholar 

  65. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

    Book  Google Scholar 

  66. Kerr S, McKinon W, Bentley A. Descriptors of restless legs syndrome sensations. Sleep Med. 2012;13:409–13.

    Article  PubMed  Google Scholar 

  67. Gemignani F, Vitetta F, Brindani F, Contini M, Negrotti A. Painful polyneuropathy associated with restless legs syndrome. Clinical features and sensory profile. Sleep Med. 2013;14(1):79–84. doi:10.1016/j.sleep.2012.08.013.

    Article  PubMed  Google Scholar 

  68. Bachmann CG, Rolke R, Scheidt U, Stadelmann C, Sommer M, Pavlakovic G, et al. Thermal hypoaesthesia differentiates secondary restless legs syndrome associated with small fibre neuropathy from primary restless legs syndrome. Brain. 2010;133:762–70.

    Article  PubMed  Google Scholar 

  69. Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165:1286–92.

    Article  PubMed  Google Scholar 

  70. Allen RP, Bharmal M, Calloway M. Prevalence and disease burden of primary restless legs syndrome: results of a general population survey in the United States. Mov Disord. 2011;26:114–20.

    Article  PubMed  Google Scholar 

  71. Silber MH, Becker PM, Earley C, Garcia-Borreguero D, Ondo WG, Willis-Ekbom Dis F. Willis-Ekbom disease foundation revised consensus statement on the management of restless legs syndrome. Mayo Clin Proc. 2013;88:977–86.

    Article  PubMed  Google Scholar 

  72. Fuhs A, Dunya Bentama D, Antkowiak R, Mathis J, Trenkwalder C, Berger K. Effects of short- and long-term variations in RLS severity on perceived health status—the COR-study. PLoS ONE. 2014;9(4):e94821.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Picchietti DL, Bruni O, de Weerd AI, et al. Pediatric restless legs syndrome diagnostic criteria: an update by the International Restless Legs Syndrome Study Group. Sleep Med. 2013;14(12):1253–1259.

    Google Scholar 

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  1. Sleep Disorders Center, Department of Clinical Neuroscience, Università Vita-Salute San Raffaele, Milan, Italy

    Luigi Ferini-Strambi

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  1. Luigi Ferini-Strambi
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Correspondence to Luigi Ferini-Strambi .

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  1. Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital, Lugano, Switzerland

    Mauro Manconi

  2. Sleep Research Institute, Madrid, Spain

    Diego García-Borreguero

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Ferini-Strambi, L. (2017). RLS/WED: Criteria, Differential Diagnosis and Prevalence of Occurrence. In: Manconi, M., García-Borreguero, D. (eds) Restless Legs Syndrome/Willis Ekbom Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6777-3_1

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