Restless Legs

Restless legs are a common complaint that cannot simply be diagnosed as restless legs syndrome without an appropriate evaluation to assess for other etiologies. A careful sleep and medication history, coupled with a complete neurologic exam, are often all that is needed to establish the correct diagnosis.

Differential Diagnosis

• Normal snoring with periodic limb movements
• Nocturnal leg cramps
  –Associated with painful, crampy calves
• Chronic insomnia
• Sleep disturbance due to medication/drugs
  –Commonly associated with decongestants, steroids, caffeine, and β-blockers
  –May be due to withdrawal from tobacco, alcohol, or illicit drugs
  –Akathisia (e.g., neuroleptics, dopamine antagonists, drug withdrawal)
  • Restless legs syndrome
    –Feelings of creeping, crawling, burning, pulling, itching, tugging, and discomfort in the legs are relieved by involuntary leg movement
    –Most patients are >50 years old
    –Often unilateral
    –Positive family history in 1/3 of cases
    –Symptoms are exacerbated by pregnancy, end-stage renal failure (dialysis increases restless legs activity; kidney transplant improves symptoms), and some medications (e.g., lithium antidepressants, dopamine antagonists)
  • Peripheral neuropathy
    –Associated with numbness, tingling, and pain
    –Leg pain not relieved by movement
    –Consider diabetes and deficiencies of vitamin B₁₂ and folate
  • Peripheral vascular disease
  • Deep venous thrombosis, venous stasis
  • Delayed deep sleep syndrome
  • Hyperthyroidism
  • Sleep deprivation
  • Sleep anxiety
  • Spinal cord/vertebral disc disease
  • Extrapyramidal symptoms due to medications (e.g., dystonic reaction, pseudoparkinsonism, neuroleptic malignant syndrome from antipsychotics)

  Workup and Diagnosis

  • History and physical examination
    –Restless legs is one of the most common causes of insomnia
    –Inquire about sleep patterns and sleep history from patient and bed partner
    –Determine whether pain is relieved by movement
    –Include complete medication history (e.g., tricyclic antidepressants are often prescribed for insomnia, but tend to worsen restless legs)
  • Initial labs may include CBC, iron studies, fasting glucose, BUN/creatinine, electrolytes, calcium, magnesium, TSH, vitamin B₁₂, and pregnancy test
    –If anemic, a workup for blood loss is indicated (e.g., colon and upper GI evaluation, urinalysis for hematuria, consider endometrial biopsy in older women)
• Sleep study to define sleep pathology

Treatment

• Withdraw medications that may cause extrapyramidal side effects (e.g., tricyclic antidepressants, reserpine, propranolol, phenothiazines, metoclopramide, methyldopa, haloperidol, oral contraceptive pills)
• Iron replacement and treatment of underlying pathology (e.g., colon cancer) for anemic patients
• Dopamine agonists (e.g., carbidopa/levodopa, pergolide, pramipexole, ropinirole) are often useful
• Carbamazepine is useful, but may result in cognitive impairment and fatigue
• Gabapentin has been very effective and has fewer side effects (especially useful in patients with concomitant neuropathy)
• Clonidine is useful in patients with hypertension
• Narcotics may be used for short-term relief
• Offer emotional support

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Leg symptoms

Read excerpts from these other book chapters related to Leg symptoms:

Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Leg symptoms

• Back to symptom: Leg symptoms: Introduction (review 1708 causes)
• Next Book Extract About Leg symptoms: Genu Varum (Bowed Legs) (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Leg symptoms

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Genu Varum (Bowed Legs) (In A Page: Pediatric Signs and Symptoms)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Genu Varum (Bowed Legs) (In A Page: Pediatric Signs and Symptoms)
• LEG PAIN (Differential Diagnosis in Primary Care)
• Edema of the leg (Handbook of Signs & Symptoms (Third Edition))
• Intermittent claudication (Handbook of Signs & Symptoms (Third Edition))
• Leg pain (Handbook of Signs & Symptoms (Third Edition))

Tools & Services:

• Bookmark this page
• Take a survey relating to Leg symptoms
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City