How is RLS diagnosed?

[fritz34]

HOW IS RESTLESS LEG SYNDROME DIAGNOSED?

As we have mentioned before, there is no hard and fast test for RLS. Instead, a series of questions is asked and, depending on the answers, a diagnosis of RLS is inferred, that is,assumed.

The questions are as follows:

1. Do you have the urge to move your limbs voluntarily?

2. Do your urges/symptoms worsen with rest?

3. Do your urges/symptoms improve with movement or exercise?

4. Do your urges/symptoms worsen in the evening and at night?

The problem with this test is that the questions are unable to exclude confounding conditions ("mimics"). The following conditions also satisfy the 4 diagnostic criteria listed above:

- Cramps

- Positional discomfort

- Local leg pathology

- Similar disorders.

These "mimics" are *NOT*RLS and are far more likely to be present in the general population than true RLS. Family history may be helpful in weighting the diagnosis toward genuine RLS, since there may be a genetic component present. In most cases an extended clinical interview and workup will increase the chances of an accurate diagnosis.

Source: a number of scientific journals, including Sleep Medicine and The Journal of Clinical Sleep Medicine.

A NOTE ABOUT PAIN

Pain is associated with RLS, but normally it is confined to the jerking or leg movement that is characteristic of RLS/PLMD. However, constant pain whether severe or not is *not* RLS and should be investigated by a physician as soon as possible to screen for for fibromyalgia, myopathy and other conditions which have nothing to do with RLS/PLMD.

[Elisse3]

I get pain with my RLS it’s a deep aching pain in my calves feels like it’s in the muscle but i know it’s not. I used to get the creepy crawling feelings but not any more just the pain 🙁 Oh and the urge to move my legs it’s usually the right leg that has the RLS the worse

[Munroist]

Should the first question be:

1. Do you have the urge to move your limbs INvoluntarily?

[Elisse3 in reply to Munroist]

The urge to move your legs is voluntary it means you HAVE to move them. Involuntary is when you have plmd your legs are moving and you don’t don’t know they are moving as you are asleep

[Munroist in reply to Elisse3]

I sort of see what you mean. For me the movement is pretty much involuntary as it's an irresistible urge to move. My understanding is that if you HAVE to do something then it's no longer voluntary. When you are asleep it's clearly not voluntary either.

Maybe voluntary is not the right word to use and the definition from the website is better i.e. an irresistible urge to move.

[Elisse3 in reply to Munroist]

It took me ages many years ago to understand it . 😊 But i assure you voluntary is correct

[ChrisColumbus in reply to Munroist]

Agreed: none of the IRLSSG, RLS-UK or RLS.ORG use the term 'voluntary' or 'voluntarily' in their symptom checker. IF it's medically correct it's unhelpful in that it's too open to misinterpretation. 'Irresistible urge' or just 'urge' is much clearer. I see no reason to change the accepted diagnostic criteria.

[fritz34 in reply to ChrisColumbus]

Well, you'll have to take it up with the authors of the references cited. They are way smarter than me, I assure you.

[ChrisColumbus in reply to fritz34]

"Voluntary actions or activities are done because someone chooses to do them and not because they have been forced to do them." RLS sufferers are in effect forced to move to ease symptoms. Adding 'voluntary' to accepted definitions when it's not used by IRLSSG, RLS-UK or RLS.ORG just muddies things unnecessarily.

We should be aiming for clarity.

PS sorry to be argumentative on this point - it's just that lazy use of language by your source annoys me. I must be getting old!

PPS: as a new poster, please do complete your profile.

[smilingjane in reply to ChrisColumbus]

Sorry to but in here but I had to. I agree with Chris.Language used correctly, especially in medical situations is crucial.

If I were to touch a hot oven door and take my hand straight away because of the pain, would that be a voluntary action? no of course not.

The case with RLS is similar. There isn't a choice, you have to move.

[SueJohnson in reply to fritz34]

Although what you list is pretty much the same, the official definition is:

All of the following must be true for a diagnosis of RLS: 1) The urge to move the legs and sometimes the arms 2) The onset or worsening of symptoms during periods of inactivity when lying down and sometimes when sitting 3) Symptoms occur or worsen in the evening or bedtime. They are usually dormant in the morning 4) Symptoms get better when walking or stretching as long as it is continued. 5) Can't be explained by another medical or behavioral condition.

[Elisse3 in reply to ChrisColumbus]

I don’t think anyone certainly not me changing the criteria for RLS i was explaining what voluntary meant where RLS was concerned

[fritz34 in reply to Munroist]

No. Involuntary movement is PLMD - Periodic Limb Movement Disorder. Also known as Nocturnal Myoclonus or Myoclonic Jerk.

[ChrisColumbus in reply to fritz34]

PLMD is of course indeed often described, unnecessarily, as periodic nocturnal *involuntary* movement during sleep, as if movement during sleep can be anything but involuntary!

But 'voluntary' movement applied to RLS seems an inappropriate and unnecessary addition to the IRLSSG criteria

[Amrob]

Hi, I'm wondering who the intended audience is for this series of papers (or web pages) ?

There was a guy on here a few weeks ago talking about setting up a restless legs clinic. Are you that person?

[fritz34 in reply to Amrob]

No. My background is glass and water chemistry. I'm just a long time sufferer.

[ChrisColumbus in reply to Amrob]

I believe you're thinking of RLSLearner , a doctor in Australia who has a wife with RLS, who aims to set up the Restless Legs Clinic.

[Amrob in reply to ChrisColumbus]

That's the one! Thanks

[fritz34]

I have no agenda. But I have much information, videos, etc. but I am unsure how or even if I am permitted by the admins here to share them.

As I said, I am a retired tech type and long-time RLS/PLMD sufferer, that's all.

I am a former admin of the FB group facebook.com/groups/8623297...

[Elisse3 in reply to fritz34]

I know that group 🙄