Table 3

Differential diagnosis

Meeting Criteria

Comment

Disorder


Urge to move & unpleasant sensations in the legs

Symptoms begin/worsen during periods of rest or inactivity.

Symptoms relieved with movement

Symptoms worse in the evening/night

Definite RLS

Awake symptom diagnosis made by clinical history; uncomfortable urge to move with or without deep creepy-crawling sensation brought on at time of inactivity or rest (sitting or lying); immediate relief either complete or partial with movement; symptomatic relief is persistent as long as movement continues; presence of circadian pattern with peak around midnight and nadir in the morning

RLS


Urge to move -

Symptoms begin/worsen during periods of rest or inactivity.

Symptoms relieved with movement

Orthostatic hypotension

Neurological disorder with "urge to move"

Feeling of restlessness which may be localized in legs, brought on by sitting still; should not occur while lying down but might be relieved by movement; occurs in patients with orthostatic hypotension

Hypotensive akathisia


Unpleasant sensations in the legs

Symptoms relieved with movement

Symptoms worse in the evening/night

No positive response to dopaminergic drugs

Pain Disorder

Dysesthesias and pain in the legs, frequently one-sided, often radicular arrangement of sensory symptoms, atrophic changes of musculature, no urge to move the legs, symptoms can be initiated by sitting and lying and improve by movement, usually neurological and neurophysiological deficits, does not respond to dopaminergic therapy

Radiculopathy


Unpleasant sensations in the legs

Symptoms relieved with movement

Symptoms worse in the evening/night -

Vascular Disorder

Dysesthesias and pain in the legs. May appear to occur with or after rest but is associated with or occurs after periods of standing/walking; ntensity increased by movement and usually relieved by prolonging rest often best in a lying position, no urge to move, no circadian pattern, usually no sleep disturbances, frequently associated with skin alterations and edemas. Often associated with vascular disease, circadian pattern if any relates more to activity levels

Vascular claudication, neurogenic claudication


Urge to move

Symptoms begin/worsen during periods of rest or inactivity

Periodic limb movements

History of neuroleptics

Neurological disorder with "urge to move"

Looks like very severe RLS affecting the whole body -but usually without any sensations of pain reported by RLS patients often no relief with movement;, should have a history of specific medication exposure

Neuroleptic-induced akathisia


Unpleasant sensations in the legs

Symptoms begin/worsen during periods of rest or inactivity

No positive response to dopaminergic drugs

Pain Disorder

Sensory symptoms commonly reported as numbness, burning, and pain; not as common in RLS; numbness is rare in RLS, no urge to move; sensory symptoms usually present throughout the day, less frequent at night, complete and persistent relief is not obtained while walking or during sustained movement

Neuropathy

No periodic limb movements


Unpleasant sensations in the legs

Symptoms begin/worsen during periods of rest or inactivity.

Pain Disorder

Patients after surgeries frequently do not remember the origin of their complaints. They almost always report symptoms in the legs or in the back, when lying or sitting or during movement.

Chronic pain syndrome (lumbal, cervical)


Unpleasant sensations in the legs

Symptoms relieved with movement

Disorders without "urge to move"

Often comes on with prolonged sitting or lying in the same position but usually relieved by a simple change in position, unlike RLS, which often returns when change of position, movement, or walking is not continued, no circadian pattern

Positional discomfort


Symptoms relieved with movement

Symptoms worse in the evening/night

Neurological disorder with "urge to move"

Leg cramps or charley horse cramps can come on at night and are relieved with stretching or walking; no urge to move; experienced as a usually painful muscular contraction, often involving the calf muscles, unlike RLS sensations; sudden onset, occurs not regularly, short duration, usually palpable contractions

Nocturnal leg cramps


Unpleasant sensations in the legs

Symptoms worse in the evening/night

Sleep disturbance

Sleep-related Disorders

Involuntary muscle (myoclonic) twitch which occurs during falling asleep, described as an electric shock or falling sensation which can cause movements of legs and arms. Occurring once or twice per night, frequent in the population.

Hypnic jerks


Unpleasant sensations in the legs

Symptoms worse in the evening/night

Sleep disturbance

Psychiatric Disorders

Depressive disorder with somatic symptoms like psychomotor agitation and diverse somatic complaints, circadian pattern with early awakening in the morning, daytime sleepiness.

Depression, various forms with somatic syndrome


Urge to move

No positive response to dopaminergic drugs

No sleep disturbance

Neurological disorder with "urge to move"

Occurs in subjects who fidget, especially when bored or anxious, but usually do not experience associated sensory symptoms, discomfort, or conscious urge to move; symptoms do not bother the subject, usually lacks a circadian pattern, more of a type of psychic restlessness, less sleep disturbances, no response to dopaminergic medication

Volitional movements, foot tapping, leg rocking


Urge to move

No positive response to dopaminergic drugs

No periodic limb movements

Disorders without "urge to move"

Discomfort centered more in joints, may not have prominent circadian pattern as seen in RLS, increase of symptoms during movement .does not respond to dopaminergics, usually no PLMs

Arthritis, lower limb


Urge to move

Sleep disturbance

Disorders without "urge to move"

Multiple, alternating, multiform complaints in muscle groups and joints; sometimes leg-accentuated but mostly whole body affected; frequent sleep disorders, no circadian pattern, no relief by movement, no dopaminergic response

Fibromyalgia


Urge to move

Vascular Disorder

Discomfort in legs, some relief with massage or inactivity

Varicose veins


Garcia-Borreguero et al. BMC Neurology 2011 11:28   doi:10.1186/1471-2377-11-28

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