Symptoms of Restless Legs Syndrome
In 1995, the International Restless Legs Syndrome Study Group, then comprising 28 investigators from seven countries, defined the four primary features of RLS.
1. The desire to move the legs in association with unusual or uncomfortable sensations (paresthesias/dysesthesias) deep within the legs, usually in the calves; in some cases, the arms may also be affected. These sensations are described as creeping, burning, tingling, cramping, aching, itching, pulling, crawling, or "water flowing" deep within the affected extremities. Patients with mild or moderate RLS characterize these sensations as uncomfortable; for the most part, they are not perceived as painful. In rare cases, unusual sensations occur in the feet. In even rarer cases, these sensations may also be present in the trunk or genital area. These feelings may move from one part of the body to another or may affect only one side of the body (asymmetric). For example, one leg may have unusual sensations whereas the other does not.
2. Motor restlessness in response to or in an effort to relieve unusual sensations or discomfort. To the extent that a patient feels a compelling urge to move, these movements may be termed involuntary; however, in so far as a patient chooses which type of movement to perform, these movements are voluntary. Such movements are often repetitive and may include pacing, rocking, shaking, tossing and turning in bed, stretching, bending, marching in place, or engaging in certain repetitive exercises, such as riding an exercise bike or walking on a treadmill. Many individuals develop their own routine of stereotypical movements and tend to repeat these same movements in response to uncomfortable sensations.
3. Symptoms become obvious or worse while at rest (during periods of inactivity or relaxation) and may be temporarily diminished by voluntary movements of the affected limb(s). This restlessness is sometimes mistaken as "fidgetiness" or "nervousness." The unusual sensations and motor restlessness associated with RLS may also be provoked by prolonged periods of inactivity such as occurs during travel in a plane, train, or car.
4. Symptoms occur most frequently during the evening or the early part of the night (e.g., between 6 p.m. and 4 a.m.). Individuals with even the most severe RLS symptoms typically obtain some measure of relief during the early morning hours. Worsening of symptoms while at rest and at nighttime may be a very distinctive pattern that is unique to restless legs syndrome.