is suspected. There are several potential diagnostic dilemmas. Akathisia representsan inner sense of restlessness accompanied by an intense desire to move. Thesepatients do not typically complain of limb paresthesia. The restlessness is usuallygeneralized, but may be most prominent in the legs. The condition is usually associ-ated with the use of neuroleptic (dopamine blocking) drugs. Akathisia patients gener-ally have milder sleep complaints and less severe PLMS than is seen in RLS.
Akathisia tends to be associated with whole-body rocking movements or marchingin place, and it may concurrently show mild extrapyramidal features or tardivedyskinesia.Painful legs and moving toes present with neuropathic leg pain associated withpersistent, semi-rhythmic toe movements, which cannot easily be reproduced voli-tionally, and may be only partially suppressed.
The condition may be associatedwithperipheral nerve injuryorminor leg trauma, butmany patients haveno identifiableetiology or pathology. This syndrome differs clinically from RLS in that the sensorysymptoms are described as painful, are not worsened by immobility, are not neces-sarily worse at night, and are not improved with movement.Nocturnal leg cramps are a common multifactorial disorder manifested by parox-ysmal, disorganized spasms that usually involve the feet or calf muscles. The presen-tation is quite different from that of RLS, but patients may initially describe their RLSsymptoms simply as ‘‘night cramps,’’ which can lead to misdiagnosis if a more exten-sive history is not taken.Other conditions in the differential diagnosis include body positional discomfortsyndrome, where patients simply cannot find a comfortable position to lie in, neuro-pathic or radicular pain, and generalized anxiety.
Historically, epidemiologic studies of RLS were limited by the subjective nature of thedisease,thelackofstandardizeddiagnosticcriteria,andtheindolentonsetofthecondi-tion. Ekbom initially estimated a 5% prevalence of RLS in the general population.
Subsequent general population prevalence surveys varied from 1% to 29%.
Similar to smaller reports, 9.6% of all people met the criteria for RLS. Ingeneral, northern European countries showed increased prevalence compared withMediterranean countries. The vast majority of these persons were not previously diag-nosed, despite frequently reporting symptoms to their physicians.RLS can occur in all ethnic backgrounds; however, most feel that Caucasians aremost affected. While most Caucasian surveys show an approximate 10% prevalence,surveys in Asian populations report much lesser prevalences (
). People of African descent have never been specifically studied, but anecdotally African Ameri-cans rarely present with RLS. It is unclear whether this represents a true lesser prev-alence, or rather differences in medical sophistication and referral patterns. Womenusually have higher RLS rates.
GENETICS OF RLS
In 40%–60% of cases, a family history of RLS can be found, although this is often notinitially reported by the patient.
Twin studies also show a very high concordancerate.
Most pedigrees suggest an autosomal dominant (AD) pattern,
althoughan autosomal recessive (AR) pattern with a very high carrier rate is possible. Todate at least 6 gene linkages have been shown in family studies, 5 risk-factor genesidentified through genome-wide association studies, and 1 through candidate gene
Restless Legs Syndrome