RLS-like symptoms: differential diagnosis by history and clinical assessment

Restless legs syndrome (RLS) is a distressing condition with an impact on various aspects of an individual's life. However, the condition is underrecognized due to a lack of awareness and the fact that the patient does not describe symptoms easily associated with RLS. In clinical practice, the main misdiagnoses are the following: circulation problems, venous diseases, arthritis, back or spinal injury. It is possible to make a diagnosis of RLS based on the patient's medical history and physical examination, in conjunction with the essential criteria of International RLS Study Group (IRLSSG). If the patient fulfils each of the four criteria, a diagnosis of RLS is likely. Supportive features (including response to a dopaminergic agent, and positive family history for RLS) as well as associated features (natural clinical course, sleep disturbance, normal findings on physical examination) are not necessary for a diagnosis to be made but may support the diagnosis in ambiguous cases. In most conditions that may be confused with RLS (sleep starts, nocturnal leg cramps, neuroleptic-induced akathisia, painful leg and moving toe syndrome), RLS can be excluded for the lack of response to the dopaminergic treatment, as well as for the lack of the typical circadian profile.