Restless legs syndrome mimicking S1 radiculopathy

Area of Science:

• Neurology
• Sleep Medicine

Background:

• Restless Legs Syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs.
• RLS often presents with sensory disturbances and is a common cause of chronic insomnia.
• Misdiagnosis of RLS is frequent due to its varied and heterogeneous symptom presentation, mimicking other conditions.

Observation:

• A case of severe, chronic idiopathic RLS, developing during pregnancy and persisting postpartum, is presented.
• The patient was misdiagnosed with S1 radiculopathy for 34 years, despite extensive investigations and treatment changes.
• Referral to a sleep clinic for concurrent insomnia led to the correct diagnosis of RLS.

Findings:

• Appropriate RLS treatment with Pramipexole, a recommended dopaminergic agent, resulted in excellent response and immediate symptom resolution.
• The URGE acronym (Urge to move, Rest induces, Getting active relieves, Evening/night worsening) summarizes key RLS symptoms.
• RLS symptoms, including pain and paresthesia, can mimic other conditions, leading to diagnostic challenges and delayed treatment.

Implications:

• This case highlights the critical importance of recognizing RLS mimics, such as S1 radiculopathy.
• Accurate RLS diagnosis is crucial for effective management and improving patient quality of life.
• Increased awareness among physicians across specialties is needed to address the common misdiagnosis of RLS.