Restless legs syndrome

What it is

Restless legs syndrome is a common sensory complaint in the elderly. It is characterized by ill-defined leg discomfort that occurs in the evening when the patient is reclining, or at night when the patient is trying to sleep, and the uncomfortable sensation is relieved by movement. It is a sensory, not a motor, syndrome, and that one line accounts for both the examination and the treatment. Put in one line elsewhere, it is an urge to move the legs at night, worse at rest and better with movement.

How it presents

Examination is normal or shows at most mild distal sensory loss. There are no motor changes and no reflex changes. It also appears among the complaints listed around fibromyalgia, alongside poor sleep, exhaustion, muscle cramps, insomnia and chronic diffuse pain. It has to be told apart from akathisia, which reads much like it. An uncomfortable sensation with a constant need to move around, so that the patient can sit still for only a few minutes at a time, appearing in a patient who has been taking olanzapine, is akathisia and not restless legs syndrome; tardive dyskinesia and acute dystonia are the other two on that same list of drug effects.