GPAtlas🧭 When to suspect
Restless legs syndrome (RLS), also called Willis–Ekbom disease, is a common sensorimotor disorder defined by an irresistible urge to move the legs, usually accompanied by unpleasant creeping, crawling, pulling or aching sensations.
It is a clinical diagnosis – there is no confirmatory test – resting on five essential criteria.
Suspect it when symptoms are worse at rest, relieved by movement, and worse in the evening or at night.
The key primary-care task is to separate primary (idiopathic) disease, which is lifelong and often familial, from secondary RLS driven by a reversible cause – chiefly iron deficiency, chronic kidney disease (CKD), pregnancy, and culprit medications.
The five criteria are remembered as URGE.
| Essential criterion (all five required) | Detail and clinical note |
|---|---|
| U – Urge to move the legs | • Usually accompanied by uncomfortable sensations (creeping, crawling, pulling, aching, itching) • Occasionally the urge occurs without sensation |
| R – Worse at Rest | Begins or worsens during rest or inactivity, such as lying or sitting. |
| G – Relieved by movement (Getting up) | Partially or totally relieved by walking or stretching, at least for as long as the activity continues. |
| E – Worse in the Evening/night | Symptoms are worse in the evening or at night, or occur only then. |
| Not better explained by a mimic | Not solely accounted for by another condition – e.g. nocturnal leg cramps, positional discomfort, arthralgia, venous stasis, peripheral neuropathy or habitual foot-tapping. |
All five criteria must be present to diagnose RLS. Before reaching for a prescription, the two highest-value actions are to check iron status and to review the drug list for agents that provoke or worsen symptoms.
|
⚠️ Common pitfall • Labelling every night-time leg symptom as RLS. • Nocturnal leg cramps (painful, palpable muscle contraction with no urge to move), peripheral neuropathy (constant burning or numbness, not relieved by movement) and akathisia (generalised, often drug-induced inner restlessness) are common mimics. • The discriminator is the URGE pattern – an urge to move that is relieved by movement, worse at rest, and worse in the evening. |
Source: NICE · International RLS Study Group (IRLSSG)
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