Pediatric restless legs syndrome

Diagnostic criteria
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By Grant M Warmouth MD and Daniel G Glaze MD

The diagnostic criteria for restless legs syndrome (RLS) in adults are (1) an urge to move the limbs with or without sensations; (2) worsening at rest; (3) improvement in the sensation with activity; and (4) worsening of symptoms in the evening (Ondo 2005). Restless legs syndrome can be difficult to diagnose in children since children can report symptoms differently than adults. Therefore, different multilevel criteria were established in 2003 to help characterize this disorder in children. These diagnostic criteria differentiate between definite, probable, and possible restless legs syndrome in children, and although the multi-tiered approach may seem cumbersome, it is intended to capture the entire spectrum of childhood restless legs syndrome. The diagnostic criteria for definite restless legs syndrome in children are intended to be applied to children aged 2 through 12 years, with adult criteria utilized for those 13 years or older (Allen et al 2003).

Diagnostic criteria for definite restless legs syndrome in children (Allen et al 2003):

  • The child meets all 4 essential adult criteria for restless legs syndrome, AND
  • The child relates a description in his or her own words that is consistent with leg discomfort;
    (The child may use terms such as oowies, tickle, spiders, boo-boos, want to run, and a lot of energy in my legs, to describe symptoms. Age-appropriate descriptors are encouraged.)
    OR
  • The child meets all 4 essential adult criteria for restless legs syndrome, AND
  • Two of the 3 following supportive criteria are present:
    - Sleep disturbance for age
    - A biologic parent or sibling has definite restless legs syndrome
    - The child has a polysomnographically documented periodic limb movement index of 5 or more per hour of sleep

The diagnosis of definite restless legs syndrome in children is more stringent than the adult criteria, and this was intentionally determined to avoid over diagnosis of restless legs syndrome in children and to account for the greater extent of motor activity seen in normal children compared to adults. There are also diagnostic categories of probable and possible restless legs syndrome intended to be utilized for children aged 0 through 18 years. All the diagnostic criteria acknowledge that familial clustering is commonly seen when restless legs syndrome presents before the age of 45 years (Allen et al 2003).

Diagnostic criteria for probable restless legs syndrome in children (Allen et al 2003):

  • The child meets all essential adult criteria for restless legs syndrome , except criterion number 4 (the urge to move/sensations are worse in the evening/night), AND
  • The child has a biologic parent or sibling with definite restless legs syndrome
    OR
  • The child is observed to have behavior manifestations of lower extremity discomfort when sitting or lying, accompanied by motor movement of the affected limbs; the discomfort has characteristics of adult criteria 2,3,4,** AND
  • The child has a biologic parent or sibling with definite restless legs syndrome **
     

**Intended for use with young children or cognitively impaired children who do not have sufficient language to describe sensory component of restless legs syndrome

Diagnostic criteria for possible restless legs syndrome in children (Allen et al 2003):

  • The child has periodic limb movement disorder, AND
  • The child has a biologic parent or sibling with definite restless legs syndrome, but the child does not meet definite or probable childhood restless legs syndrome definitions