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The DSM-V Sleep-Wake Disorders Work Group Proposes:
A. Each of the following criteria must be met.
The patient reports:
1. An urge to move the legs usually accompanied or caused by uncomfortable and unpleasant sensations in the legs (or for pediatric RLS the description of these symptoms should be in the child's own words).
2. The urge or unpleasant sensations begin or worsen during periods of rest or inactivity. 3. Symptoms are partially or totally relieved by movement
4. Symptoms are worse in the evening or at night than during the day or are present only at night or in the evening. (The worsening occurs independently of any differences in activity, which is important for pediatric RLS as children are sitting much of the day at school).
B. These symptoms are accompanied by significant distress or impairment in social, occupational, academic, behavioral or other important areas of functioning indicated by the presense of at least one of the following:
1. Fatigue or low energy
2. Daytime sleepiness
3. Cognitive impairments (e.g., attention, concentration, memory, learning)
4. Mood disturbance (e.g., irritability, dysphoria, anxiety)
5. Behavioral problems (e.g., hyperactivity, impulsivity, aggression)
6. Impaired academic or occupational function
7. Impaired interpersonal/social functioning
C. Frequency: Remains under discussion pending consideration of secondary data analysis
D. Duration: Remains under discussion pending considerations of secondary data analysis.
E. The occurance of the above symptoms are not solely accounted for as symptoms primary to another medical or behavioral condition (e.g., positional discomfort, leg cramps, habitual foot tapping, arthritis, neuropathic pain and peripheral ischemia).
F. The sleep difficulty occurs despite adequate age-appropriate circumstances and opportunity for sleep.
Clinically Comorbid Conditions:
1. Mental/Psychiatric Disorder (to be specified)
2. Medical Disorder (to be specified)
3. Another Disorder (to be specified)
The Proposed 2010 Revised International Restless Legs Syndrome Group Diagnostic Criteria for RLS
THESE ARE PROVISIONAL CRITERIA STILL UNDER REVIEW BY IRLSSG
Restless legs syndrome (RLS), a neurological sensorimotor disorder often profoundly disturbing sleep, is diagnosed by ascertaining a syndrome that consists of all of the following features:
1. An urge to move the legs usually but not always accompanied by or felt to be caused by uncomfortable and unpleasant sensations in the legs.1
2. The urge to move the legs and any accompanying unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting.
3. The urge to move the legs and any accompanying unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues. 2
4. The urge to move and any accompanying unpleasant sensations during rest or inactivity only occur or are worse in the evening or night than during the day. 3
5. The occurrence of the above features are not solely accounted for as symptoms primary to another medical or a behavioral condition (e.g., positional discomfort, leg cramps, habitual foot tapping, arthritis.)
Specifiers for Clinical Course of RLS4
A. Chronic-persistent RLS: Symptoms when not treated would occur on average at least twice weekly for the past year.
B. Intermittent RLS: symptoms when not treated occurred on average < 2/week for the past year, with at least 5 lifetime events.
Specifier for Clinical Significance for RLS
The symptoms of RLS cause significant distress or impairment in social, occupational, academic or other important areas of functioning by its impact on sleep, mood, cognition, health, daily activities or energy/vitality.
Footnotes: (IN THE DSM 5, THIS INFORMATION IS PROVIDED IN THE TEXT RATHER THAN AS FOOTNOTES).
1. Sometimes the urge to move the legs is present without the uncomfortable sensations and sometimes the arms or other parts of the body are involved in addition to the legs.
2. When symptoms are very severe, relief by activity may not be noticeable but must have been previously present.
3. When symptoms are very severe, the worsening at night may not be noticeable but must have been previously present.
4.The clinical course criteria do not apply for pediatric cases.
Clinical features supporting the diagnosis of RLS
The following features, although not essential for diagnosis, are closely associated with RLS and should be noted when present.
1. Presence of periodic limb movements in sleep (PLMS) or resting wake (PLMW) at rates greater than expected for age.
2. Reduction in symptoms at least initially with dopaminergic treatment.
3. Family history of RLS among first-degree relatives.