title: Nature and variants of idiopathic restless legs syndrome: observations from 152 patients referred to secondary care in the UK.
abstract: BACKGROUND
  Heterogeneity in clinical presentation and daytime somnolence in restless legs syndrome (RLS) have been poorly explored in the UK.
  
  
  METHODS
  Analysis of database of 152 cases of primary RLS compiled from clinical consultation using a structured questionnaire administration and clinical examination, spanning six years of referral. Standard evaluations included use of the Epworth Sleepiness Scale (ESS). Secondary RLS was excluded and polysomnography performed in some when clinically indicated.
  
  
  RESULTS
  The mean duration of RLS before appropriate treatment initiation was 12.7 years (age range of patients 26-90 years). 79% of patients had insomnia while 30% had excessive daytime sleepiness (EDS). Severe pain, restless arms and paroxysmal RLS causing lifestyle alterations also occurred.
  
  
  CONCLUSIONS
  This study suggests that there is considerable delay before appropriate therapy in RLS. A large number have EDS and insomnia among others, is the commonest presenting feature. Phenotypic heterogeneity may cause diagnostic difficulty.
authors.affiliation: Guys' Kings College and St Thomas' Schools of Medicine, London, U.K.
authors.forename: R
authors.initials: R
authors.lastname: Holmes
authors.forename: S
authors.initials: S
authors.lastname: Tluk
authors.forename: V
authors.initials: V
authors.lastname: Metta
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.forename: R
authors.initials: R
authors.lastname: Rao
authors.forename: A
authors.initials: A
authors.lastname: Williams
authors.forename: K R
authors.initials: KR
authors.lastname: Chaudhuri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D030541:Databases, Genetic; D005260:Female; D014644:Genetic Variation / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012148:Restless Legs Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics*; D006113:United Kingdom / Q000453:epidemiology