Letter to the Editor
Restless legs and restless legs-like syndrome
To the Editor:
Four mandatory essential diagnostic criteria have been
suggested for the diagnosis of restless legs syndrome (RLS)
. Supportive diagnostic criteria (positive family history,
These data suggest the existence of RLS-like syndrome
associated with depression and anxiety, in whom essen-
tialbut not supportivecriteria for RLS are fulfilled and
in whom treatment with antidepressants is helpful. Our
observations prove the value of supportive diagnostic RLS
criteria and confirm the high frequency of psychiatric
 Bassetti CL, Mauerhofer D, Gugger M, et al. Restless legs syndrome: a
clinical study of 55 patients. Eur Neurol 2001;45:6774.
E-mail address: email@example.com
Sleep Medicine 7 (2006) 534
www.elsevier.com/locate/sleepresponse to dopaminergic therapy, periodic limb move-
ments in sleep) corroborate the diagnosis in cases with
diagnostic uncertainty . The presence of psychiatric
symptoms was noted in patients with restless legs by
Wittmaack in 1861, who coined the term anxietas tibiarum
. A recent study suggested a high frequency of
psychiatric symptoms in RLS .
In this retrospective study, we analyzed 74 consecutive
RLS patients (38 women, mean ageGSD 57G15 years)from our sleep center (20032004). We differentiated
patients with classical RLS (RLS-C with all essential
criteria and R2 supportive criteria) from those with RLS-like syndrome (RLS-L with all essential criteria but no
There were 66 (89%) patients with RLS-C and 8 (11%)
with RLS-L. RLS-L patients were younger (51G13 vs.63G14 years, PZ0.05) and more commonly female (75 vs.48%, PZ0.04). Psychiatric evaluations were performed inpatients, in whom a psychiatric disorder was suspected.
Abnormalities were found in 17 (26%) RLS-C patients and
in five (63%) RLS-L patients (PZ0.03, usually anxietyand depression). In 7 of 8 RLS-L patients, improvement of
RLS was achieved with antidepressants. Pain complaints
and restless lips  were more frequent in RLS-C (no
quantification available).Received 31 August 2005; Received in revised form 20
April 2006; Accepted 16 May 2006C.L. Bassetti*
Neurologische PoliklinikUSZ, Frauenklinikstrasse
26, 8091 Zurich, Switzerlandsymptoms in RLS. More studies are needed to understand
whether or not (as we believe) this RLS-like syndrome
belongs to the spectrum of RLS.
 Allen C, Picchietti D, Hening D, et al. Restless legs syndrome:
diagnostic criteria, special considerations, and epidemiology. Sleep
 Wittmaack T. Pathologie und Therapie der Sensibilitatsneurosen.
Leipzig: Schafer, 1861.1389-9457/$ - see front matter q 2006 Elsevier B.V. All rights reserved.
* Corresponding author. Tel.: C11 41 1 255 55 03; fax: C11 41 1 255
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