Table 2 Differential diagnosis restless legs syndrome vs diabetic painful neuropathy
From: Diabetic Painful Neuropathy and Restless Legs Syndrome in Diabetes
Parameter | Restless legs syndrome | Diabetic painful neuropathy |
|---|---|---|
Chief complaints | ||
Chief symptom | Urge to move leg(s) | Pain |
Associated symptom | Uncomfortable and unpleasant sensations | Numbness |
Epidemiology | ||
Gender | More frequent in women | No gender gradient |
Age | Increase in prevalence with age; seen in children as well | Increases with duration of diabetes |
Pregnancy | Common in pregnancy, esp. third trimester | Usually not seen in GDM |
Family history | May be present | History of diabetes may be present |
Symptoms | ||
Clinical course | Chronic-persistent or intermittent | Variable/progressive |
Common Site | Legs, usually middle of calf or thigh | Legs, usually distal to proximal progression |
Symmetry | May be unilateral, bilateral or may change | Usually symmetrical; rarely, may be symmetric |
Spread | May spread to arms, other body parts | May spread to arms, with distal to proximal progression |
Diurnal variation | More in evening, night May be present throughout the day in severe cases | More in evening, night May be present throughout the day |
Association with activity | Sensations began/worsen during rest/inactivity | No such association |
Relief | By movement such as walking/stretching/exercise | No such association |
Exclusion criteria | ||
Exclusion criteria | Myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort, habitual foot tapping | Alcohol, vitamin B12 deficiency, neurotoxic chemotherapy, hypothyroidism, renal disease, malignancies, infections such as HIV, chronic inflammatory demyelinating neuropathy, inherited neuropathies, vasculitis |
Sleep/distress | ||
Sleep quality/quantity | Impaired | May be impaired |
Daytime somnolence | Absent | May be present |
Distress | May be significant | May be significant |
Signs | ||
Leg movements | May be reported by bed partner | No such complaint |
Periodic leg movements | Present | Absent |
Ankle reflex | Present | May be absent |
Vibration/pinprick sensation | Normal/may be impaired | Normal |
Therapy | ||
Response to dopaminergic treatment | Positive | Absent |
Treatment | Dopamine agonists, alpha-2 delta ligands | Pregabalin, duloxetine, tapentadol, gabapentin |