Restless legs syndrome may affect up to 10% of adults and around 4% of children and adolescents. In children, it is often mistaken for growing pains, and diagnosis can take more than a decade.
Restless legs syndrome can go unidentified for more than a decade while patients and doctors look for other explanations. The neurological disorder may affect up to 10% of adults and around 4% of children and adolescents. The clearest sign is an overwhelming need to move the legs while resting. Symptoms usually get worse in the afternoon or at night. The condition is widely considered underdiagnosed, especially when symptoms are mild, occasional or described only as vague discomfort.
The condition is also known as Willis-Ekbom disease. Patients may feel tingling, itching, pain or a vague discomfort in their legs. Movement can bring relief. Because symptoms may be mild, moderate or occasional, many people blame tiredness, long periods of sitting or poor circulation instead of seeking a neurological assessment.
International diagnostic criteria generally require a characteristic pattern: an irresistible urge to move the legs, worsening during rest, temporary relief with movement and greater intensity in the evening or at night. Doctors must also consider whether another condition better explains the symptoms.
That habit of dismissing the discomfort creates another obstacle. As ConSalud.es reports, patients who arrive in primary care may first be sent to a vascular surgeon because their initial complaint sounds like a circulation problem. Some then move between specialists before anyone considers a neurological disorder. An earlier report also examined how many cases may remain unidentified in Spain. The result can be years of broken sleep and daytime tiredness before doctors recognise the underlying pattern.
Diagnosis depends mainly on a careful interview, not on one decisive test. Doctors need to find out where the sensations occur. They must ask whether the patient feels restless or has an irresistible need to move, and whether movement makes the symptoms better or worse. The international IRLSSG-based approach also looks for symptoms that worsen in the evening or at night. It requires doctors to rule out similar problems, including cramps, growing pains and other causes of leg discomfort. Sleep studies may be used in selected cases. Magnetic resonance imaging and electromyograms can support the assessment or help rule out similar conditions.
Childhood cases are particularly easy to miss.
In children, parents may provide the most useful diagnostic observations because a young patient may not be able to describe tingling or an internal urge to move. Repeated leg movements while falling asleep or during sleep can therefore be clinically important even when the child reports only pain or restlessness.
Young children may struggle to describe tingling or an inner feeling of restlessness. Parents therefore become important observers. Repeated changes of position during sleep or frequent leg movements may offer clues, especially when the problem appears at certain times of day. Without those details, symptoms may be labelled as growing pains and the condition can continue without a clear diagnosis. Independent guidance on childhood restless legs also says the key question is not simply whether the legs hurt. Doctors need to know whether the discomfort gets worse when the child is inactive and improves with movement.
Iron is an important part of the medical assessment, but a normal blood test does not rule out the disorder. According to the specialist, nearly 95% of people with restless legs have normal analytical results. The brain may need iron even when routine tests show no obvious iron deficiency. That matters because treatment decisions cannot rely only on finding a clear shortage in the bloodstream. Clinical reviews still recommend checking iron status when restless legs symptoms are suspected, since iron deficiency is an important factor that may be treatable.
Doctors also look for related conditions. Restless legs syndrome may occur during pregnancy or alongside chronic kidney disease and neurological problems such as polyneuropathies or disorders affecting the spinal cord. The Sociedad Española de Neurología (SEN) says the condition is about twice as common in women as in men. Between 11% and 30% of women without previous symptoms may develop it during pregnancy, particularly in the third trimester.
Treatment recommendations have changed sharply in recent years. International guidance has moved away from routine long-term use of dopaminergic medicines because they can trigger augmentation. In this phenomenon, symptoms become more severe or start earlier in the day. Patients who have taken these drugs for years are now being reassessed. Some may be moved to another treatment.
Correcting iron levels is one of the main strategies when it is clinically indicated. Supplements may be given by mouth or intravenously in selected cases. Gabapentin and pregabalin are among the other medicines used. The disorder is chronic and can change over time, so patients need continued medical follow-up. Doctors may need to adjust the approach rather than treat the first prescription as permanent.
The practical lesson is direct. Recurring leg discomfort during rest should not automatically be dismissed as fatigue, circulation trouble or normal childhood pain. Earlier recognition could shorten a diagnostic route that lasts more than ten years. The SEN is preparing a new edition of its restless legs syndrome guide for publication in 2027. Its stated aim is to improve screening and diagnosis across different levels of care. That is the right priority. The main problem is not that the condition lacks recognisable patterns, but that patients and primary care services can treat those patterns as ordinary for years.
