From the Guidelines
To grade the severity of restless leg syndrome (RLS), use the International Restless Legs Syndrome Study Group Rating Scale (IRLS) as it is a validated tool that assesses severity based on key criteria such as intensity of RLS urges, distress caused by symptoms, impact on daily activities, effect on sleep, and frequency of symptoms 1.
Key Criteria for Grading Severity
The IRLS scores range from 0-40, with scores of 1-10 indicating mild RLS, 11-20 moderate, 21-30 severe, and 31-40 very severe.
- Mild RLS: Minimal discomfort, no interference with sleep or daily activities
- Moderate RLS: Significant discomfort, some sleep disruption
- Severe RLS: Substantial impact on sleep and daily functioning
- Very Severe RLS: Makes normal sleep and daily activities nearly impossible
Importance of Accurate Severity Assessment
Accurate severity assessment is crucial for developing appropriate treatment plans, which may include lifestyle modifications for mild cases or medications like dopamine agonists, alpha-2-delta calcium channel ligands, or opioids for more severe cases 1.
Additional Considerations
Tracking symptom patterns over time using a diary can help determine if RLS is worsening or improving with treatment. It's also important to consider how symptoms affect quality of life and to tailor treatment plans accordingly.
Recent Guidelines
Recent guidelines from the American Academy of Sleep Medicine suggest the use of ferrous sulfate, dipyridamole, extended-release oxycodone, and bilateral high-frequency peroneal nerve stimulation for the treatment of RLS, while suggesting against the use of certain medications such as levodopa, pramipexole, and ropinirole 1.
From the FDA Drug Label
The IRLS scale contains 10 items designed to assess the severity of sensory and motor symptoms, sleep disturbance, daytime somnolence, and impact on activities of daily living and mood associated with RLS. The range of scores is 0 to 40, with 0 being absence of RLS symptoms and 40 the most severe symptoms To grade the severity of restless leg syndrome, you can use the International Restless Legs Syndrome Rating Scale (IRLS scale), which assesses the severity of symptoms such as:
- Sensory and motor symptoms
- Sleep disturbance
- Daytime somnolence
- Impact on activities of daily living and mood The scale has a range of 0 to 40, with:
- 0 indicating absence of RLS symptoms
- 40 indicating the most severe symptoms 2
From the Research
Grading Severity of Restless Leg Syndrome
To grade the severity of restless leg syndrome, the following methods can be used:
- The International Restless Legs Severity Scale (IRLS) is a ten-item scale that has been developed and validated for assessing the severity of restless legs syndrome 3, 4.
- The IRLS can be evaluated using separate subscale scores, one for symptoms and the other for symptom impact 3.
- The scale has been found to have high levels of internal consistency, inter-examiner reliability, test-retest reliability, and convergent validity 4.
- The IRLS is dominated by a single severity factor that explains at least 59% of the pooled item variance, indicating that it is a relatively uniform disorder in which the severity of the basic symptoms is strongly related to their impact on the patient's life 4.
Recommended Scales
The following scales are recommended for assessing the severity of restless legs syndrome:
- The International Restless Legs Scale (IRLS) 5
- The Augmentation Severity Rating Scale 5
- The Pediatric RLS Severity Scale (although it requires validation) 5
Considerations
When grading the severity of restless legs syndrome, it is essential to consider the following: