The sensations may be bilateral or unilateral and their predominant location may shift in individual patients, even during a single bout of symptoms. Patients move to relieve limb discomfort. Such movements are often stereotypical and repetitive and may include walking or pacing, rocking, shaking, tossing and turning in bed, leg stretching, leg flexions, deep knee bends, marching in place, or cyclical body rocking. Symptoms are usually substantially, if not completely, relieved by walking or other motor activities. However, they may recur shortly or even immediately after the patient stops moving and rests.
Symptoms are worse in the evening or night.
The diagnosis of RLS requires that all four features of these minimal feature above be present at some point in the course of the disorder. For very severely affected individuals, the symptoms may be so pronounced that the circadian pattern, and even the worsening of symptoms during rest, may no longer be evident to the patient. Early in the course of the disorder, mildly affected patients may report symptoms only during the usual time for sleep. They may not be aware of any relation between symptoms and inactivity. A clinical severity rating scale, a structured diagnostic interview, and a diagnostic questionnaire are currently being developed and validated.