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Volume 13 No. 03
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Accepted Papers

Scientific Investigations

F-Wave Duration as a Specific and Sensitive Tool for the Diagnosis of Restless Legs Syndrome/Willis-Ekbom Disease

Patrizia Congiu, MD, PhD1; Maria Livia Fantini, MD, PhD, MSc2; Giulia Milioli, MD, PhD3; Paolo Tacconi, MD4; Michela Figorilli, MD1; Gioia Gioi, MD1; Bruno Pereira, PhD5; Francesco Marrosu, MD4; Liborio Parrino, MD3; Monica Puligheddu, MD, PhD1
1Sleep Disorders Center, University of Cagliari, Italy; 2Neurology Department, CHU Clermont-Ferrand, University of Auvergne, France; 3Sleep Disorders Center, University of Parma, Italy; 4Neurology UOC, University of Cagliari, Italy; 5Biostatistics Unit (DRCI), CHU Clermont-Ferrand, France

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Study Objectives:

Restless legs syndrome, also known as Willis-Ekbom disease (RLS/WED), is a frequent condition, though its pathophysiology is not completely understood. The diagnosis of RLS/WED relies on clinical criteria, and the only instrumental tool, the suggested immobilization test, may lead to equivocal results. Recently, neurophysiological parameters related to F-wave duration have been proposed as a diagnostic aid. The aim of this study is to assess and compare the diagnostic values of these parameters in diagnosis of RLS/WED.


Fifteen women affected by primary RLS/WED and 17 age- and sex- matched healthy subjects. A complete electroneurographic evaluation, including nerve conduction studies (NCS), cutaneous silent period (CSP), and F-wave parameters, namely amplitude, F-wave duration (FWD), and the ratio between FWD and duration of the corresponding compound muscle action potential (FWD/CMAPD).


No subject showed alterations of the NCS. However, FWD and FWD/CMAPD of both upper and lower limbs were significantly longer in patients than controls. Tibial FWD/CMAPD best discriminated RLS/WED patients from controls. A cutoff of 2.06 yielded a sensitivity of 69.2%, a specificity of 94.1%, a positive predictive power of 90%, and a negative predictive power of 80% (area under the curve = 0.817; 95% confidence interval = 0.674–0.959). The combination of ulnar or tibial FWD/CMAPD increases the sensitivity (85.7%) while slightly decreasing the specificity (87.5%, positive predictive value: 85.7%, negative predictive value: 87.5%).


Lower limb FWD/CMAPD ratio may represent a supportive diagnostic tool, especially in cases of evening lower leg discomfort of unclear interpretation.


Congiu P, Fantini ML, Milioli G, Tacconi P, Figorilli M, Gioi G, Pereira B, Marrosu F, Parrino L, Puligheddu M. F-wave duration as a specific and sensitive tool for the diagnosis of restless legs syndrome/Willis-Ekbom disease. J Clin Sleep Med. 2017;13(3):369–375.

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