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Periodic limb movement disorder

Last reviewed: 18 Aug 2025
Last updated: 13 May 2025

Summary

Definition

History and exam

Key diagnostic factors

  • poor sleep
  • daytime impairment
  • periodic limb movements (mostly legs)
Full details

Other diagnostic factors

  • age >70 years
  • re-enactment of dreams during the night
  • irresistible urge to move legs, and abnormal sensations in lower limbs
  • snoring
  • early-morning dry mouth
  • headache
  • elevated body mass index
  • withdrawal from benzodiazepines or barbiturates
  • use of antipsychotics
  • use of dopaminergic drugs
  • pallor
  • iron deficiency
  • diabetes mellitus
  • spinal cord injury
  • episodes of sudden onset of sleep during the day; may or may not be associated with loss of muscle tone
Full details

Risk factors

  • age >70 years
  • female sex
Full details

Diagnostic investigations

1st investigations to order

  • polysomnography: electromyography (EMG) evaluation of limb movements
  • polysomnography: electroencephalogram (EEG) evaluation
  • polysomnography: assessment of sleep-related breathing disorders
  • CBC
  • serum ferritin
  • BUN
Full details

Investigations to consider

  • actigraphy
Full details

Treatment algorithm

ACUTE

primary (idiopathic) PLMD

PLMD associated with other conditions

撰稿人

作者

Tim Soane, BMBS (Hons), MSci, MRCP (Edin), PhD

Neurology Registrar

Department of Clinical Neurosciences

Western General Hospital

Edinburgh

UK

利益声明

TS has been reimbursed for attending conferences by Biogen, Roche, and Novartis.

Suvankar Pal, BSc (Hons), MBBS (Dist), MRCP (UK), MD (Res), PGCME, FHEA
Suvankar Pal

Consultant Neurologist and Honorary Senior Lecturer

Department of Clinical Neurosciences

Western General Hospital

Edinburgh

UK

利益声明

SP declares that he has no competing interests.

Richard Davenport, DM, FRCP Edin
Richard Davenport

Consultant Neurologist and Honorary Senior Lecturer

Department of Clinical Neurosciences

Western General Hospital

Edinburgh

UK

利益声明

RD declares that he has no competing interests.

同行评议者

Paul Reading, MBBS

Consultant Neurologist

James Cook University Hospital

Middlesbrough

UK

利益声明

PR declares that he has no competing interests.

Karl Doghramji, MD

Director

Sleep Disorders Center

Thomas Jefferson University Hospital

Philadelphia

PA

利益声明

KD is a speaker for Sanofi-Aventis, King Pharmaceuticals, Takeda Pharmaceuticals, Sepracor, and Pfizer; a consultant for Sanofi-Aventis, Takeda Pharmaceuticals, Sepracor, Pfizer, and Neurocrine Biosciences; and has stock in Merck.

Kirstie Anderson, BMedSci, MBBS, MRCP, DPhil

Consultant Neurologist

Department of Neurology

Freeman Hospital

Newcastle upon Tyne

UK

利益声明

KA declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Garcia-Borreguero D, Ferini-Strambi L, Kohnen R, et al. European guidelines on management of restless legs syndrome: report of a joint task force by the European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society. Eur J Neurol. 2012;19:1385-1396. 摘要

Ferri R, Fulda S, Allen RP, et al. World Association of Sleep Medicine (WASM) 2016 standards for recording and scoring leg movements in polysomnograms developed by a joint task force from the International and the European Restless Legs Syndrome Study Groups (IRLSSG and EURLSSG). Sleep Med. 2016 Oct;26:86-95. 摘要

Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025 Jan 1;21(1):137-52.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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