Summary
Definition
History and exam
Key diagnostic factors
- poor sleep
- daytime impairment
- periodic limb movements (mostly legs)
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 medication
- 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
Risk factors
- age >70 years
- female sex
Diagnostic tests
1st tests to order
- polysomnography: electromyography (EMG) evaluation of limb movements
- polysomnography: electroencephalogram (EEG) evaluation
- polysomnography: assessment of sleep-related breathing disorders
- CBC
- serum ferritin
- BUN
Tests to consider
- actigraphy
Treatment algorithm
primary (idiopathic) PLMD
PLMD associated with other conditions
Contributors
Authors
Tim Soane, BMBS (Hons), MSci, MRCP (Edin), PhD
Neurology Registrar
Department of Clinical Neurosciences
Western General Hospital
Edinburgh
UK
Disclosures
TS has been reimbursed for attending conferences by Biogen, Roche, and Novartis.
Suvankar Pal, BSc (Hons), MBBS (Dist), MRCP (UK), MD (Res), PGCME, FHEA
Consultant Neurologist and Honorary Senior Lecturer
Department of Clinical Neurosciences
Western General Hospital
Edinburgh
UK
Disclosures
SP declares that he has no competing interests.
Richard Davenport, DM, FRCP Edin
Consultant Neurologist and Honorary Senior Lecturer
Department of Clinical Neurosciences
Western General Hospital
Edinburgh
UK
Disclosures
RD declares that he has no competing interests.
Peer reviewers
Paul Reading, MBBS
Consultant Neurologist
James Cook University Hospital
Middlesbrough
UK
Disclosures
PR declares that he has no competing interests.
Karl Doghramji, MD
Director
Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia
PA
Disclosures
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
Disclosures
KA declares that she has no competing interests.
Differentials
- Nocturnal epilepsy
- Sleep-disordered breathing
- Sleep starts
More DifferentialsGuidelines
- International classification of sleep disorders, 3rd edition, text revision (ICSD-3-TR)
- Manual for the scoring of sleep and associated events
More GuidelinesPatient information
Insomnia
Sleep apnea in adults (obstructive)
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