Periodic limb movement disorder

Last reviewed: 23 Apr 2022
Last updated: 26 Feb 2020

Summary

Definition

History and exam

Key diagnostic factors

  • poor sleep
  • daytime somnolence and fatigue
  • periodic limb movements (mostly legs)
More key diagnostic factors

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
  • history of neuroleptic medication
  • history 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
Other diagnostic factors

Risk factors

  • age >70 years
  • female sex
More risk factors

Diagnostic investigations

1st investigations to order

  • polysomnography: electromyography (EMG) evaluation of limb movements
  • polysomnography: EEG evaluation
  • polysomnography: assessment of sleep-disordered breathing
  • FBC
  • serum ferritin
  • urea
  • Epworth's Sleepiness Scale
More 1st investigations to order

Emerging tests

  • actigraphy

Treatment algorithm

ACUTE

primary PLMD: with restless legs syndrome

primary PLMD: without restless legs syndrome

secondary PLMD

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 travel and attendance to the Multiple Sclerosis Academy MasterClass by Biogen.

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

Disclosures

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

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.

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