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Periodic limb movement disorder

Last reviewed: 1 Oct 2024
Last updated: 17 Jan 2024

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 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
Full details

Risk factors

  • age >70 years
  • female sex
Full details

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
Full details

Tests to consider

  • actigraphy
Full details

Treatment algorithm

ACUTE

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
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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