Summary
Definition
History and exam
Key diagnostic factors
- poor sleep
- daytime somnolence and fatigue
- 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
- 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
Risk factors
- age >70 years
- female sex
Diagnostic investigations
1st investigations to order
- polysomnography: electromyography (EMG) evaluation of limb movements
- polysomnography: EEG evaluation
- polysomnography: assessment of sleep-disordered breathing
- CBC
- serum ferritin
- BUN
- Epworth Sleepiness Scale
Emerging tests
- actigraphy
Treatment algorithm
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

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 ed (ICSD-3)
- The treatment of restless legs syndrome and periodic limb movement disorder in adults - an update for 2012: practice parameters with an evidence based systematic review and meta-analyses
More GuidelinesPatient leaflets
Insomnia
Sleep apnea in adults (obstructive)
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