eMedicine Specialties > Neurology > Sleep-Related Diseases

Periodic Limb Movement Disorder: Differential Diagnoses & Workup

Author: Wayne E Anderson, DO, Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center
Contributor Information and Disclosures

Updated: Aug 26, 2009

Differential Diagnoses

Chorea in Adults
Psychogenic Nonepileptic Seizures
Chorea in Children
Restless Legs Syndrome
Complex Partial Seizures
Seizures and Epilepsy: Overview and Classification
Early Myoclonic Encephalopathy
Sleep Stage Scoring
Epilepsia Partialis Continua
Temporal Lobe Epilepsy
Frontal Lobe Epilepsy
Tourette Syndrome and Other Tic Disorders
Narcolepsy
Uremic Encephalopathy
Parkinson Disease
Uremic Neuropathy
Parkinson-Plus Syndromes

Other Problems to Be Considered

Anemia
Back pain
Benign epilepsy syndromes
Iron deficiency
Myoclonic epilepsy
Myoclonus
Paroxysmal kinesigenic choreoathetosis
Sleep apnea
Spinal injury

Workup

Laboratory Studies

  • Because anemia, uremia, and the use of tricyclic antidepressant, antidopaminergic, or dopaminergic medications can lead to a secondary form of periodic limb movement disorder, laboratory screening studies should be obtained to rule out anemia or significant metabolic abnormalities.
  • A urine drug screen may be appropriate.

Other Tests

Sleep laboratory

  • Definitive diagnosis requires polysomnography.
  • Observation in a sleep laboratory allows documentation of the movements and rapid diagnosis.
  • Variability from night to night occurs in both adults and children with documented periodic limb movement disorder.9

More on Periodic Limb Movement Disorder

Overview: Periodic Limb Movement Disorder
Differential Diagnoses & Workup: Periodic Limb Movement Disorder
Treatment & Medication: Periodic Limb Movement Disorder
Follow-up: Periodic Limb Movement Disorder
References

References

  1. Vetrugno R, D'Angelo R, Montagna P. Periodic limb movements in sleep and periodic limb movement disorder. Neurol Sci. Jan 2007;28 Suppl 1:S9-S14. [Medline].

  2. Martinez-Mena JM, Pastor J. [Polyneuropathy in patients with periodic leg movements during sleep]. Rev Neurol. Nov 1998;27(159):745-9. [Medline].

  3. Voderholzer U, Müller N, Haag C, Riemann D, Straube A. Periodic limb movements during sleep are a frequent finding in patients with Gilles de la Tourette's syndrome. J Neurol. Aug 1997;244(8):521-6. [Medline].

  4. Ferri R, Gschliesser V, Frauscher B, Poewe W, Högl B. Periodic leg movements during sleep and periodic limb movement disorder in patients presenting with unexplained insomnia. Clin Neurophysiol. Feb 2009;120(2):257-63. [Medline].

  5. Haba-Rubio J, Staner L, Krieger J, Macher JP. What is the clinical significance of periodic limb movements during sleep?. Neurophysiol Clin. Dec 2004;34(6):293-300. [Medline].

  6. Nozawa T, Ichikawa H, Takeuchi T. Periodic limb movements and sleep-wake disorder. Psychiatry Clin Neurosci. Apr 1998;52(2):192-4. [Medline].

  7. Picchietti DL, Rajendran RR, Wilson MP, Picchietti MA. Pediatric restless legs syndrome and periodic limb movement disorder: Parent-child pairs. Sleep Med. Mar 20 2009;[Medline].

  8. Walters AS, Silvestri R, Zucconi M, Chandrashekariah R, Konofal E. Review of the possible relationship and hypothetical links between attention deficit hyperactivity disorder (ADHD) and the simple sleep related movement disorders, parasomnias, hypersomnias, and circadian rhythm disorders. J Clin Sleep Med. Dec 15 2008;4(6):591-600. [Medline].

  9. Picchietti MA, Picchietti DL, England SJ, Waiters AS, Couvadelli BV, Lewin DS, et al. Children show individual night-to-night variability of periodic limb movements in sleep. Sleep. Apr 1 2009;32(4):530-5. [Medline].

  10. Littner MR, Kushida C, Anderson WM, et al. Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep. May 1 2004;27(3):557-9. [Medline].

  11. Hening WA, Allen RP, Earley CJ, et al. An update on the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep. May 1 2004;27(3):560-83. [Medline].

  12. Inami Y, Horiguchi J, Nishimatsu O, et al. A polysomnographic study on periodic limb movements in patients with restless legs syndrome and neuroleptic-induced akathisia. Hiroshima J Med Sci. Dec 1997;46(4):133-41. [Medline].

  13. Horiguchi J, Inami Y, Sasaki A, et al. Periodic leg movements in sleep with restless legs syndrome: effect of clonazepam treatment. Jpn J Psychiatry Neurol. Sep 1992;46(3):727-32. [Medline].

  14. Pieta J, Millar T, Zacharias J, et al. Effect of pergolide on restless legs and leg movements in sleep in uremic patients. Sleep. Sep 15 1998;21(6):617-22. [Medline].

  15. Picchietti DL, England SJ, Walters AS, et al. Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder. J Child Neurol. Dec 1998;13(12):588-94. [Medline].

  16. Iriarte J, Urrestarazu E, Alegre M, et al. Oscillatory cortical changes during periodic limb movements. Sleep. Dec 15 2004;27(8):1493-8. [Medline].

  17. Mello MT, Silva AC, Rueda AD, et al. Correlation between K complex, periodic leg movements (PLM), and myoclonus during sleep in paraplegic adults before and after an acute physical activity. Spinal Cord. Apr 1997;35(4):248-52. [Medline].

  18. Ulfberg J, Jonsson R, Lindberg E, et al. [Restless legs. A much neglected syndrome]. Lakartidningen. Mar 10 1999;96(10):1183-4, 1187-8. [Medline].

  19. [Guideline] Vignatelli L, Billiard M, Clarenbach P. EFNS guidelines on management of restless legs syndrome and periodic limb movement disorder in sleep. Eur J Neurol. Oct 2006;13(10):1049-65. [Medline].

  20. Wetter TC, Pollmacher T. Restless legs and periodic leg movements in sleep syndromes. J Neurol. Apr 1997;244(4 Suppl 1):S37-45. [Medline].

Further Reading

Keywords

periodic limb movement disorder, PLM, restless leg syndrome, RLS, nocturnal myoclonus, sleep disorders, PLMS, periodic limb movements during sleep, ADHD, attention deficit hyperactivity disorder, PLM disorder, diabetes mellitus, spinal cord tumor, sleep apnea syndrome, narcolepsy, uremia, anemia, sleep disturbances, sleep apnea

Contributor Information and Disclosures

Author

Wayne E Anderson, DO, Assistant Professor of Internal Medicine/Neurology, Western University of Health Sciences; Assistant Professor of Family Medicine, Touro University College of Osteopathic Medicine; Consulting Staff in Pain Management, Department of Neurology, California Pacific Medical Center
Wayne E Anderson, DO is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Law Medicine and Ethics, California Medical Association, and San Francisco Medical Society
Disclosure: Cephalon Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; King Honoraria Consulting

Medical Editor

Sydney Louis, MB, BCh, MD, Emeritus Professor, Department of Neurology, Brown University School of Medicine
Sydney Louis, MB, BCh, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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