Laboratory Studies

Because anemia, uremia, hyperglyecemia, and iron deficiency can lead to a secondary form of periodic limb movement disorder (PLMD), laboratory screening studies should be obtained to rule out such metabolic abnormalities.

A urine drug screen may be appropriate.

Sleep Study

Definitive diagnosis of periodic limb movement disorder (PLMD) requires polysomnography.^[20]Obtaining a sleep study to evaluate for PLMD, obstructive sleep apnea (OSA), and other underlying sleep disorders may be especially useful in patients with generalized and persistent fatigue, including those with diagnosed depression and in whom antidepressant therapy has been ineffective.^[21]Observation in a sleep laboratory allows documentation of the movements and rapid diagnosis.

Periodic leg movements in sleep (PLMS) are a common symptom in restless legs syndrome and are a frequent finding in polysomnography. An elevated number of PLMS are defined as PLMD.

Variability from night to night occurs in both adults and children with documented PLMD.^[22]

Other Tests

The Stanford PLM automatic detector (S-PLMAD) is a robust, automated leg movement detector used to score periodic limb movement functions. According to one study, the S-PLMAD works well in controls and sleep disorder patients.^[23]

Additional testing, such as cerebrospinal fluid (CSF) analysis or magnetic resonance imaging (MRI) of the brain, may be warranted if the patient history and clinical presentation are suggestive of pathologies such as sporadic Creutzfeldt-Jakob disease or fatal familial insomnia, as sleep disturbances including periodic limb movement disorder (PLMD) are common features of these conditions.^[24]

Treatment & Management

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Author

Deepak K Gupta, MD Assistant Professor of Neurological Sciences, The Robert Larner, MD, College of Medicine at The University of Vermont; Movement Disorders Neurologist, Binter Center for Parkinson’s Disease and Movement Disorders, University of Vermont Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Magalie E Carey, BS MD Candidate, The Robert Larner, MD, College of Medicine at The University of Vermont

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

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, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Alliance, Bioserenity, Ceribell, Eisai, Greenwich, LivaNova, Neurelis, Neuropace, Nexus, RSC, SK life science, Sunovion<br/>Serve(d) as a speaker or a member of a speakers bureau for: Alliance, Aquestive, Bioserenity, Eisai, Greenwich, LivaNova, Neurelis, SK life science, Sunovion<br/>Received research grant from: Cerevel, LivaNova, Greenwich, SK biopharmaceuticals, Takeda.

Additional Contributors

Wayne E Anderson, DO, FAHS, FAAN Assistant Professor of Internal Medicine/Neurology, College of Osteopathic Medicine of the Pacific Western University of Health Sciences; Clinical Faculty in Family Medicine, Touro University College of Osteopathic Medicine; Clinical Instructor, Departments of Neurology and Pain Management, California Pacific Medical Center

Wayne E Anderson, DO, FAHS, FAAN is a member of the following medical societies: American Academy of Neurology, American Headache Society, California Medical Association, California Neurology Society, International Headache Society, San Francisco Medical Society, San Francisco Neurological Society

Disclosure: Nothing to disclose.

Sections Periodic Limb Movement Disorder
Overview
Presentation
DDx
Workup
Treatment
Medication
Questions & Answers
References

Periodic Limb Movement Disorder Workup

Laboratory Studies

Sleep Study

Other Tests

References

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