The restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are distinguishable
but overlapping disorders. Both feature nocturnal involuntary limb movements (periodic
limb movements) that can cause sleep disruption, but each has distinct clinical features
that are relevant to the diagnosis and management of the patient. The diagnosis of
RLS is made by meeting established clinical criteria, not from discovery of periodic
limb movements of sleep (PLMS) on a sleep study. PLMD, however, does require the presence
of PLMS on polysomnography as well as an associated sleep complaint. Moreover, PLMS
are themselves nonspecific, occurring both with RLS and with other sleep disorders
as well as in normal individuals. The diagnosis of PLMD, then, requires not merely
finding a significant number of PLMS but also excluding other potential causes for
the associated sleep complaint. Treatment of RLS is based on consideration of the
pattern and severity of the disorder, with dopaminergic drugs generally favored for
initial treatment. Anticonvulsants, opioids, and sedative/hypnotics also have a role.
A treatment algorithm is provided to assist with the management of RLS. Treatment
of PLMD relies on many of the same medications, but is generally more straightforward
and places a greater reliance on levodopa compounds and sedative-hypnotics.
KEYWORDS
Restless legs - periodic limb movements - insomnia - diagnosis - treatment
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Suzanne LesageM.D.
RLS Center, Asthma and Allergy, 1B76, Johns Hopkins Bayview Medical Center
5501 Hopkins Bayview Circle, Baltimore, MD 21224
