These movements can lead the patient to wake up, and if so, sleep interruption can be the origin of excessive daytime sleepiness.

Medical agents must be taken into consideration: several psychopharmacological drugs (serotonergic and tricyclic antidepressants, venlafaxine and mirtazapine) heighten the risk of PLMD.

[10] People with PLMD often do not know the cause of their excessive daytime sleepiness and their limb movements are reported by a spouse or sleep partner.

PLMD cannot be diagnosed by polysomnogram (PSG) alone, it is necessary to obtain a full medical history and taking into account all available information.

As people usually ignore the cause of their daytime impairments, PLMS during sleep are mostly found through laboratory examination rather than clinical complaints.

[1] Recent studies showed actigraphy may be combined to PSG as a screening tool for PLMD diagnosis.

Actigraphs are watch-shaped devices - usually worn by adult population on the wrist - used to record sleep and wake periods for at least a week.

Recent actigraphy devices allow more precise recordings which helps evaluating if actual movements meet diagnostic criteria for PLMD.

[4] Other relevant causes of Insomnia and Hypersomnia have to be ruled out before diagnosing PLMD (most importantly anxiety, obstructive sleep apnea, and narcolepsy).

[12] PLMD can be effectively treated with dopaminergic agents (pramipexole, ropinirole, cabergoline, and rotigotine) and it has been found that patients with a low ferritin level respond well to oral iron supplements.

[4] Adverse effects of these agents have been reported and include the occurrence of restless leg syndrome triggered by the medication, as well as cortical arousals, which are a cause of disturbed sleep.

However, it remains insufficient evidences related to the efficacy of pharmacological treatment in PLMD, and its use has been based on the dopaminergic medication effect on RLS.

[5] PLMD is estimated to occur in approximately 4% of adults (aged 15–100),[8] but is more common in the elderly, especially females, with up to 11% experiencing symptoms.

Based on adult criteria and PSG analysis, studies showed prevalence of isolated PLMD in children population with no other comorbidity about 1.2 to 1.5%.

[20][21] Periodic limb movements during sleep are associated with a lower quality of life in children with monosymptomatic nocturnal enuresis[22]