5 minute segment of a polysomnogram, demonstrating 7 PLMs with arousals People with<unk>  often do not know the cause of their excessive daytime sleepiness and their<unk><unk> s are reported by a spouse or sleep partner.<unk>  cannot be diagnosed by polysomnogram (PSG) alone, it is necessary to obtain a full medical history and taking into account all available information. Polysomnography is recognized as the assessment method which brings most precise information on sleep quality, sleep structure and physiological parameters during sleep (respiration, heart rate,<unk> s). Therefore, diagnostic of<unk>  can usually be established only in laboratory settings. As people usually ignore the cause of their daytime impairments, PLMS during sleep are mostly found through laboratory examination rather than clinical complaints. Video-Polysomnography may be recommended to distinguish PLMS from other leg<unk> s during sleep time which may be similar to PLMS when it comes to duration and pattern. Measures from PSG allocated to the diagnostic of<unk>  are essentially based on electromyography (EMG) measuring muscle activity. EMG electrodes are usually placed on anterior tibialis muscle. Recent studies showed actigraphy may be combined to PSG as a screening tool for<unk>  diagnosis. Actigraphs are watch-shaped device - 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<unk> s meet diagnostic criteria for<unk> . Recent studies showed actigraph records reflect quite accurately PLMI criterion. Crucial for the diagnosis are the inter-movement intervals and the frequency of PLMS - each<unk>  must happen within a 4 to 90 second interval from the previous<unk> . The periodic<unk><unk>  index (PLMI), which corresponds to the number of periodic<unk><unk> s per hour, must be more than 15<unk> s per hour in adults and 5<unk> s or more per hour in children. The diagnosis of<unk>  requires a visible cause-effect relationship between PLMS and an observed sleep disturbance or daytime impairment (both disturbance and impairment have to be clinically significant). Other relevant causes of Insomnia and Hypersomnia have to be ruled out before diagnosing<unk>  (most importantly anxiety, obstructive sleep apnea, and narcolepsy). Furthermore, symptoms can not be better explained by any other conditions. For the differential diagnosis it is important to differentiate<unk>  from other leg<unk> s during sleep, which are high-frequency: * alternating leg<unk>  activity (ALMA) are very similar events and could be mistaken for PLMS * hypnagogic foot tremor (HFT) events are also very similar to PLMS and could be misdiagnosed * excessive fragmentary myoclonus (EFM) events are shorter than PLMS Classification<unk>  is classified in the third edition of the International Classification of Sleep<unk> s (ICSD-3) which presents current sleep<unk> s nosology. ICSD-3 is divided in 7 sections and<unk>  is classified in the Sleep-Related<unk><unk> s' section. There are some updates from ICSD-2. The diagnosis is more strict. A simple complaint is no longer enough: a significant clinical impairment is needed. Sleep impairments need to be clearly caused by PLMS and the symptoms also need to be explained solely by the PLMS.
Periodic limb movement disorder
Periodic paralysis
Cramp fasciculation syndrome
Essential tremor
Holmes tremor
Torsion dystonia
Lonomia
Oromandibular dystonia