ORIGINAL ARTICLE Periodic leg movements in sleep in patients with supratentorial cerebral infarction Gulcin Benbir • Derya Karadeniz Received: 18 September 2011 / Accepted: 19 September 2011 / Published online: 19 January 2012 Ó Belgian Neurological Society 2012 Abstract The pathophysiology of periodic leg move- ments in sleep (PLMS) is complex, and still lacks a con- sensus. Consecutive 35 patients with the diagnosis of acute supratentorial ischemic stroke and 35 age- and sex-mat- ched control subjects were prospectively investigated. Clinical and sociodemographic evaluation and a whole- night polysomnographic recording were performed. In patients with supratentorial ischemic stroke, 27 patients (77.2%) had PLMS-index more than 5/h, and 19 out of 35 patients (54.3%) had PLMS-index more than 15/h; while only 10 participants (28.5%) in control group had PLMS- index more than 5/h, and 6 participants (17.1%) had PLMS-index more than 15/h (p \ 0.05). None of the demographic variables showed statistically significant relationship with PLMS, such as gender (p = 0.952) and age (p = 0.435). Territorial localization of ischemic lesions showed no relation with the presence of PLMS (p = 0.867), PLMS-index (p = 0.432), or restless legs syndrome (p = 0.833). All patients demonstrated PLMS contralateral to ischemic lesion except eight patients with bilateral PLMS; these were also more prominent contra- laterally. Our study supports the hypothesis that destructive lesions causing the loss of cortical or subcortical inhibition exerting on the reticular formation on spinal pathways could lead to the development of PLMS. Keywords Periodic leg movements in sleep Á Supratentorial cerebral infarction Á Subcortical disinhibition Á Restless legs syndrome Introduction Periodic leg movements in sleep (PLMS) are sleep related phenomena characterized by periodic episodes of repetitive and highly stereotyped limb movements [1]. These move- ments are characterized by the dorsiflexion of ankle and toes, a partial flexion of knee and sometimes hip, and connected to the nocturnal awakenings and unrefreshing sleep. PLMS were first described by Symonds [2, 3] as ‘nocturnal myoclonus’ and polysomnographic (PSG) recording was first performed by Lugaresi et al. [4]. The term ‘periodic leg movement disorder’ (PLMD) is defined by the International Classification of Sleep Disorders as PLMS accompanied by a clinical sleep disturbance or a complaint of daytime fatigue [5]. Although various con- ditions such as uremia, iron deficiency, peripheral neu- ropathy, radiculopathy, and spinal cord and brainstem lesions are well-known to induce PLMS; [6–8] the under- lying pathophysiology is still not well-known. It was sug- gested that the loss of cortical or subcortical inhibition exerting on the brainstem generator might cause PLMS [9]. There are three case reports, wherein focal supratentorial cerebral infarctions involving the corona radiata, lenticu- lostriate region, pallidum and internal capsule were accused of PLMS [10–12], supporting the hypothesis that PLMS arise from suprasegmental disin-hibition of lower spinal circuitry [13]. On the basis of these data, we aimed to investigate patients with supratentorial infarctions for the PLMS. Methods and materials Consecutive 35 patients hospitalized in our neurology department with the diagnosis of ischemic cerebrovascular G. Benbir (&) Á D. Karadeniz Sleep Disorders Unit, Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey e-mail: drgulcinbenbir@yahoo.com 123 Acta Neurol Belg (2012) 112:27–32 DOI 10.1007/s13760-011-0002-0