What are the American Academy of Sleep Medicine (AASM) treatment guidelines for Periodic Limb Movement Disorder (PLMD)?

From the Guidelines

The American Academy of Sleep Medicine (AASM) suggests against the use of valproic acid and triazolam for the treatment of Periodic Limb Movement Disorder (PLMD) in adults, as stated in the 2025 clinical practice guideline 1. The AASM guideline provides recommendations for the treatment of restless legs syndrome (RLS) and PLMD, with a focus on pharmacological and non-pharmacological interventions.

• The guideline suggests that treatment for PLMD is generally not necessary unless the movements cause significant sleep disturbance or are associated with RLS.
• For patients with PLMD who experience clinical symptoms, the guideline does not provide specific recommendations for first-line therapy, but suggests against the use of certain medications, including valproic acid and triazolam.
• The guideline also emphasizes the importance of addressing underlying conditions that may contribute to PLMD, such as iron deficiency, which should be corrected with iron supplementation.
• Regular follow-up is recommended to assess treatment efficacy and manage potential side effects. The AASM guideline is based on a rigorous review of the evidence, using the grading of recommendations assessment, development, and evaluation (GRADE) methodology 1.
• The guideline provides conditional recommendations for various medications, including gabapentin, IV iron sucrose, and vitamin C, for special populations, such as adults with end-stage renal disease (ESRD).
• The guideline also notes that there is limited evidence for the treatment of PLMD in pediatric populations, but suggests that oral iron supplementation may be a low-risk and accessible treatment option for children with iron deficiency.

From the Research

American Academy of Sleep Medicine (AASM) Treatment Guidelines for Periodic Limb Movement Disorder (PLMD)

• The AASM recommends dopaminergic agents, particularly dopamine agonists, as the primary treatment for PLMD 2.
• Effective dopaminergic agents for PLMD include levodopa with decarboxylase inhibitor, and the dopaminergic agonists pergolide, pramipexole, and ropinirole 2.
• Other dopamine agonists, such as talipexole, cabergoline, piribidel, and alpha-dihydroergocryptine, and the dopaminergic agents amantadine and selegiline, may also be effective in treating PLMD, but their level of effectiveness is not currently established 2.
• Gabapentinoid agents, such as gabapentin enacarbil and pregabalin, have shown comparable short-term efficacy to dopaminergics with a lower risk of augmentation of symptoms 3.
• Iron supplementation therapy, including treatment with ferric carboxymaltose, may be considered for patients with low iron stores 3.
• Oxycodone-naloxone can be used in severe refractory cases of PLMD 3.

Treatment Options

• Dopaminergic agents are considered first-line therapy for PLMD 4, 5.
• Ropinirole, a dopamine agonist, has been demonstrated to be effective and safe in treating the motor symptoms of PLMD and improving sleep quality 4.
• Anticonvulsants, benzodiazepines, opiates, and iron supplementation are also used to treat PLMD, although they may be considered second-line treatment options 6, 4.