Case 36 - Restlessness and jerking upon recumbency when trying to fall asleep  pp. 255-261

Restlessness and jerking upon recumbency when trying to fall asleep

By Roberto Vetrugno and Pasquale Montagna

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Clinical history

A 56-year-old woman was admitted to hospital after a 2-year history of uncomfortable sensations with pain and paresthesia accompanied by an urge to move the legs at rest upon recumbency, especially in the evening and at night. In the last year, involuntary jerks of the trunk and limbs had appeared, arising repetitively when she was awake and lying supine and co-existing with motor restlessness, together causing difficulties in initiating and maintaining sleep and resulting in complaints of excessive daytime sleepiness (EDS) and tiredness. Her past medical history included tension headaches. There was no family history of movement disorders.

Examination

A neurological examination showed generalized increased deep tendon reflexes, but plantar responses were flexor. Her average resting systemic blood pressure was 120/70 mmHg and her heart rate was 68 bpm. Sudden acoustic, visual and tactile (glabella tapping) stimuli did not evoke any abnormal motor phenomena. A neuropsychological assessment, including the mini mental state examination, was normal. Routine blood analyses including a complete blood count, creatinine, electrolytes, liver enzymes, bilirubin, uric acid, lactate dehydrogenase, glucose, iron, ferritin and thyroid function were normal. Brain and spinal cord MRIs were normal.

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