Teaching video NeuroImages: Daytime sleepiness and automatic behavior due to severe restless legs syndrome

Abstract

A 76-year-old man complained of daytime sleepiness and frequent arousals from sleep due to a sense of whole-body restlessness, followed by automatic frequently injurious behavior. A video-polysomnography revealed periodic leg movements (figure) and arousal followed by sleep episodes while standing, rhythmic marching, and falling (videos 1 and 2 on the Neurology® Web site at Neurology.org). A reevaluation of his history revealed symptoms compatible with restless legs syndrome (RLS). Rotigotine1 proved very effective, supporting the diagnosis of RLS. Periodic leg movement disorder leading to sleep-related rhythmic movement disorder could also be considered. Automatic behavior denotes severe sleep deprivation2 and may represent a non-REM parasomnia. Severe RLS may present with automatic behavior complicating its diagnosis.