Consensus Roadmap on Periodic Leg Movements during Sleep (PLMS): Outcomes of the International PLMS Taskforce

Stephany Fulda; Mathias Baumert; Matteo Cesari; Stefan Clemens; Yves Dauvilliers; Luigi Ferini Strambi; Samson G Khachatryan; Brian B Koo; Mauro Manconi; Emmanuel Mignot; Marie-Hélène Pennestri; Thomas Penzel; Giuseppe Plazzi; Matthew Salanitro; Rosalia Silvestri; Ambra Stefani; Robert Thomas; John W Winkelman; Rochelle Zak; Raffaele Ferri

doi:10.1093/sleep/zsag093

Consensus Roadmap on Periodic Leg Movements during Sleep (PLMS): Outcomes of the International PLMS Taskforce

Sleep. 2026 Apr 6:zsag093. doi: 10.1093/sleep/zsag093. Online ahead of print.

Authors

Stephany Fulda¹, Mathias Baumert², Matteo Cesari³, Stefan Clemens⁴, Yves Dauvilliers^{5

6}, Luigi Ferini Strambi^{7

8}, Samson G Khachatryan⁹, Brian B Koo^{10

11}, Mauro Manconi^{1

12

13}, Emmanuel Mignot¹⁴, Marie-Hélène Pennestri¹⁵, Thomas Penzel¹⁶, Giuseppe Plazzi^{17

18}, Matthew Salanitro¹⁶, Rosalia Silvestri¹⁹, Ambra Stefani³, Robert Thomas²⁰, John W Winkelman²¹, Rochelle Zak²², Raffaele Ferri²³

Affiliations

¹ Sleep Medicine Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland.
² Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia.
³ Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
⁴ East Carolina University, Greenville, North Carolina, USA.
⁵ National Reference Centre for Orphan Diseases (Narcolepsy/Idiopathic Hypersomnia/Kleine-Levin Syndrome), Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France.
⁶ Institute of Neurosciences of Montpellier, INSERM, Montpellier, France.
⁷ IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences/Neurology, Sleep Disorders Center, Milan, Italy.
⁸ Vita-Salute San Raffaele University, Milan, Italy.
⁹ Department of Neurology and Neurosurgery, National Institute of Health, Yerevan, Armenia; Sleep Disorders Center, Somnus Neurology Clinic, Yerevan, Armenia.
¹⁰ Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
¹¹ Department of Neurology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
¹² Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
¹³ Department of Neurology, Inselspital, Bern, Switzerland.
¹⁴ Stanford Center for Sleep Research and Medicine / Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA.
¹⁵ Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada; Hôpital en santé mentale Rivière-des-Prairies (CIUSSS-NIM), Montreal, QC, Canada.
¹⁶ Interdisciplinary Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹⁷ UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
¹⁸ Department of Biomedical, Metabolic and Neuroscience, University of Modena and Reggio Emilia, Italy.
¹⁹ Department of Clinical and Experimental Medicine, Sleep Medicine Center, University of Messina, AOU G. Martino, Messina, Italy.
²⁰ Department of Medicine, Division of Pulmonary Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
²¹ Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
²² Sleep Disorders Center, University of California, San Francisco, California, USA.
²³ Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy.

PMID: 41947375
DOI: 10.1093/sleep/zsag093

Abstract

Periodic leg movements during sleep (PLMS) are a frequently observed motor phenomena in polysomnography, yet their biological meaning and clinical relevance are debated. Further, how these should be evaluated and tabulated for optimal evaluation is uncertain. To address these gaps, an international, multidisciplinary taskforce convened a series of online meetings followed by an in person taskforce workshop held in Troina, Italy, on November 14-15, 2025, where agreement was reached through iterative discussion (qualitative; no Delphi or predefined voting thresholds). This taskforce roadmap summarizes the taskforce conclusions across five priority domains: (1) clinical significance and impact, (2) measurement and characterization, (3) treatment, (4) basic and translational research, and (5) PLMS across the life span and epidemiology. For each domain, we delineate where the field currently stands, identify critical gaps in knowledge, and propose concrete strategies, including key milestones, study designs, and infrastructure needs, to advance the field in a coordinated and standardized manner. A central unifying theme is that PLMS should no longer be viewed solely as a countable polysomnographic index, but rather as a spectrum of sleep related motor activity with heterogeneous neurophysiological substrates and variable clinical impact. Achieving progress will require harmonized scoring standards, validated automated and wearable technologies, large longitudinal and outcome oriented studies, and sustained international collaboration. This roadmap provides a framework to guide research, clinical innovation, and future guideline development, but it is not a clinical practice guideline or standards statement.

Keywords: PLMS scoring standards; Periodic leg movements during sleep; cardiovascular comorbidity; longitudinal monitoring; translational sleep research; wearable sleep technology.

© The Author(s) 2026. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.