Introduction People with spinal cord injury (SCI) have a high prevalence of sleep disorders, which often remain undiagnosed and untreated, resulting in reduced quality of life. Their sleep may be disturbed by pain and spasms, but these could also be symptoms of Restless Leg Syndrome (RLS) or Periodic Limb Movements (PLMs). Studies estimate that RLS affects 17-19% of people with SCI. Little is known about the management of RLS or PLMs after SCI.

Method A systematic review was conducted following PRISMA guidelines, searching 5 databases, for studies of any intervention to manage RLS and/or PLMs in people with SCI. Outcomes of interest were changes in severity of RLS or PLMs, or effects on sleep quality (see table 1).

Results 465 Manuscripts were identified. 12 studies fulfilled inclusion/exclusion criteria, totalling 108 participants. Risk of bias assessment revealed low evidence quality due to small sample sizes and lack of randomised controlled trials.

Interventions investigated included • L-dopa and pramipexole were shown to reduce PLMs objectively measured by polysomnography, and subjectively reported RLS symptoms.

• Exercise reduced the PLM index measured by polysomnography.

• Intrathecal baclofen injection reduced PLMs.

Discussion It is thought that in people with SCI dopaminergic medications exert their effect in the spinal cord rather than in the brain.

Reviewed papers report potential confusion between PLMs and spasticity, and between neuropathic pain and RLS.

The RLS diagnostic criteria are challenging to apply after SCI. It is unclear how a patient with altered sensation following SCI will experience the ‘urge’ to move.

Conclusions There is evidence that some sleep measures improved with dopaminergic medication or exercise. Clinicians should consider investigation for RLS and PLMs in patients with neuropathic pain or spasticity unresponsive to usual treatment, with symptoms predominating in the evening or at night. These patients may respond to treatment for these sleep disorders.