Upper extremity symptoms can develop in restless legs syndrome, but are rarely the initial symptom. Objectives: To report a case of restless legs syndrome with restless arms as the initial symptom, and to review the literature. Design: Case report and literature review. Patient: A 78-year-old man had arm restlessness and sleep disturbance. A polysomnogram demonstrated sub-clinical periodic leg movements 1 year after the onset of his symptoms. Results: Two years later, he developed lower

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... y symptoms that fit the criteria for restless legs syndrome. To our knowledge, this is the first case of restless legs syndrome with arm restlessness as the initial symptom in an otherwise neurologically normal person. Conclusion: Restless legs syndrome may initially exhibit upper extremity symptoms.