Periodic limb movement disorder

Periodic limb movements of sleep are repetitive limb movements (mostly of the legs), occurring mainly during non-rapid eye movement (non-REM) sleep; they are characterized by dorsiflexion of the toes and ankles and occasionally flexion of the hip and knee.

Periodic limb movement disorder may be diagnosed when the periodic limb movement of sleep index (PLMS-I; the number of periodic limb movements per hour of sleep) is >15 and results in clinical sleep disturbance. The diagnosis is confirmed by polysomnography, and other causes of sleep-wake disturbance must be excluded.

PLMS may arise in normal individuals, and their clinical significance in terms of sleep disturbance and excessive daytime sleepiness is controversial.

May be either primary (idiopathic) or secondary. Secondary periodic limb movement disorder (PLMD) may occur in restless legs syndrome, obstructive sleep apnea syndrome, REM sleep behavior disorder (RBD), narcolepsy, congestive heart failure, essential hypertension, end-stage renal disease, spinal cord injury, syringomyelia, alcohol dependence, Parkinson disease, and Tourette syndrome.

May be related to intake of medications including lithium, tricyclic antidepressants, and selective serotonin-reuptake inhibitors.

There is no evidence for treatment of primary PLMD. Treatment is traditionally with dopamine agonists, benzodiazepines, and opiates.

Periodic limb movements of sleep (PLMS) are characterized as repetitive limb movements (mostly of the legs) arising mainly during non-rapid eye movement (non-REM) sleep.[1]American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Westchester, IL: American Academy of Sleep Medicine; 2014.[2]Garcia-Borreguero D, Ferini-Strambi L, Kohnen R, et al. European guidelines on management of restless legs syndrome: report of a joint task force by the European Federation of Neurological Societies, the European Neurological Society and the European Sleep Research Society. Eur J Neurol. 2012;19:1385-1396. http://www.ncbi.nlm.nih.gov/pubmed/22937989?tool=bestpractice.com [3]Zucconi M, Ferri R, Allen R, et al. The official World Association of Sleep Medicine (WASM) standards for recording and scoring periodic leg movements in sleep (PLMS) and wakefulness (PLMW) developed in collaboration with a task force from the International Restless Legs Syndrome Study Group (IRLSSG). Sleep Med. 2006;7:175-183. http://www.sleep-journal.com/article/PIIS1389945706000049/fulltext http://www.ncbi.nlm.nih.gov/pubmed/16459136?tool=bestpractice.com [4]Hornyak M, Feige B, Reimann D, et al. Periodic leg movements in sleep and periodic limb movement disorder: prevalence, clinical significance and treatment. Sleep Med Rev. 2006;10:169-177. http://www.ncbi.nlm.nih.gov/pubmed/16762807?tool=bestpractice.com [5]Aurora RN, Kristo DA, Bista SR, et al. The treatment of restless legs syndrome and periodic limb movement disorder in adults-an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep. 2012;35:1039-1062. http://www.aasmnet.org/Resources/PracticeParameters/TreatmentRLS.pdf http://www.ncbi.nlm.nih.gov/pubmed/22851801?tool=bestpractice.com Periodic limb movement disorder (PLMD) may be diagnosed when the frequency of periodic limb movements of sleep is >15/hour in adults.[1]American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Westchester, IL: American Academy of Sleep Medicine; 2014. The periodic limb movements must be accompanied by sleep disturbance and excessive daytime sleepiness. The association with sleep disturbance and excessive daytime sleepiness is controversial, however, and the etiology is unclear. This topic focuses on the diagnosis and management of PLMD in adults.