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The Cleveland Clinic

Sleep Disorders: Periodic Limb Movement Disorder

Introduction to PLMD

Periodic limb movement disorder (PLMD) is a sleep disorder characterized by rhythmic movements of the limbs during sleep. The movements typically involve the legs, but upper extremity movements may also occur. Movements occur periodically throughout the night and can fluctuate in severity from one night to the next.

What Causes PLMD?

The causes of PLMD are unknown. However recent research has shown that people with a variety of medical problems including Parkinson's disease and narcolepsy may have frequent periodic limb movements in sleep.

PLMD may be induced by medications, most notably, antidepressants.

What Are the Symptoms of PLMD?

Symptoms of PLMD are usually leg movements with the extension of the big toe in combination with a partial flexing of the ankle, knee, or hip. Movement of the legs is more typical than movement of the arms. It can often cause a partial or full awakening, and patients are frequently unaware of these movements.

How Is PLMD Diagnosed?

A sleep partner may observe the occurrence of periodic limb movements, which often affect the partner before the patient knows of his or her behavior. In other cases, the diagnosis is made on an overnight polysomnogram (test that records sleep and the bioelectrical signals coming from the body during sleep). This test is often used to assess the cause of daytime sleepiness or recurrent awakenings from sleep. Blood work may be done in order to test iron status, folic acid, vitamin B12, thyroid function, and magnesium levels.

How Is PLMD Treated?

Generally, there are several classes of drugs that are used to treat PLMD. These include the Parkinson's disease drugs, anticonvulsant medications, benzodiazepines, and narcotics. Current treatment recommendations consider the anti-Parkinsons medications as a first line of defense. Medical treatment of PLMD often significantly reduces or eliminates the symptoms of these disorders.

There is no cure for PLMD and medical treatment must be continued to provide relief.



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Periodic Limb Movement Disorder

What is narcolepsy?

Narcolepsy is a chronic disease of the central nervous system. Excessive daytime sleepiness (EDS) is the main symptom and is present in 100% of patients with narcolepsy. Other primary symptoms of narcolepsy include:

  • loss of muscle tone (cataplexy),
  • distorted perceptions (hypnagogic hallucinations), and
  • inability to move or talk (sleep paralysis).

Additional symptoms include disturbed nocturnal sleep and automatic behavior (patients carry out certain actions without conscious awareness). All of the symptoms of narcolepsy may be present in various combinations and degrees of severity.

Narcolepsy usually begins in teenagers or young adults and affects both sexes equally. The first symptom to appear is excessive daytime sleepiness, which may remain unrecognized for a long time in that it develops gradually over time. The other symptoms can follow excessive daytime sleepiness by months...

Read the Narcolepsy article »



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