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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