| Periodic limb movement disorder | |
|---|---|
| Classification and external resources | |
| ICD-9 | 327.51 |
| DiseasesDB | 29476 |
| MeSH | D009207 |
Periodic Limb Movement Disorder (PLMD), previously known as Nocturnal myoclonus, is a sleep disorder where the patient moves limbs involuntarily during sleep, and has symptoms or problems related to the movement.
If the patient moves limbs during sleep but there are no negative consequences, the condition is simply called periodic limb movements of sleep (PLMS). Not all patients with PLMS have PLMD (in fact, most people with PLMS do not have a disorder, and do not require any treatment).
PLMD is diagnosed with the aid of a polysomnogram or PSG. PLMD is diagnosed by first finding PLMS on a PSG, then integrating that information with a detailed history from the patient and/or bed partner. PLMS can range from a small amount of movement in the ankles and toes, to wild flailing of all four limbs. These movements, which are more common in the legs than arms, occur for between 0.5 and 5 seconds, recurring at intervals of 5 to 90 seconds. A formal diagnosis of PLMS requires three periods during the night, lasting from a few minutes to an hour or more, each containing at least 30 movements followed by partial arousal or awakening.
PLMD can cause insomnia and daytime sleepiness. It is estimated to occur in approximately 4% of adults (aged 15–100)[1], but is more common in the elderly, especially females, with up to 11% experiencing symptoms.[2]. PLMS appears to be related to restless legs syndrome (RLS) - a study of 133 people found that 80% of those with RLS also had PLMS.[3] However the opposite is not true: many people who have PLMD do not also have restless leg syndrome.
Factors that increase the likelihood of PLMD in the absence of restless leg syndrome include being a shift worker, snoring, coffee drinking, stress, and use of hypnotics. Being a woman, the presence of musculoskeletal disease, heart disease, obstructive sleep apnea, cataplexy, doing physical activities close to bedtime and the presence of a mental disorder were significantly associated with having a higher risk of both PLMD and restless legs syndrome.[1]
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Treatment
PLMD is treated by medications aimed at reducing or eliminating the leg jerks or the arousals. Non-ergot derived dopaminergic drugs (pramipexole and ropinirole) are preferred.[4] Other dopaminergic agents such as co-careldopa, co-beneldopa, pergolide, or lisuride may also be used. These drugs decrease or eliminate both the leg jerks and the arousals. These medications are also successful for the treatment of RLS restless legs syndrome.
In one study, co-careldopa was superior to dextropropoxyphene in decreasing the number of leg kicks and the number of arousals per hour of sleep. However, co-careldopa and, to a lesser extent, pergolide may shift the leg movements from the nighttime to the daytime.[5] Clonazepam, (Klonopin), in doses of 1 mg has been shown to improve objective and subjective measures of sleep.[6]
'Jimmy Legs'
Jimmy Legs is an informal nickname given to periodic limb movement disorder by Cosmo Kramer from the television show Seinfeld. His girlfriend has PLMD and he doesn't like sleeping in the same bed with her after having sexual intercourse. Frank Costanza also mentions in the same episode that his wife has 'Jimmy Arms', and that they sleep in different beds for that very reason.
See also
References
- ^ a b J Psychosom Res. 2002 Jul;53(1):547-54. Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. Ohayon MM, Roth T.
- ^ J Psychosom Res. 2004 May;56(5):543-8. Restless legs syndrome and periodic limb movement disorder in the elderly. Hornyak M, Trenkwalder C.
- ^ Clinical, polysomnographic, and genetic characteristics of restless legs syndrome: a study of 133 … J Montplaisir, S Boucher, G Poirier, G Lavigne, O … - Mov Disord, 1997
- ^ "Periodic Limb Movements in Sleep". Armenian Health Network, Health.am. Sep 21 2006. http://sleep.health.am/sleep/more/periodic-limb-movements-in-sleep/. Retrieved 2009-07-15.
- ^ Kaplan PW, Allen RP, Buchholz DW, Walters JK. A double-blind, placebo-controlled study of the treatment of periodic limb movements in sleep using carbidopa/levidopa and propoxyphene. Sleep. 1993;16(8):717-723.
- ^ Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) Acute placebo-controlled sleep laboratory studies with clonazepam. European Neuropsychopharmacology , Volume 11 , Issue 2 , Pages 153 - 161. M . Saletu
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