Periodic Limb Movement Disorder - Causes, Symptoms, Diagnosis, and Treatment

Creator: Dr. Shanthwani Francis
Published: 2022-12-30T13:06:03

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Periodic limb movement disorder (PLMD) is a condition that involves repetitive limb (arms and legs) movements during sleep.

Written by

Dr. Shanthwani Francis

Medically reviewed by

Dr. Abhishek Juneja

December 30, 2022

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Contents

What Is Periodic Limb Movement Disorder (PLMD)?
What Are the Causes of Periodic Limb Movement Disorder?
What Are the Symptoms of Periodic Limb Movement Disorder?
How Can Periodic Limb Movement Disorder Be Diagnosed?
What Are the Treatment Options for Periodic Limb Movement Disorder?

Introduction:

Sleep-associated movement diseases are an important category of sleep disorders commonly seen in many people. Periodic limb movement disorder (PLMD) is a disease in which the patient moves limbs involuntarily and intermittently. Restless legs syndrome (RLS) refers to a voluntary response to an urge to move the legs due to unpleasant sensations. Although similarities exist between PLMD and RLS, the major change between the two conditions is that PLMD takes place only during sleep, whereas RLS occurs when the patient is awake and asleep. During PLMD, the patient is often unaware of limb movements.

What Is Periodic Limb Movement Disorder (PLMD)?

PLMD is a sleep disorder that involves involuntary and rhythmic movements of the legs and feet during sleep. In certain cases, arms are also affected. PLMD is mostly seen during the initial stage of sleep (when the person changes from wakefulness to sleep). The movements usually consist of bending and jerking of the big toe, hip, knee, and ankle. The movements repeatedly occur at regular intervals of about five to 90 seconds. The frequency of the movements can vary each night. These movements disturb the sleep pattern of the person and lead to daytime sleepiness. The person may or may not wake up during the movements. In most cases, the patient is unaware of this disorder unless the sleeping partner notices the movements and informs the patient. Although it can happen at any age, middle-aged and older people are the ones who are more prone to PLMD.

What Are the Causes of Periodic Limb Movement Disorder?

PLMD can be of two types:

Primary: When PLMD appears on its own in a person, it is known as primary PLMD.

Secondary: When PLMD develops in a person due to any underlying medical problem or certain medications, it is called secondary PLMD. The exact cause of primary PLMD has not been found. However, researchers believe that it may be due to any abnormalities present in the nerves traveling from the brain to the limbs.

The causes of secondary PLMD are as follows:

Diabetes.
Iron deficiency.
Any injury or tumor (abnormal growth of tissues) in the spinal cord.
Narcolepsy (a disorder that causes the excessive urge to sleep during waking hours).
Patients with kidney diseases.
Anemia (low level of oxygen-carrying substance in the blood).
High usage of caffeine.
Sudden withdrawal from sedative medicines (used to relax and get better sleep).
Side effects of medicines used to treat depression and psychotic disorders.

What Are the Symptoms of Periodic Limb Movement Disorder?

Daytime sleepiness.
Short attention span.
Poor memory.
Depression.
Sleeplessness during the night.
Bending and tightening of the knee, ankle, and big toe while sleeping at night.
Excessive tiredness.
Bed partners complain about being kicked by the patient during sleep.

How Can Periodic Limb Movement Disorder Be Diagnosed?

No lab test can prove that the patient has PLMD. However, certain tests can find out the underlying medical cause that could lead to PLMD. The tests are listed below:

Physical Examination: The doctor will conduct a thorough examination of the patient to find out the underlying cause of the sleep problem. The doctor gets information from the patient regarding lifestyle factors and family medical history. The doctor also finds out about the medications being taken by the patient for any other disorder.

Blood Tests: The doctor asks the patient to conduct a blood test to detect anemia or any other deficiencies (folic acid, vitamin B12). The levels of magnesium and thyroid function tests are also done.

Urine Samples: The urine sample of the patient is collected to find out the presence of any drugs that can contribute to sleep problems.

Sleep Diary: The doctor may instruct the patient to finish a sleep diary for two weeks. A sleep diary is an everyday update of all information related to the sleep patterns of the patient. Pieces of information regarding bedtime, wake-up time, time taken to fall asleep, and the number and duration of sleep interruptions should be recorded. The sleep diary should also contain information about the consumption of alcohol or caffeine, past or present medicines, and the history of any family member having any kind of sleep disorder.

Polysomnogram (PSG): PSG is a sleep study test. It records breathing, heart rate, brain waves, body positions, level of oxygen in the blood, and eye movements during sleep. It is conducted at a sleep center mostly during the night, and the patient is asked to come two hours before bedtime. During this test, electrodes (medium through which electricity enters or leaves an object) are placed on the patient’s chin, scalp, and the outer edge of the eyelids. The monitors attached to the chest of the patient record heart rate and breathing. The electrodes record signals when the patient is awake and during sleep. The test measures the amount of time taken to fall asleep. The PSG helps to rule out the conditions that can cause sleep disorders and excessive movement of limbs.

What Are the Treatment Options for Periodic Limb Movement Disorder?

Treatments usually do not cure the disorder but might improve the symptoms of PLMD. The following treatment options can be done:

Avoiding Caffeine: Foods and drinks that have caffeine should not be consumed as it increases PLMD symptoms. Examples include chocolates, soda, and coffee.

Lifestyle Changes: Mild to moderate cases of PLMD may be treated with lifestyle changes. This includes intake of a diet rich in iron, reducing the consumption of alcohol, and sticking to a proper bedtime routine that has a regular bedtime and wake-up time. Techniques that manage stress, like meditation, breathing exercises, and yoga, are advised.

Medications: Several types of medications are given to treat PLMD.

Dopamine agonists: Drugs to elevate the amount of dopamine (a brain chemical that helps to regulate the movements of muscles) are given.
Benzodiazepines: These act as sedatives that help the patient sleep comfortably during repeated limb movements. However, most people avoid using such drugs for fear of getting addicted after prolonged usage.
Gamma-Aminobutyric acid (GABA) Agonists: These drugs stop the release of certain brain chemicals, helping to reduce muscle contractions (muscle contractions are the tightening, shortening, or lengthening of muscles while doing some activity).
Iron Supplements: In patients with low iron levels in the blood, the doctor may prescribe iron tablets.

Conclusion:

As most patients with PLMD are unaware of uncontrolled limb movements, it is important to listen to the bed partner. Although the patient does not feel much discomfort due to PLMD, untreated cases may lead to insomnia (a disorder that makes the patient feel hard to fall asleep), depression, and other mental health disorders. Hence, it is very important to visit the doctor in the initial stages and get the right treatment.

Frequently Asked Questions

1. What Factors Can Contribute to Periodic Limb Movement Disorder?

Periodic limb movement disorder is classified as either primary or secondary. An underlying medical condition causes secondary periodic limb movement disorder (PLMD). The cause of primary periodic limb movement disorder (PLMD), on the other hand, is unknown. It has been linked to abnormalities in nerve regulation from the brain to the limbs, but the precise nature of these abnormalities is unknown. In 80 to 90 percent of cases, PLMS is associated with restless leg syndrome (seen during a sleep study), obstructive sleep apnea, narcolepsy, REM behavioral disorder, uremia, spinal cord tumor, and ADHD.

2. What Is the Most Effective Treatment for PLMD?

Since most PLM is associated with RLS, dopaminergic medications such as Pramipexole, Ropinirole, Rotigotine, and other drugs such as Gabapentin and Pregabalin may cause a reduction in periodic limb movement disorder (PLMD) by inhibiting the release of certain neurotransmitters that stimulate muscle contractions. The relaxation of contractions as a result. Baclofen is the most commonly used agent for periodic limb movement disorder (PLMD).

3. Is PLMD a Neurological Condition?

Periodic limb movement disorder (PLMD) is a common neurological disorder that, if left untreated, causes serious impairment. However, this condition is rarely identified in clinical practice, most likely due to a lack of understanding and/or facilities for diagnosis.

4. How to Naturally Manage PLMD?

Caffeine-containing foods and beverages should be avoided as they aggravate periodic limb movement disorder (PLMD) symptoms. Chocolate, soda, and coffee are some examples. Mild to moderate periodic limb movement disorder (PLMD) can be treated with lifestyle changes, which include eating an iron-rich diet, limiting alcohol consumption, and adhering to a regular bedtime and wake-up routine. Stress management techniques such as meditation, breathing exercises, and yoga are recommended.

5. Is PLMD Treatable?

Treatment may alleviate periodic limb movement disorder (PLMD) symptoms, but it does not usually cure the illness, especially if it is a primary periodic limb movement disorder (PLMD) with no identified etiology. Treatment is not required if the movements related to periodic limb movement disorder (PLMD) do not seriously interfere with sleep or have an impact on everyday life or relationships. It is also important to treat the underlying condition in the case of secondary periodic limb movement disorder (PLMD).

6. How Serious Is a PLMD?

People with minor symptoms may not require therapy because periodic limb movement disorder (PLMD) is not regarded as medically severe. Severe types of the disease, on the other hand, might have lasting effects, such as chronic sleepiness during the day or feeling fatigued.

7. When Does PLMD Occur During Sleep?

PLMS are more common during the first and second stages of non-rapid eye movement (NREM) sleep. During the third stage of NREM and REM sleep, the movements are less frequently occurring.

8. How Is PLMD Treated in Children?

A doctor may prescribe an iron supplement that also contains vitamin C. Iron absorption will be increased by vitamin C. Iron supplementation might cause constipation in some children. Keep track of the child's diet by taking more high-fiber meals and drinking more fluids, which can relieve constipation; the child may also require stool softener on occasion.

9. Can PLMD Be Caused by Anxiety?

The actual cause of periodic limb movement disorder (PLMD) is unknown, but it may be connected to a lack of dopamine or nerve problems. Some drugs and medical conditions, such as antidepressants and Parkinson's disease, may raise the possibility of periodic limb movement disorder (PLMD). Anxiety is not the primary cause of periodic limb movement disorder (PLMD), but it could be a symptom or an associated condition. If patients have periodic limb movement disorder (PLMD) and anxiety, speak with the doctor about a diagnosis and treatment options.

10. How Is PLMD Diagnosed?

A polysomnography exam, commonly known as a sleep study, is used to diagnose periodic limb movement disorder (PLMD). This test records brain waves, heart rate, oxygen levels, eye movements, nerve and muscle functioning, and blood pressure. The test is normally performed overnight in a laboratory at a sleep disorder unit or approved sleep center. A physical exam may also be performed by a doctor to identify underlying problems such as iron deficiency anemia and metabolic abnormalities.

11. What Causes One’s Legs to Jerk in Bed?

Periodic limb movement disorder (PLMD) is characterized by repetitive stiffness or twitching of the legs during sleep. It is a unique movement disorder that only happens while sleeping, and it is also known as periodic leg movements in sleep.

12. What to Do to Stop Kicking In One’s Sleep?

To avoid kicking in sleep, limit caffeine or other stimulants for six hours before night, quit smoking, have a healthy diet, take iron supplements if there are low blood iron levels, reduce stress, maintain ideal body weight, reduce noises by using a face mask and earplugs, and breathe in through the nose rather than the mouth.

13. What Are the Possible Long-Term Consequences Of PLMD?

Periodic limb movement disorder (PLMD) may have a number of long-term consequences. Periodic limb movement disorder (PLMD) can cause fatigue, drowsiness, or hyperactivity during the day. Children may struggle with focus and perform poorly in school. Some children may be misdiagnosed as having attention deficit hyperactivity disorder (ADHD).

14. Is Parkinson’s Disease Linked To PLMD?

Periodic limb movement disorder (PLMD) is not an early sign of Parkinson's disease, a movement and balance disorder. Periodic limb movement disorder (PLMD), on the other hand, maybe more common in people who have Parkinson's disease or other medical issues. These PLMS-related problems and/or sequelae can lead to brain hypoxia and neuroinflammation, raising the risk of Parkinson's disease and thereby suggesting that PLMS may be linked to Parkinson's disease.

15. Is PLMD Harmful to the Arms?

Periodic limb movement disorder (PLMD) produces repeated movements of the legs and feet while sleeping. The condition might also affect the arms in some circumstances. During sleep, people with PLMD have leg or arm twitches or jerks every 20 to 40 seconds.

16. Is PLMD Caused by a Stroke?

Stroke is not the primary cause of periodic limb movement disorder (PLMD), but other illnesses such as restless legs syndrome (RLS), iron deficiency, kidney disease, diabetes, Parkinson's disease, and some drugs could be contributing factors.

Sources

Dr. Abhishek Juneja

Neurology

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