Periodic Limb Movements During Sleep Mimicking REM Sleep Behavior Disorder: A New Form of Periodic Limb Movement Disorder

Abstract Introduction While REM sleep without atonia (RSWA) in REM sleep behavior disorder (RBD) is associated with male sex, age greater than or equal to 50 years, alpha-synucleinopathies, and narcolepsy, the characteristics of patients with RSWA/persistent periodic limb movements of sleep in REM sleep (RSWA/PLMS-REM) without dream enactment behaviors are unexplored. The aim of this study was to compare the demographics, comorbidities, and concomitant medication use between RSWA/PLMS-REM patients and non-RSWA/non-PLMS-REM controls. Based on anecdotal clinical observations, we hypothesized that these patients are more commonly young, women, have psychiatric or neurological diseases, and use antidepressants. Methods We conducted a retrospective review of the Mayo Clinic electronic medical record to identify all patients with RSWA/PLMS-REM between November 2018 and November 2020. After excluding all patients with RBD, restless legs syndrome, narcolepsy, and RSWA/non-PLMS-REM, we identified 27 patients. All in-lab polysomnograms (PSGs) were reviewed to calculate the periodic limb movement index per hour of REM sleep (REM-PLMI). We also identified a control group of 15 individuals without RSWA, reviewed their PSGs, and calculated the REM-PLMI. Results The mean REM-PLMI of patients with RSWA was 64 +/- 8.3 (standard error of mean (SEM)) per hour versus 1 +/- 0.6 (SEM) per hour in non-RSWA controls (p < 0.001). Patients with RSWA/PLMS-REM and non-RSWA controls had similar age and gender, 62 +/- 3 (SEM) versus 58 +/- 3 (SEM) years and 81% versus 87% men, respectively. However, psychiatric diagnosis, neurological disorders, and antidepressants use were more common among RSWA/PLMS-REM patients compared to non-RSWA controls with p = 0.0002, p = 0.0035 and p = 0.0074 respectively (Fisher’s Exact Test). Conclusion Psychiatric diagnosis, neurological disorders, and antidepressant use are more common among RSWA/PLMS-REM patients compared to non-RSWA/non-PLMS-REM controls. Further research to determine the implications of a diagnosis of RSWA/PLMS-REM for the future development of alpha-synucleinopathies are needed and currently ongoing. Support (if any):

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The validity of the PAM-RL device for evaluating periodic limb movements in sleep and an investigation on night-to-night variability of periodic limb movements during sleep in patients with restless legs syndrome or periodic limb movement disorder using this system

Sleep Medicine ◽

10.1016/j.sleep.2013.08.790 ◽

2014 ◽

Vol 15 (1) ◽

pp. 138-143 ◽

Cited By ~ 14

Author(s):

Mina Kobayashi ◽

Kazuyoshi Namba ◽

Eiki Ito ◽

Shingo Nishida ◽

Masaki Nakamura ◽

...

Keyword(s):

Movement Disorder ◽

Restless Legs Syndrome ◽

Limb Movement ◽

Periodic Limb Movements ◽

Periodic Limb Movement ◽

Limb Movements ◽

Periodic Limb Movement Disorder ◽

Restless Legs

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Restless Legs Syndrome and Periodic Limb Movement Disorder in Children

Journal of Child Science ◽

10.1055/s-0039-1678661 ◽

2019 ◽

Vol 09 (01) ◽

pp. e38-e49 ◽

Cited By ~ 1

Author(s):

Denise Sharon ◽

Arthur Scott Walters ◽

Narong Simakajornboon

Keyword(s):

Movement Disorder ◽

Restless Legs Syndrome ◽

Pediatric Population ◽

Limb Movement ◽

Periodic Limb Movements ◽

Evidence Based ◽

Periodic Limb Movement ◽

Limb Movements ◽

Periodic Limb Movement Disorder ◽

Restless Legs

Introduction Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) have been studied more than any other sleep-related movement disorder in the pediatric population. A common feature to both, periodic limb movements, occurs in many other disorders and also in reportedly healthy children and adolescents. In this review, we discuss the different types of limb movements as it pertains to pediatric RLS and PLMD and provides an update on these disorders. Methods A literature search was performed with the following inclusion criteria: English publication, limb movements, leg movements, periodic limb movements of sleep, periodic limb movements during wake, PLMD, RLS, with each of the modifiers, children, pediatric, and adolescents. Identified publications were reviewed and their reference lists were searched for additional relevant publications. Results A total of 102 references were included in this review. These included epidemiological studies, prospective and retrospective studies, case series, observational data, reviews, and consensus guidelines. A critical summary of these findings is presented. Conclusion The limited evidence-based data support the importance of evaluating limb movements in the context of the clinical symptomatology presented by the child or the adolescent. Further research is needed to (1) better understand the pathophysiological mechanisms resulting in periodic limb movements as encountered in the pediatric PLMD or RLS patient and their impact on the overall health and well-being, (2) develop objective diagnostic criteria for RLS and differentiate it from its “mimics” in the pediatric population, and (3) establish evidence-based guidelines for treatment.

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Sleep-related movement disorders

10.1093/med/9780199682003.003.0023 ◽

2017 ◽

Author(s):

Alessandro Gradassi ◽

Federica Provini

Keyword(s):

Movement Disorder ◽

Eye Movement ◽

Movement Disorders ◽

Behavior Disorder ◽

Periodic Limb Movement ◽

Rapid Eye Movement Sleep ◽

Healthy Individuals ◽

Periodic Limb Movement Disorder ◽

Sleep Behavior ◽

Rhythmic Movement Disorder

Sleep-related movement disorders are conditions characterized by simple and usually stereotyped movements that disturb sleep. They comprise periodic limb movement disorder, nocturnal leg cramps, sleep-related bruxism, sleep-related rhythmic movement disorder, and movement disorders due to drugs or medical conditions. Some of these movements, such as bruxism, might occur during both wakefulness and sleep, but a clear worsening of the symptoms during sleep is necessary in order to include the condition among sleep-related movement disorders. Sleep-related movement disorders may occasionally be present in healthy individuals, but the manifestations must disturb sleep with daytime consequences in order to be classified within this group of disorders. Finally, sleep-related movement disorders must be distinguished from parasomnias, such as sleepwalking or rapid eye movement sleep behavior disorder (RBD), which normally show more complex muscular patterns and behaviors.

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Clinical Overview of REM Sleep Behavior Disorder

Seminars in Neurology ◽

10.1055/s-0037-1605595 ◽

2017 ◽

Vol 37 (04) ◽

pp. 461-470 ◽

Cited By ~ 1

Author(s):

Verna Porter ◽

Alon Avidan

Keyword(s):

Rem Sleep ◽

Muscle Tone ◽

Clinical Manifestations ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Lewy Body Dementia ◽

Acute Onset ◽

Periodic Limb Movement Disorder ◽

Sleep Behavior ◽

Muscle Atonia

AbstractRapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by loss of muscle atonia during REM sleep that allows motor responses to dream content. Patients display patterns of unusual, complex, and even violent motor activities. There is a high risk for harm to the patients or their bedpartners. REM sleep behavior disorder is more likely to occur in synucleinopathies such as Parkinson's disease, Lewy body dementia, and multiple system atrophy and may precede clinical manifestations by decades. In secondary RBD, brainstem centers involved in muscle atonia during REM are disrupted. These conditions include multiple sclerosis, cerebral vascular accidents, and brainstem tumors. The acute onset of RBD may associate with the use of antidepressants and acute withdrawal from alcohol. The diagnosis of RBD should be confirmed by polysomnography utilizing multiple-limb electromyography and synchronized digital video monitoring and demonstrate elevation of muscle tone during REM sleep along with dream enactment behavior. The differential diagnosis includes sleepwalking, nocturnal seizures, sleep apnea, and periodic limb movement disorder. Management focuses on maximizing safety, use of clonazepam/melatonin, and discussion of prognosis with patients.

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