Periodic limb movements during sleep: a narrative review

ZusammenfassungDas Restless-Legs-Syndrom (RLS) ist eine zentralnervöse, genetisch prädisponierte, durch biochemische Faktoren getriggerte chronisch-progrediente sensomotorische Störung, oft mit Beginn im Kindes- oder Jugendalter. Zugrundeliegend wird eine zerebrale Störung des Eisen- und Dopamin-Stoffwechsels postuliert. Diese manifestiert sich durch den unwiderstehlichen Zwang seine Extremitäten bewegen zu müssen, verbunden mit Parästhesien und Dysästhesien. Die Beschwerden nehmen in Ruhe und in der Nacht zu und bessern sich durch Bewegung. RLS sollte eigentlich mit Restless-Limbs-Syndrome übersetzt werden, da langfristig auch Beschwerden in den Armen auftreten können. Kinder ab 18 Monaten können bereits betroffen sein. Die Prävalenz im Kindes- und Jugendalter beträgt 2–4 %, in Assoziation mit ADHS noch höher. Die Diagnose des RLS beruht auf anamnestischen und somit subjektiv geprägten Aussagen, die bei Kindern mit beschränkten sprachlichen Ausdrucksmöglichkeiten schwierig zu werten sind. Bis zu 75 % der RLS-Betroffenen entwickeln im Schlaf periodische Extremitätenbewegungen, welche die Nachtruhe empfindlich stören können (PLMS, periodic limb movements in sleep). Mitbetroffen sind die kognitive Leistungsfähigkeit, Stimmung und Lebensqualität am Tag. Eisenmangel, Genussmittel und gewisse Medikamente können die Beschwerden verstärken. Im Gegensatz zum RLS können PLMS mit neurophysiologischen Messungen objektiviert werden. Therapeutisch steht an erster Stelle die Behandlung eines allfälligen Eisenmangels. Entwickelt wurden Algorithmen für intravenöse Therapien. Falls angezeigt, kommen L-Dopa oder Dopamin-Agonisten zur Anwendung. Da auch Kinder eine Zunahme der RLS-Symptome unter dieser Therapie erleben (Augmentationen), wird zunehmend eine primäre Gabe von Alpha-2-Liganden bevorzugt.Dieser Artikel möchte auf die wichtige Aufgabe von Kinderärzten und Grundversorgern bei der rechtzeitigen Erkennung und Behandlung von RLS/PLMS hinweisen.

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Actimetry-documented persistent Periodic Limb Movements during EEG-confirmed deep General Anesthesia: a case report.

10.31219/osf.io/bgjsa ◽

2019 ◽

Author(s):

Friedrich Lersch ◽

Pascal Jerney ◽

Heiko Kaiser ◽

Cédric Willi ◽

Katharina Steck ◽

...

Keyword(s):

Case Report ◽

Motor Activity ◽

General Anesthesia ◽

Burst Suppression ◽

Periodic Limb Movements ◽

Deep Sclerectomy ◽

Limb Movements ◽

Periodic Leg Movements ◽

Increase Motor Activity ◽

Leg Movements

Motor activity during general anesthesia (GA) without curarization is often interpreted as reflecting insufficient analgosedation. Here we present the case of an octogenarian scheduled for deep sclerectomy receiving opioid-sparing electroencephalography-(EEG)-guided anesthesia. Periodic Leg Movements (PLM) made their appearance with ongoing surgery while his raw EEG displayed a pattern of deep GA (burst suppression). To the best of our knowledge, this is the first description of actimetry-documented persisting PLM during EEG-monitored GA. Recognizing PLM in the context of GA is of importance for anesthesiologists, as increasing sedation may increase motor activity.

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523 Characteristics of Patients with REM Sleep without Atonia/Periodic Limb Movements of Sleep without Dream Enactment Behaviors

SLEEP ◽

10.1093/sleep/zsab072.522 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A206-A206

Author(s):

Lina Barker ◽

Maja Tippmann-Peikert

Keyword(s):

Rem Sleep ◽

Psychiatric Diagnosis ◽

Neurological Disorders ◽

Rem Sleep Behavior Disorder ◽

Control Group ◽

Periodic Limb Movements ◽

Limb Movements ◽

Sleep Behavior ◽

Rem Sleep Without Atonia ◽

Antidepressant Use

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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Periodic limb movements in patients with obstructive sleep apnea syndrome

Scientific Reports ◽

10.1038/s41598-021-95018-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaobo Zhou ◽

Bo Zhou ◽

Zhe Li ◽

Qiao Lu ◽

Shaoping Li ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Periodic Limb Movements ◽

Limb Movements ◽

Factors Associated ◽

Obstructive Sleep ◽

Apnea Syndrome

AbstractThe aim of the study was to assess the factors associated with periodic limb movements during sleep (PLMS) among obstructive sleep apnea syndrome (OSAS) patients and identify the role of PLMS in patients with OSAS. 303 adult patients with OSAS were included in the study. All patients completed physical examination, Epworth sleepiness scale (ESS), and polysomnography. Diagnosis of PLMS was made if the periodic leg movements index (PLMI) was ≥ 15. Chi-square test, ANOVA, univariate and multivariate logistic regression analyses were conducted to identify factors associated with PLMS among OSAS patients. Statistical analyses were performed with SPSS 26.0 for mac. Statistically significant difference was considered if P value < 0 .05. Among the 303 adult patients with OSAS, 98 patients had significant PLMS and the other 205 had no significant PLMS. Compared with OSAS patients without PLMS, OSAS patient with PLMS were older, had shorter REM duration and greater apnea–hypopnea index (AHI) (P < 0.05). The study suggests that PLMS is a matter of concern among patients with OSAS. A better understanding of the role of PLMS among OSAS patients could be useful in better recognition, intervention and treatment of OSAS.

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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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Motor pattern of periodic limb movements during sleep

Neurology ◽

10.1212/wnl.57.2.300 ◽

2001 ◽

Vol 57 (2) ◽

pp. 300-304 ◽

Cited By ~ 92

Author(s):

F. Provini ◽

R. Vetrugno ◽

S. Meletti ◽

G. Plazzi ◽

L. Solieri ◽

...

Keyword(s):

Motor Pattern ◽

Periodic Limb Movements ◽

Limb Movements

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519 Restless Legs and Periodic Limb Movements in 86 patients with Multiple Sclerosis

SLEEP ◽

10.1093/sleep/zsab072.518 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A205-A205

Author(s):

Davide Sparasci ◽

Raffaele Ferri ◽

Anna Castelnovo ◽

Claudio Gobbi ◽

Chiara Zecca ◽

...

Keyword(s):

Multiple Sclerosis ◽

Diagnostic Criteria ◽

Large Population ◽

Female Gender ◽

Clinical Findings ◽

Periodic Limb Movements ◽

Limb Movements ◽

Cross Sectional ◽

Restless Legs ◽

Maintenance Of Wakefulness Test

Abstract Introduction The aim of this study was to assess the prevalence of restless legs syndrome (RLS), periodic limb movements during sleep (PLMS) and their overlap in a large population of patients with multiple sclerosis (MS), and to compare clinical and paraclinical findings between patients with and without RLS/PLMS. Methods In this cross–sectional, observational, instrumental study, eighty-six patients (M/F: 27/59; mean age 48.0 ± 10.8 years) with a diagnosis of MS underwent a structured telephone interview assessing the five standard diagnostic criteria for RLS. Seventy-six participants underwent Video-polysomnography and Maintenance of Wakefulness Test (MWT). Instrumental and clinical findings were subsequently statistically compared to investigate their association with RLS and PLMS index (PLMSI). Results RLS and PLMS (PLMSI ≥15/h) prevalence in patients with MS was of 31.4% and 31.6% respectively. Among patients with RLS, 37.5% had a PLMSI ≥15/h. In the group with PLMS, 37.5% met all diagnostic criteria for RLS. No differences were found between patients with and without RLS (F = 0.99, p = 0.45), and between patients with and without a PLMSI ≥15/hour (F = 0.32 p = 0.94) on the pool of clinical and instrumental variables. Conclusion RLS is highly prevalent and severe in patients with MS. The prevalence of PLMS is comparable to the general population. The low percentage of patients with RLS having a high PLMSI, together with the absence of correlation between RLS and female gender and older age, support the existence of a distinct symptomatic form of RLS in MS. Support (if any):

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