PLMD & RLS

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Diagnosis

PLMD
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, however, the diagnosis is made by a sleep technician during an overnight polysomnogram, which records sleep and the bioelectrical processes that govern it. This test is often used to assess the cause of excessive daytime sleepiness, such as PLMD and obstructive sleep apnea.

RLS
The diagnosis of RLS is based on the patient's description and personal history of his or her affliction. Because it presents no external secondary symptoms, RLS can be difficult to identify. There are studies designed to quantify the effects of RLS, though these are used mostly for research purposes. For example, a Suggested Immobilization Test, or Forced Immobilization Test, is performed while the patient either voluntarily keeps his or her legs motionless or while the legs are immobilized with a stretcher. The limb movements are then monitored with an EMG. In both PLMD and RLS, a complete examination to exclude secondary causes is warranted.

Furthermore, it is necessary to distinguish PLMD from other more serious types of nocturnal movement, such as seizure. Nocturnal seizures present problems for patients because they can cause injury and are indicative of disorders that require specialized treatment. Also, iron and calcium deficiencies often produce symptoms that mirror RLS, such as leg cramping and tenderness.

Treatment

Generally, there are three classes of drugs that are used to treat PLMD and RLS. These are benzodiazepines, Parkinson drugs, and narcotics. Medical treatment of PLMD and RLS often significantly reduces or eliminates the symptoms of these disorders, though not always. There is no cure for PLMD or RLS, and medical treatment must be continued to provide potential relief.

Clonazepam is the most commonly employed benzodiazepine treatment. It is effective in many cases, but not all, and it usually causes drowsiness or sedation. Sometimes, clonazepam allows the patient a better, more restful night's sleep without affecting the occurrence of limb movement. Patients with PLMD may have other sleep disorders, such as obstructive sleep apnea, which the use of clonazepam could worsen.

The drugs used to treat Parkinson's disease are also very effective against PLMD and RLS. These include, L-dopa/carbidopa, bromocriptine (which suppresses the excretion of prolactin), pergolide, and selegiline. If either benzodiazepines or Parkinson's medications do not relieve symptoms, then narcotics, such as codeine, oxycodone, methadone, and propoxyphene are sometimes employed.

In May of 2005, ropinirole hydrochloride (e.g., Requip®), which also is used to treat Parkinson's disease, was approved by the Food and Drug Administration (FDA) to treat moderate-to-severe (i.e., 15 or more episodes per month) restless legs syndrome. This medication may result in extreme drowsiness and may cause patients to fall asleep during daily activities (e.g., driving). Other side effects include dizziness, nausea and vomitting, sweating upon standing.

PLMD & RLS, Diagnosis, Treatment reprinted with permission from sleepdisorderchannel.com
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