Periodic limb movement disorder

For many patients and their bed partners, securing a diagnosis and providing reassurance is sufficient and no pharmacologic treatment is required.

Caffeine and alcohol intake, antidepressants, and some hypnotic agents may exacerbate the symptoms of PLMD. Accordingly, avoidance of these agents, together with improved sleep hygiene (relatively strict sleep schedule and avoiding sleep deprivation, smoking, and late-night exercise), may alleviate symptoms. However, there is no evidence to support this course of action. Additional sleep hygiene resources are available through the American Academy of Sleep Medicine. American Academy of Sleep Medicine: healthy sleep habits Opens in new window

Treatment recommended for SOME patients in selected patient group

May be considered in patients with depression.

The effect of bupropion has not been studied in large double-blind placebo-controlled studies. Its efficacy and optimal dose is therefore unclear.

A trial of a low dose, with cessation of therapy if adverse effects are intolerable or if there is no clinical benefit after 1 week, seems pragmatic.

In a case series of 5 patients, 10 weeks of treatment with bupropion in 5 depressed patients who also met criteria for having pretreatment PLMD demonstrated a reduction in measures of PLMD and an improvement in depression.[32]Nofzinger E, Fasiczka A, Berman S, et al. Bupropion SR reduces periodic limb movements associated with arousals from sleep in depressed patients with periodic limb movement disorder. J Clin Psychiatry. 2000;61:858-862. http://www.ncbi.nlm.nih.gov/pubmed/11105739?tool=bestpractice.com

Treatment recommended for SOME patients in selected patient group

There has been one study of 9 patients with primary PLMD without restless legs syndrome, in which treatment with melatonin significantly reduced movement parameters, such as periodic limb movements of sleep (PLMS), PLMS index, PLMS with arousals, and PLMS-Arousal index.[31]Kunz D, Bes F. Exogenous melatonin in periodic limb movement disorder: an open clinical trial and a hypothesis. Sleep. 2001;24:183-187. http://www.ncbi.nlm.nih.gov/pubmed/11247054?tool=bestpractice.com

PLMD associated with other medical conditions may cease or improve with treatment of the underlying cause (e.g., reversal of iron deficiency state or of uremia).

PLMD may occur in restless legs syndrome, obstructive sleep apnea syndrome, rapid eye movement sleep behavior disorder, narcolepsy, congestive heart failure, essential hypertension, end-stage renal disease, spinal cord injury, syringomyelia, alcohol dependence, Parkinson disease, and Tourette syndrome.

See Restless legs syndrome, Obstructive sleep apnea in adults, Parasomnias in adults, Narcolepsy, Heart failure with reduced ejection fraction, Essential hypertension, Chronic kidney disease, Chronic spinal cord injury, Alcohol use disorder, Parkinson disease, Tourette syndrome.

Treatment recommended for SOME patients in selected patient group

PLMD may cease or improve with cessation of certain causative drugs (e.g., benzodiazepines, lithium, selective serotonin-reuptake inhibitors, tricyclic antidepressants, and barbiturates).