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Periodic limb movement disorder
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{{stub}} '''Periodic Limb Movement Disorder''' or '''PLMD''' or '''sleep myoclonus''' or '''nocturnal myoclonus''' is a form of Periodic Leg Movements of Sleep (PLMS) involving very frequent movements that disturb the quality of sleep.<ref name="ICD11">{{Cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1846518306 | title = Periodic Limb Movement Disorder {{!}} ICD-11 for Mortality and Morbidity Statistics | last = | first = | authorlink = | date = |website=[[World Health Organization]]|archive-url=|archive-date=|url-status=|access-date=2022-01-10}}</ref> Patients with PLMD are normally unaware of the movements, and it can only be diagnosed via polysomnography (PSG).<ref name="sleepeducation">{{Cite web|url=https://sleepeducation.org/sleep-disorders/periodic-limb-movements/ | title = Periodic Limb Movements | last = Robards | first = Katherine|website=American Academy of Sleep Medicine - Sleep Education|language=en-US|access-date=2022-01-10 | date = | authorlink = |archive-url=|archive-date=|url-status=}}</ref> The International Classification of Sleep Disorders, 2nd edition (ICSD-2) defines PLMD as: "periodic episodes of repetitive, highly stereotyped, limb movements that occur during sleep (PLMS)".<ref name="NBK560727"/> Both arm and leg movements can occur, but leg movements are much more common, and PLMD is diagnosed only when there are a minimum of 15 stereotyped movements ''per hour'' during sleep, particularly extension of the big toe or ankle, and sometimes knee or hip flexing.<ref name="NBK560727"/><ref name="BMJ"/> ==Signs and symptoms== *[[Fatigue]] *[[Unrefreshing sleep|Unrefreshing sleep or non-restorative sleep]] *Daytime tiredness or sleepiness<ref name="Ch">{{Cite book | title = Encyclopedia of Sleep| date = 2013 |url=https://www.sciencedirect.com/science/article/pii/B9780123786104003880 | pages = 43–47 | last = Ferri | first = R. | authorlink = | last2 = Novelli | first2 = L. | authorlink2= | last3 = Bruni | first3 = O. | authorlink3 =|isbn=978-0-12-378611-1|chapter=Periodic Limb Movement Disorder|language=en|location=Waltham|publisher=Academic Press | editor-last = Kushida|editor-first = Clete A.|doi=10.1016/B978-0-12-378610-4.00388-0|pmc=|pmid=|quote=|via=|chapter-url=https://www.sciencedirect.com/science/article/pii/B9780123786104003880}}</ref> The [[World Health Organization]] classes PLMD as a sleep disorder associated with a "clinical sleep disturbance or a complaint of daytime fatigue that cannot be better explained by another cause".<ref name="NBK560727"/> ==ME/CFS== Periodic Limb Movement Disorder is recognized as a common comorbidity of [[ME/CFS]] by the U.S. ME/CFS Clinician Coalition (2020).<ref name="USMECFS2020">{{Cite web | title = Diagnosing and Treating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last = U.S. ME/CFS Clinician Coalition |edition=2 | date =July 2020|url= https://bridgesandpathways.org.au/wp-content/uploads/2021/02/DiagnosingAndTreatingMECFSV2_USCoalition_2020.pdf | pages = 4}}</ref> and is particularly common in people with [[Restless leg syndrome|Restless Leg Syndrome]], which also affects many people with ME/CFS. ==Possible causes == PLMD is more common in people aged over 70, people with [[restless legs syndrome]], which causes urges to regularly move legs in the daytime, neurodegenerative diseases such as [[Parkinson's disease]], people with diabetes, and low [[iron]] and certain other medical conditions.<ref name="BMJ">{{Cite web|url=https://bestpractice.bmj.com/topics/en-us/1169 | title = Periodic limb movement disorder - Symptoms, diagnosis and treatment | last = | first = | authorlink = | date = Feb 26, 2020 | website = BMJ Best Practice US|archive-url=|archive-date=|url-status=|access-date=2022-01-10}}</ref><ref name="NBK560727">{{Cite book | title = Periodic Limb Movement Disorder | date = 2021 | url=http://www.ncbi.nlm.nih.gov/books/NBK560727/ | last= Joseph | first = Valentina | last2 = Nagalli | first2 = Shivaraj|location=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=32809562}}</ref> The movements can also be related to use of certain medications including [[lithium]], a mood stabilizer used got bipolar disorder, [[:Category:Tricyclic antidepressants|tricyclic antidepressants]] (TCAs) such as [[amitriptyline]], and [[:Category:Selective serotonin reuptake inhibitors|selective serotonin reuptake inhibitors]] (SSRIs), which should be ruled out before diagnosis.<ref name="BMJ" /><ref name="NBK560727"/> ==Treatment== A number of different medications have shown positive results in patients with PLMD, although many were very small clinical trials.<ref name="guidelines">{{Cite web|url=https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/TreatmentRLS.pdf | title = Guideline Update - Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder | last= | first = | authorlink = | date = 2012 | website = Sleep Education - American Academy of Sleep Medicine|archive-url=|archive-date=|url-status=|access-date=2022-01-10}}</ref> ==Notable articles== ==See also== *[[Restless legs syndrome]] ==Learn more== *[https://sleepeducation.org/sleep-disorders/periodic-limb-movements/ Periodic Limb Movements] - Sleep Education, American Academy of Sleep Medicine ==References== {{reflist}} [[Category:Potential comorbidities]] [[Category:Diagnoses]] [[Category:Sleep disorders]]
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