nocturnal myoclonus (periodic limb movement disorder, PLMD, periodic limb movements of sleep, PLMS)
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Introduction
A condition related to restless legs syndrome characterized by repetitive, periodic & stereotypical movement of the limbs, usually the legs, during quiet waking or non REM sleep.
Although 85% of patients with restless legs syndrome also have nocturnal myoclonus, the reverse is not true & patients with nocturnal myoclonus may present instead with insomnia or excessive daytime sleepiness.
Etiology
- lumbar disc disease predisposes to nocturnal myoclonus
- autonomic (sympathetic) activation may play role[5]
- dysfunction of dopaminergic hypothalamic A11 nucleus that synapse on preganglionic sympathetic neurons
- idiopathic
* not associated with Parkinson's disease or parkinson plus syndromes
Epidemiology
- prevalence increases with age
- common disorder
Clinical manifestations
- repetitive, periodic & stereotypical movement of the limbs
- insomnia
- excessive daytime sleepiness
- physical examination is normal
- patients may intermittently kick their bed partner
Laboratory
Diagnostic procedures
- polysomnography (required for diagnosis)
Differential diagnosis
- hypnic jerks
- partial seizure
- sleep apnea
- rapid eye movement sleep behavioral disorder
- associated with Parkinson's disease & parkinson plus syndromes
Management
- treatment only indicated if marked fragmentation of sleep[7]
- therapy targeted towards improving sleep quality
- benzodiazepines not indicated[7]*
- also see management of restless legs syndrome
* used to treat rapid eye movement behavioral disorder
More general terms
Additional terms
- rapid eye movement sleep behavioral disorder (RBD)
- restless legs syndrome; Willis-Ekbom disease (RLS)
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1039-40
- ↑ UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 3.0 3.1 3.2 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
- ↑ Alessi C In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ 5.0 5.1 5.2 5.3 Guggisberg AG et al, The significance of the sympathetic nervous system in the pathophysiology of periodic leg movements in sleep. Sleep 2007, 30:755 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17580597
- ↑ Chesson AL Jr, Wise M, Davila D et al Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder. An American Academy of Sleep Medicine Report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 1999 Nov 1;22(7):961-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/10566915
- ↑ 7.0 7.1 7.2 7.3 Medical Knowledge Self Assessment Program (MKSAP) 18, 19. American College of Physicians, Philadelphia 2018, 2021
Patient information
nocturnal myoclonus (periodic limb movement disrder, PLMD) patient information