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Periodic Limb Movement Disorder (PLMD)

Sleep disorder characterized by repetitive limb movements during sleep.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Periodic Limb Movement Disorder (PLMD)?

Periodic limb movement disorder (PLMD) is a sleep disorder characterized by repetitive, stereotyped limb movements (often dorsiflexion of foot, knee, hip flexion) occurring at intervals of 5-90 seconds during sleep. Movements last 0.5-10 seconds, 4 or more consecutive episodes form a series. Although the patient is unaware, sleep is fragmented and daytime sleepiness develops.

Diagnostic criteria (ICSD-3): periodic limb movement index (PLMI) on polysomnography >15/hour in adults, >5/hour in children, AND clinical sleep disturbance/daytime sleepiness, AND not better explained by another sleep disorder. PLMS without symptoms (periodic limb movements in sleep) is just a finding, PLMD is a clinical disorder.

Etiology: idiopathic (primary), secondary causes (RLS - in 80-90% of patients, iron deficiency anemia, peripheral neuropathy, end-stage renal disease, spinal cord injury, narcolepsy, REM sleep behavior disorder, drugs - SSRI, SNRI, TCA, antipsychotic, lithium, antiemetic withdrawal). Pathophysiology: dopaminergic system dysfunction (low serum ferritin, brain iron deficiency), spinal hyperexcitability. Treatment: iron supplementation (if ferritin <75 ng/mL), dopamine agonist (pramipexole, ropinirole - augmentation risk), gabapentin enacarbil, alpha-2-delta ligand, opioids (refractory).

Symptoms

Daytime sleepiness, fatigue, decreased concentration
Non-restorative sleep, frequent awakenings
Bedpartner observation: leg kicking, hip flexion (80% only known by partner)
Sometimes patient feels: brief leg jerks during sleep
Insomnia, sleep latency prolongation
Restless leg syndrome (RLS) symptoms (in 80-90%)
Morning fatigue, headache
Cognitive findings: attention disorder, memory complaint
Mood disturbance, depression, anxiety
Decline in quality of life
In children: ADHD-like symptoms

Risk Factors

Restless leg syndrome (high overlap)
Iron deficiency, low ferritin (<75 ng/mL)
End-stage renal disease, hemodialysis
Diabetic peripheral neuropathy
Pregnancy (especially 3rd trimester)
Advanced age (>65 - prevalence 30-45%)
Spinal cord injury
Narcolepsy, REM behavior disorder
Drugs: SSRI (sertraline), SNRI (venlafaxine), TCA, lithium
Antipsychotics (haloperidol, risperidone)
Caffeine, alcohol, nicotine excess
Family history (genetic factor present)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Daytime sleepiness, weakness, despite adequate sleep duration
  • Bedpartner: complaint of leg kicking
  • Restless legs + uncomfortable sensation
  • Insomnia + frequent leg movement
  • Mood-cognitive deterioration
  • Behavioral problem in child + sleep complaint
  • Diabetes-renal disease + new sleep complaint
  • Antidepressant-antipsychotic + new sleep disturbance
  • Insomnia not responding to other treatments

Treatment Methods

01
Sleep history + bedpartner story
02
Polysomnography (PSG) - gold standard (PLMI calculation)
03
Iron panel: ferritin, TSAT, hemoglobin (target ferritin >75 ng/mL)
04
Vitamin B12, folate, creatinine, TSH
05
EMG, peripheral nerve examination (peripheral neuropathy)
06
Iron replacement: ferrous sulfate 325 mg 1-3×/day (with food, vitamin C)
07
- IV iron sucrose (oral intolerance, severe deficiency)
08
- Target: ferritin >75 ng/mL
09
Drug review: discontinue/reduce SSRI, antipsychotic
10
Caffeine, alcohol, nicotine reduction
11
Sleep hygiene improvement
12
Drug treatment options (in case of clinical disorder):
13
- Alpha-2-delta ligand: gabapentin enacarbil 600 mg, pregabalin 75-300 mg (first-line, augmentation no)
14
- Dopamine agonist: pramipexole 0.125-0.5 mg, ropinirole 0.25-2 mg (augmentation risk - long-term avoid)
15
- Levodopa (only short-term)
16
- Opioid (refractory): tramadol, oxycodone-naloxone (selected, addiction risk)
17
- Benzodiazepine: clonazepam 0.5-2 mg (only sleep continuity)
18
Pregnancy: iron + non-pharmacologic + selected gabapentin
19
Long-term follow-up: PSG repeat (treatment effectiveness, augmentation evaluation)
20
Sleep medicine specialist consultation

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.