A Simple Guide to Periodic Limb Movement Disorder, Diagnosis, Treatment and Related Conditions

By Kenneth Kee

This book describes Periodic Limb Movement Disorder, Diagnosis and Treatment and Related Diseases

Periodic limb movement disorder (PLMD), previously known as nocturnal myoclonus, is a sleep disorder where the patient moves limbs involuntarily and periodically during sleep, and has symptoms or disorders related to the movement.

PLMD should not be mistaken for restless legs syndrome (RLS).

RLS happens while awake and when asleep, and when awake, there is a voluntary reaction to an uncomfortable feeling in the legs.

PLMD on the other hand is involuntary, and the patient is often not aware of these movements altogether.

Many people who have RLS also have a disorder called periodic limb movement in sleep (PLMS).

PLMS induces the legs or arms to twitch or jerk about every 10 to 60 seconds during sleep.

These movements induce the person to wake up often and get less sleep.

PLMS normally affects the legs, but it also can affect the arms.

Not everyone who has PLMS also has RLS.

RLS is featured by a voluntary response to an urge to move legs due to discomfort.

It is mostly not known what are the precise causes of PLMD, but in many instances the patient also has other medical disorders such as Parkinson's disease or narcolepsy.

Factors that elevate the possibility of PLMD in the absence of RLS are:
Being a shift worker,
Snoring,
Coffee drinking,
Stress,
Use of hypnotics, particularly in the case of benzodiazepine withdrawal.

For women, a higher risk of both PLMD and restless legs syndrome is linked with:
The presence of musculoskeletal disease,
Heart disease,
Obstructive sleep apnea,
Cataplexy,
Doing physical activities close to bedtime and
The presence of a mental disorder

Medical agents that increase the risk of PLMD are several psychopharmacological drugs (serotonergic and tricyclic antidepressants, venlafaxine and mirtazapine).

PLMS appears to have a beginning in the spinal cord.

In fact, PLMS was believed to be linked with higher spinal reflexes.

Presentations of PLMS appear to happen in disorders linked with dopaminergic dysfunctions.

The low ferritin levels in adult population are believed to explain PLMD where higher RLS severity and elevated PLMS were significantly linked with low ferritin levels.

The lack of iron may induce restriction of dopamine formation which may be causing PLMS.

Patients with PLMD will have complaints of excessive daytime sleepiness (EDS), falling asleep during the day, difficulty falling asleep at night, and difficulty staying asleep throughout the night.

Patients also demonstrate involuntary limb movements that happen at periodic intervals anywhere from 20–40 seconds apart.

They often only persist the first half of the night during non-REM sleep stages.

Movements do not happen during REM due to muscle atonia.

PLMD is diagnosed with the help of a polysomnogram or PSG.

PLMD is diagnosed by first detecting PLMS (periodic limb movements of sleep) on a PSG, then integrating that data with a detailed history from the patient and bed partner.

PLMD is often treated with anti-Parkinson medicines (pramipexole, ropinirole, cabergoline, and rotigotine) and also react to anticonvulsants, benzodiazepines, and narcotics.

Patients must stay on the treatment in order to obtain relief

There is no known cure for this disorder.

Patients with a low ferritin level react well to oral iron supplements

Caffeine, alcohol or antidepressants are not advised as they could worsen the PLMD

TABLE OF CONTENT
Introduction
Chapter 1 Periodic Limb Movement Disorder
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Restless Leg Syndrome
Chapter 8 Intermittent Claudication
Epilogue

• Language: English
• Publisher: Kenneth Kee
• Release date: Jan 21, 2023
• ISBN: 9798215645970

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

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