Bedtime-related jerks in the upper limbs associated with restless arms syndrome

Abstract

A 73-year-old man complained at bedtime of "electric shock" sensations, corresponding to myoclonic-like jerks, observed solely in both arms, causing severe insomnia. These involuntary movements appeared at rest and were accompanied by an urge to move that relieved symptoms (video on the Neurology ® Web site at Neurology.org). To date, few observations have been reported on arm restlessness and periodic movements of the upper limbs.1,2 This variant shares common features with restless legs syndrome and periodic limb movement disorder, such as therapeutic response to dopaminergic agonists. Clinicians should be aware of restlessness of the upper limbs, which likely remains underdiagnosed and requires appropriate therapeutic management.

<p>Restless arms syndrome: prevalence, impact, and management strategies</p>

“…Similarly, in patient number 10 the neuroleptic haloperidol, administered due to an initial diagnosis of hemi-chorea-hemiballismus, worsened symptoms while the introduction of levodopa markedly improved RAS 28. In all other patients dopamine agonists had been used with ropinirole being very efficient in patient number 2,21 and pramipexole being reported to be efficient in the other patients 22,24–27…”

“…Among the supportive features, PLMs (supportive feature 1) were not reported in half of the patients, probably because no polysomnography had been performed 23,26,28. PLMs were present in the other five patients 21,22,24,25,27. Periodic movements were present in the upper limbs of patient number 7 with movements of repeated extension of the small finger and in patient number 9 25,27.…”

“…PLMs were present in the other five patients 21,22,24,25,27. Periodic movements were present in the upper limbs of patient number 7 with movements of repeated extension of the small finger and in patient number 9 25,27. Whether PLMs in the upper limbs had been characterized with electromyogram of the extensor carpi radialis (ECR) muscle in the other three patients was not reported.…”

“…Case 124YYYYYYYn.r.n.r. 6 Munhoz et al, 2012; Clin Neurol Neurosurg . Case 224YYYYYn.r.Yn.r.n.r 7 Ruppert et al, 2012; Mov disord25 YYYYYYYNY 8 Gupta et al, 2013; J Neurosci Rural Pract26 YYYYYn.rYNn.r 9 Ruppert et al, 2015; Neurology27 YYYYYYYNY 10 Kim et al, 2017; Acta Neurol Belg28 YYYYYn.rYn.r.n.r. Abbreviations: Y, yes; N, no; n.r., not reported.…”

Chronic back pain cured by low-dose levodopa: is it a variant of restless legs syndrome?

“… 3 , 4 “Restless Arms Syndrome” refers to those sporadic cases in which restlessness occurs initially or solely in the upper extremities. 5 , 6 In even rarer situation, restlessness starts from one’s chest or back. 7 , 8 The tricky thing is that, when restlessness happens in the back, it can be described as all kinds of feelings such as pain, soreness, fatigue, swelling, itching, etc.…”