Periodic Limb Movements while Awake (PLMA) as a Manifestation of Wearing‐Off in Parkinson's Disease: A Case Series and Review of the Literature

Abstract

BackgroundBackground: Periodic limb movements while awake (PLMA) are similar to Periodic limb movements in sleep (PLMS) but occurring during wakefulness and seen in association with restless leg syndrome (RLS). Objectives Objectives: To describe PLMA as a wearing-off phenomenon in Parkinson's Disease (PD). Methods Methods: We describe four individuals with PD and PLMS, who had associated similar periodic and stereotypic lower extremity movements during wakefulness, thought to be secondary to PLMA, and were highly responsive to dopaminergic treatment. ResultsResults: Despite the prevalence of RLS and PLMS in individuals with PD, the presence of similar movements during wakefulness has not been well characterized. The lack of a specific diagnostic criteria poses a significant diagnostic challenge. Conclusions Conclusions: We describe, for the first time to our knowledge, PLMA as a wearing-off phenomenon in PD. This entity could be classified in the spectrum of "low-dose dyskinesia," as we found that it was highly responsive to dopaminergic treatment.Periodic limb movements in sleep (PLMS) are characterized by repetitive, periodic and highly stereotypical limb movements during sleep, which may be associated with arousal. 1 PLMS are strongly associated with restless leg syndrome (RLS), which is distinguished by the presence of unpleasant or uncomfortable urge to move the legs that occurs during periods of inactivity and is transiently relieved by movement. 2,3 Patients with RLS manifest a wide variety of voluntary movements in attempt to relieve the uncomfortable subjective complaints associated with restlessness.Distinct from the more common voluntary movements performed in an attempt to relieve the subjective RLS symptoms, RLS patients may experience movements similar to PLMS but during wakefulness, referred to as periodic limb movements while awake (PLMA). 4 Although Parkinson's Disease (PD) has been associated with a higher prevalence of RLS symptoms in general, 5 to our knowledge PLMA has not been described in Parkinson's disease as a "low-dose dyskinesia." Methods and ResultsIn this case series, we describe four individuals with PD and associated PLMA as a possible wearing-off manifestation with significant