Restless Legs Syndrome and Periodic Limb Movements During Sleep: Diagnosis and Treatment

Abstract

RLS and PLMS are common neurologic disorders and increase in prevalence with aging. These disorders can be disabling conditions, causing sleep disturbance at night and excessive sleepiness during the day. Polysomnography and the suggested immobilization test are used to support the clinical diagnosis of RLS and PLMS. Although levodopa alleviates symptoms, rebound and augmentation occur frequently, limiting the long-term usefulness of this agent. The direct dopamine receptor agonists such as pergolide, pramipexole, ropinirole, and cabergoline have largely replaced levodopa as the most effective treatment for RLS and PLMS.

Clinical Significance of Periodic Limb Movement Disorder (PLMD) in Insomnia Patients

“…This finding is strengthened by the fact that common confounding variables, including age, gender, sleep apnea, and RLS, were statistically controlled for. The data can be meaningfully inter- preted in line with the common observation that PLMD often go unnoticed and appear as insomnia [29], demonstrating that the daytime consequences of insomnia and PLMD may be difficult to separate from each other. This points to the necessity of using polysomnographic registrations in the assessment and diagnosing of common sleep disorders, especially since PLMD and insomnia require very different treatment approaches.…”

An update on sleep disorders and their treatment

“…Ropinirole, pramipexole and rotigotine are all licensed for the treatment of moderate to severe restless legs syndrome. 46 Bromocriptine, cabergoline and pergolide are not recommended due to the risk of heart valve damage. 45 Levodopa has also been shown to be effective but around 80 per cent of patients develop rebound, in which symptoms return within a few hours following administration, or augmentation, in which symptoms occur earlier in the evening, prior to treatment.…”

An update on sleep disorders and their treatment

“…Ropinirole, pramipexole and rotigotine are all licensed for the treatment of moderate to severe RLS. 36 Levodopa has also been shown to be effective but around 80 per cent of patients develop rebound, in which symptoms return within a few hours following administration, or augmentation, in which symptoms occur earlier in the evening, prior to treatment. The dopaminergic agonists may also cause rebound and augmentation but to a lesser extent than levo dopa.…”