Pain and Coping
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PeriodicLimbMovementDisorder.docxRUNNING HEAD: Medical Disorders 2
Periodic Limb Movement Disorder & Restless Leg Syndrome
Chelsea Reese
The University of Alabama at Birmingham
PSY 488: Kristin T. Avis, Ph.D., CBSM
December 14, 2018
Abstract
The restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) can be separated but overlapping sicknesses. Both feature night-living happening by chance, without any planning occasional limb movements that can cause sleep disruption, but each has separate medicine-based features that are clearly connected with or related to the management of the patient. The cause of RLS is made by meeting established medicine-based judging needed things, not from discovery of occasional limb movements of sleep (PLMS) on a sleep study. PLMD does require the presence of PLMS on polysomnography as well as a connected sleep complaint. Both PLMS and RLS can happen with other sleep problems as well as in healthy people. Treatment of RLS is based on the pattern and extremeness of the problem, with rgic drugs generally liked for/preferred for first treatment. Anticonvulsants, pain-relieving drugs, and drugs that cause sleep also have a role. A treatment set of computer instructions is given to help with the management of RLS. Treatment of PLMD depends on many of the same medicines but is generally more plain/honest/easy and places a greater reliance on levodopa compounds and drug that calms or causes sleep.
Periodic Limb Movement Disorder (PLMD)
This disorder is characterized by repeated and uncontrollable movements of arms or legs occurring during sleep. This condition may affect the legs and arms and is sometimes confused with restless leg syndrome. This condition causes brief muscle twitches and leg kicks. The involuntary movements of limbs causes sleep disturbances or insomnia and a child suffering from this condition usually experiences other mental, physical, behavioral or social problems seen during the day.
As a result of disturbed sleep at night, the child may experience daytime sleepiness. However, the exact cause of this problem is not known but is associated with a family history of this condition. Low iron levels, nerve problems, poor blood circulation and kidney disorders are also common causes of this problem. This condition is also associated with other sleep problems such as narcolepsy and restless leg syndrome
To diagnose this problem, a parent may notice the signs at night when the child is sleeping, an overnight sleep study is often required to confirm the diagnosis along with other medical and physical examination such ad blood tests to determine the iron levels.
Treatment
Children and adolescents with PLMD are advised to have good sleep hygiene by having enough sleep and having regular sleep patterns, the children should also avoid caffeine as it worsens the symptoms of PLMD. In case the iron level are low, iron supplements are given to improve this condition.
Restless Leg Syndrome (RLS)
Restless leg Syndrome (RLS) is a neurological disorder characterized by a need to move the legs in order to relive uncomfortable feelings in the legs. These feelings may be defined as tingling sensation or “creepy-crawly” feeling (Kotagal, & Pianosi, 2006). When the child moves the leg, these undesired feelings are often relived. However, these feelings and sensations in the legs affect child’s sleep patterns and the child suffering from this condition may have a hard time falling asleep.
When sleeping, the child kicks and twitches the legs affecting their sleep. The child may wake up feeling tired, the child with this condition may not understand what is happening but a parent or guardian may help to detect the problem.
The problem is usually genetic although other risk factors such as iron deficiency, caffeine, and certain medications such as Prozac may cause or worsen the condition. Symptoms include, difficulty falling asleep, bedtime behavioral problems such as difficulty falling asleep, day time problems such as sleepiness during the day, mood and behavioral problems are also common in children with RLS.
This condition is diagnosed after a history of symptoms is described as well as a physical examination to rule out other problems. An overnight sleep study may also be conducted to evaluate the disorder. Patients with RLS are divided into different treatment categories Intermittent RLS: RLS that is troublesome enough when present to justify treatment but does not occur frequently enough to necessitate daily therapy. Daily RLS: RLS that is frequent and troublesome enough to require daily therapy. Refractory RLS: Refractory RLS is daily RLS that has been unsuccessfully treated with two classes of drugs (one dopaminergic and one non-dopaminergic) at the correct dose and for an adequate length of time.
Treatment
Treatment methods include; good sleep hygiene, changing bedtime habits, reading bed time stories, avoiding caffeine and reducing the discomfort with massages, cold compressors to provide temporary relief. If the blood test indicates that the iron levels are low, iron supplements are recommended to increase the ferritin levels. Self-Treatment consists of getting up and moving around it helps the unpleasant feeling temporarily go away.
Periodic limb movement disorder (PLMD) and restless leg syndrome (RLS) are sleep disorders that, at first glance, appear to be the same thing. Both conditions are characterized by a sleeper not being able to keep still. However, the two sleep disorders are distinctly different. Diagnosing which condition a patient might be suffering from is important is determining what the best course of treatment might be.
PLMD is a condition in which a patient’s limbs usually, one or both legs involuntarily and rhythmically move several times during the night. These movements are different from the normal spasms that might occur as someone tries to fall asleep with PLMD, the movements cluster at periodic intervals during the first non-REM stage of sleep. Periodic leg movement disorder suffers often do not know they have the condition.
Restless leg syndrome is characterized by the uncontrollable urge to move one’s legs or other limbs or parts of the body. Sufferers of feel an uncomfortable sensation an unexplained pain, or a crawling feeling in their legs during restful periods including while trying to fall asleep.
The difference between these two sleep disorders is that PLMD is an involuntary action in which the patient often sleeps through an episode of leg movements. With RLS however patients are awake the whole time and are jerking or kicking their legs in an effort to overcome the discomfort their brains are perceiving. So, in other words, restless leg syndrome keeps the patient awake and periodic limb movement disorder occurs when the patient is already asleep.
PLMD is often confused with restless legs syndrome (RLS) but, while the two conditions often occur together, they're not the same thing. While RLS can happen at any time, PLMD only can affect sleeping patients.
An estimate of 1 million children of school age have restless leg syndrome. Typically, restless legs symptoms are worse in the evening, when the child is at rest, lying down, or sitting.
Treatments for PLMD and RLS can differ, although some drug solutions do overlap for both disorders. The exact causes for each are unknown, though certain medications, Parkinson’s disease, and narcolepsy can trigger both disorders.
One similarity between PLMD and RLS that must not be overlooked Fatigue and excessive daytime sleepiness (EDS) are side effects of both disorders. After all, restless leg syndrome prevents sufferers from falling asleep; periodic leg movement disorder can prevent sufferers from getting a good night’s sleep even after dozing off. Seeking a diagnosis and treatment is important not only for sufferers of these disorders, but also for sleep partners whose slumber is disrupted by the restlessness of the person beside them. The mechanism is unclear but may involve abnormalities in dopamine neurotransmission in the CNS.
The role of the pediatric psychologist to determine diagnosis of RLS is based primarily upon interview with the patient. A clinical diagnosis of RLS can only made if patients complain of four key symptoms which constitute the essential criteria. Currently, there are no lab tests that can definitively confirm or deny the presence of RLS. The use of sleep studies or a suggested immobilization test may occasionally be helpful in difficult cases by demonstrating the presence of periodic limb movements. It has been proposed that response to a dopaminergic medication can be formalized as a confirmatory test. Treatment comprises the recognition and reversal of causes and symptom control. For patients with mild or infrequent symptoms, non-drug based options may be sufficient to provide symptom relief. Pharmacologic therapy of idiopathic RLS is designed to relieve the patient's sensory and motor symptoms and sleep disturbances. Such therapy is symptomatic it does not cure RLS but merely suppresses the disorder's unwanted manifestations. Curative therapy may be available to treat the underlying disorder in secondary RLS, such as iron deficiency or renal failure. The first step in selecting RLS treatment is to characterize symptoms according to intensity, persistence circadian pattern of onset, and etiology (primary or secondary).
The role of the pediatric psychologist to determine diagnosis of Periodic limb movement disorder (PLMD) is especially hard to diagnose in kids because it sometimes takes years for specific symptoms to show up. Often, children with PLMD are described as "restless sleepers" by parents.
Parents with the condition have a 50% chance of passing it onto their kids. The psychologist will also ask you about your child’s sleep history and perform a physical exam to rule out other medical conditions. A parent simply watching a child while he/ she sleeps is not good enough for a diagnosis of PLMD. The best way to diagnose it is a sleep study.
During the sleep study the child will spend the night in a sleep lab. Besides limb movements, polysomnography records eye movements, brain activity, heart rate and blood pressure. It also can tell how much oxygen is in your child’s blood and how much air is moving through her nose while she breathes.
References
https://www.everydayhealth.com/sleep/0613/how-restless-legs-syndrome-affects-children.aspx
