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Wednesday, September 17, 2014
Periodic Limb Movement treatment
Thank you, Ziad Shaman, for answering my question regarding PLMS and sleep apnea. You seemed surprised that my husband was placed on Klonopin, and assumed he was being treated for RLS. I was under the assumption that this medication was used for both syndromes. Is this not correct? If not, what other meds are recommended. I should add, that his doctor tried to put him on Requip, which did not do nearly as well as the Klonopin. He still is symptomatic, although somewhat improved with 1.5 mg of Klonopin daily. I appreciate your input.
You are correct. Medications that are used to treat Periodic Limb Movement during Sleep (PLMS) and Restless Legs Syndrome (RLS) are similar.
I would like to point out though that PLMS, as you know, occurs in a wide range of sleep disorders, including narcolepsy, rapid eye movement behavior disorder, obstructive sleep apnea syndrome, insomnia, and hypersomnia. PLMS have also been reported in subjects without any sleep complaint, and although they are rare in young individuals, they are relatively common in the older adult. PLMS are usually discovered during sleep studies and the consequences of these are unclear. However, RLS is associated with insomnia and treating RLS may improve this as well as an individuals quality of life.
Pharmacological treatment options for RLS (and PLMS) include:
- Dopaminergic agonists like pramipexole, ropinirole (Requip), and pergolide
- Dopaminergic precursors like levodopa with benserazide or carbidopa
- Benzodiazepines like clonazepam (Klonopin), temazepam, and nitrazepam
- Opiates like oxycodone, and codeine
- Antiepileptic drugs like carbamazepine, and gabapentin
Of course, each of these medications has its own set of special indications, contraindications, interactions with other medications and side effects. The help of a Sleep Specialist may be needed to decide the most appropriate therapy, if one is indicated. And as noted in the prior answer, further testing may be necessary to evaluate your husband for other sleep problems that may be exacerbating his leg symptoms.
Good luck and stay well.
Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University