From the Guidelines
The most effective treatment option for Periodic Limb Movement Disorder (PLMD) is bilateral high-frequency peroneal nerve stimulation, as it has shown initial success in short-term sham-controlled studies and a longer observational extension, providing a noninvasive and nonpharmacological approach to managing the condition 1.
Treatment Options for PLMD
The treatment of PLMD focuses on managing symptoms and improving quality of life. The following options are considered:
- Bilateral high-frequency peroneal nerve stimulation: a noninvasive and nonpharmacological treatment that has shown promise in reducing symptoms of PLMD 1.
- Pharmacological treatments: such as opioids, gabapentin, and iron supplementation, which may be considered in certain cases, but their use should be tailored to the individual patient's needs and medical history 1.
Considerations for Treatment
When considering treatment options for PLMD, it is essential to:
- Address exacerbating factors, such as alcohol, caffeine, and certain medications 1.
- Consider the individual patient's values and preferences, as well as their medical history and potential side effects of treatments 1.
- Monitor for potential adverse effects, such as augmentation with long-term use of certain medications 1.
Special Populations
In special populations, such as adults with end-stage renal disease (ESRD), conditional recommendations are made for gabapentin, IV iron sucrose, and vitamin C, while levodopa and rotigotine are not recommended due to the risk of augmentation with long-term use 1.
Pediatric Considerations
In pediatric cases, oral iron supplementation may be considered in cases of iron deficiency, but it is essential to monitor for potential side effects, such as constipation 1.
From the Research
Treatment Options for Periodic Limb Movement Disorder (PLMD)
- Dopaminergic agents are the most successful and well-studied treatment for PLMD, as well as Restless Legs Syndrome (RLS) 2, 3, 4.
- Specific dopaminergic agents that are effective in treating PLMD include:
- Other treatment options for PLMD include:
- The American Academy of Sleep Medicine recommends the following therapies for PLMD:
- Pramipexole and ropinirole as STANDARD level treatments
- Levodopa with dopa decarboxylase inhibitor, opioids, gabapentin enacarbil, and cabergoline as GUIDELINE level treatments
- Carbamazepine, gabapentin, pregabalin, clonidine, and iron supplementation as OPTION level treatments 5
Special Considerations
- PLMD therapy typically mimics RLS therapy, and the primary focus of treatment is on idiopathic RLS 5
- There is limited evidence on the treatment of PLMD in special populations, such as children, pregnant women, and the elderly 2, 4
- Further research is needed to establish the effectiveness of different treatments for PLMD and to determine the best course of treatment for individual patients 2, 6