RLS and PLMD

zombie76 · Post by **zombie76** » Tue Jul 01, 2008 5:08 am

I was diagnosed with RLS a couple of months ago and haven't gotten it under control yet (augmented with Requip and Mirapex) but am also learning that I likely have PLMD (38 PLM, 22 Arousals per hour). Everything online seems to point that way and it appears to be documented that you CAN have RLS and PLMD.
One thing that is confusing is that I was just recommended 'Clinical Management of Restless Legs' by Hening, Buchfuhrer and Lee and on page 13, the charts states that you cannot have both RLS and PLMD. I am completely confused. Any thoughts?

Post by **ViewsAskew** » Tue Jul 01, 2008 6:44 am

Zombie, I'm guessing that what they wrote is confusing writing...but you certainly CAN have both. Many of us do. And, all those doctors know that.

In fact statistically, about 80 percent of people with RLS also have PLMD. Now, only 20% or so of people with PLMD have RLS, so that goes to show PLMD doesn't have to be with RLS - it can be alone or with lots of other disorders.

If I remember, I'll look at that page and see why it's confusing.

maddielouise1 · Post by **maddielouise1** » Wed Jul 02, 2008 4:34 pm

I'd have to agree with Views, in that I too was diagnosed with both, after watching how much limb movement, arousals, awakenings, etc. I had during my sleep study. I really would have to disagree with that statement and I bet hundreds of doctors would as well.

Post by **ViewsAskew** » Wed Jul 02, 2008 5:56 pm

OK, just found my copy...

I'm not a doc, but here is what I think they are saying. They are saying that people with RLS can have PLMs - periodic movements - while asleep, or while awake, but they cannot have PLMD - the actual disorder.

If I follow their logic based on what I'm reading between the lines (and I'm guessing here), PLMD is only applied to people who have PLMs and daytime sleepiness that cannot be contributed to any other disease.

They state, on page 11, the PLMs are common with RLS. In reading this, it sounds to me as if they are saying that the PLMs we have ARE part of RLS, not PLMD. So, those of us with sleeping movements are just experiencing RLS while asleep.

So, since the movements we have and the sleepiness we have are both attributed to RLS, not PLMD (as disorders go).

This is fascinating, really, because there are many of us who have primary PLMS, but rarely have RLS. Following their logic, we simply experience our RLS while sleeping, but it's still an everyday occurrence.

zombie76 · Post by **zombie76** » Thu Jul 03, 2008 4:36 am

That logic certainly makes sense although there is such a close correlation between the two that it makes it confusing. Thanks for the research.

Post by **ViewsAskew** » Thu Jul 03, 2008 5:30 am

It IS confusing, especially as some of us have often used PLMD interchangeably with PLM. If I am understanding the text correctly, that is wrong - PLMs are just a term for the involuntary movements we have when we have RLS.

I always thought I had BOTH restless legs AND periodic limb movement disorder. Over the years, many people on these (and similar) forums have speculated that PLMD was really RLS. And, I bet if we went into sleep labs, we'd have a lot of confused technicians...and even doctors...based on the terminology.

Funny, a lot of us have also said that we have PLMW - movements while awake - even though most of the literature said that we couldn't. That PLM only happened at night and that RLS didn't include movement. Well, that's not right according to this!

So, I guess I don't have PLMD. I just have PLMs as part of my RLS.

Good find. I never bothered to read the book in detail, just skimming to areas that I was interested in. That'll teach me!

cornelia · Post by **cornelia** » Thu Jul 03, 2008 11:11 am

I think you explained it very well Ann. I totally agee with your explanation, it makes sense. I have always thought that my PLMs were part of my RLS, because I have them at daytime too and PLMD was supposed to exist only at night.

Corrie

Aiken · Post by **Aiken** » Thu Jul 03, 2008 9:27 pm

Last year, when a too-high dose of PPIs to control reflux brought my ferritin to an all-time low, my RLS ratcheted up severely, and also started producing PLMs. The PLMs weren't a side issue--they simply seemed to trigger as a sort of release from the increased creepy/electric RLS sensation. I fixed the ferritin, the creepy/electric sensation reduced by about half, and the PLMs stopped.

It's possible that I simply have both, and that both are affected by lack of iron. However, I'm much more inclined to think the PLMs are part of my flavor of RLS, and that I simply have to have it bad enough for them to show up. Either way, I consider myself lucky that iron supplements keep them subclinical in nature.

SquirmingSusan · Post by **SquirmingSusan** » Thu Jul 03, 2008 9:46 pm

This is really an interesting shift in terminology now. I guess I've never thought of my leg/body jerking as PLMD, mostly because of the way PLMD is described- as a periodic "dorsifexion" (flexing the foot up toward the knee) of the foot, that's so regular that you could set your watch by it. One of the sleep experts that I've seen here locally described it that way on a TV program once.

That is definitely NOT what mine is like. Mine is more random and violent jerking of various body parts. It's not very periodic at all, although I suppose that each separate body part that's jerking can have it's own particular time cycle. It's like I can have my right leg going at 30 seconds, my left calf jerking every 60 seconds, and my arms or torso going at 45 seconds. But I couldn't set my watch by any of those. The movements just aren't all that "periodic." They're just annoying.

I still like the term "myoclonic jerks" or just "myoclonus" and most doctors know what I'm talking about when I use those terms.

Actually, I'm happy to report that my myoclonus has been much milder lately since I've been taking tiny doses of Mirapex.

Aiken · Post by **Aiken** » Thu Jul 03, 2008 11:33 pm

That's interesting. I got the opposite, pulling my heel up towards my calf. Looks like that's called "plantar flexion."

Post by **ViewsAskew** » Fri Jul 04, 2008 12:56 am

I'm just happy that we can all use the same terminology! And, that I know what it is.

Like you, Susan, mine was NOTHING like how they describe PLMD (when I'm awake), but when I'm asleep, it is. DH has watched me - it's rhythmic, regular, etc. Dr Rye from Emory (who also has RLS), described the PLMs as these same regular movements, but said they could be from toe, ankle, knee, or hip - at least he did at the last RLS conference. And, I seem to recall that he called it PLMD - not PLMs as part of RLS! But, I'd have to get the copies of the slides to be sure.

I always assumed that what happened when I was sleeping was this...therefore I had PLMD. Since I was diagnosed with that and treated for it (NOT restless legs, which was hardly noticable at the time), I always assumed that even thought the daytime stuff didn't fit into the category neatly, that it still was that.

psychick · Post by **psychick** » Thu Jul 17, 2008 4:18 am

It's confusing, because my PLM symptoms are so so different from my RLS symptoms - It's hard to believe that they're not separate disorders.

My RLS involves my foot tapping or leg bouncing rapidly, with an inner sensation that is mildly uncomfortable if I stop the movement consciously. As soon as my attention drifts, I tend to start the movement up again. I have RLS symptoms several times of day, every day.

My PLM's occur only at night when I'm in bed and the spasms and rigidity of my legs/feet aren't things I can stop consciously, like I can stop the RLS movements.