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how to best treat Periodic limb movements disorder when Dopamine Agonists are not effective?
Answer by Dr.CEC · May 30, 2018 at 06:32 PM
You also want to treat underlying OSA if the patient is not effectively treated with CPAP. A lot of times PLMD seen in combination with OSA improves without medications if the patient starts CPAP for OSA.
Answer by AviBhar · May 30, 2018 at 09:35 PM
Also best to avoid caffeinated products and nicotine. Some SSRI may worsen symptoms of PLMD.
Answer by Apneamd · May 31, 2018 at 12:09 PM
Be careful not to treat leg movements just because they are present during a sleep study. Treat them only if they are disturbing sleep and causing arousals
Answer by sleepdoc · Jun 01, 2018 at 09:26 PM
PLMD is relatively uncommon and the limb movements seen in PSGs are mostly due to underlying sleep disordered breathing. In the days when we were doing CPAP titrations routinely, we could clearly see resolution of the limb movements, in many cases, once CPAP was applied. Unfortunately, we don'`t have that luxury anymore. However, in some patients limb movements persist despite good control of SDB. As others mentioned in earlier posts, the key is to identify the following:
- poor clinical response to CPAP with persistent arousals despite good control of AHI
- concomitant RLS symptoms
Cheers!
Answer by Dr.CEC · May 30, 2018 at 06:30 PM
Gabapentin, Horizant, Klonopin, Lyrica, or last resort Ultram or Narcotics. Dose only prior to bedtime.
Answer by drhollywood · Jun 05, 2018 at 04:59 PM
Check for other underlying problems such as low iron and thyroid conditions.
Good points. SSRIs also excacerbate limb movements and I always tell pt.s to discuss SSRI dosing with psych providers.