Periodic limb movement disorder

In some patients with excessive sleepiness the most conspicuous abnormality is the occurrence of periodic limb movements in sleep ( PLMS) consisting of repetitive stereotypic dorsiflexion of the big toe accompanied by flexion of the ankle, and sometimes the knee and the thigh. The movements recur at intervals of !0 to 90 s and last for 0.5 to 5 s. The periodic limb movement index is the number of movements per hour of total sleep time as determined by polysomnography. An index of 5 or more is regarded as abnormal.

However, recent articles cast some doubt on the responsibility of PLMS in causing excessive sleepiness, (2,25) and there is no evidence that anti-PLMS medications are useful in alleviating excessive sleepiness in these subjects. (26>

Secondary disorders of wakefuless

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