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Question : For around 12 years, I’ve suffered from sunset to sunrise from severe cramping and uncontrollable leg jerks that responded to no known medical treatment. Is this restless leg syndrome? What’s the best treatment?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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February 10, 2012
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A:

Your symptoms sound like it could be “Periodic Limb Movement Disorder” (PLMD). It’s a disease in which your sleep is disrupted by repeated jerking or cramping of the legs. The movements usually last a few seconds, with bending of the knee, ankle and big toe. And it repeats about every 30 to 40 seconds.

Most people with this are unaware that the movements are happening because they happen in their sleep. But they do have daytime sleepiness. Because it only happens during sleep, I wouldn’t expect it to last from sundown until sunrise (unless that’s when you’re sleeping).

PLMD sometimes may come with restless legs syndrome (RLS). In fact, an estimated 80% of people with RLS have PLMD too. In some people, PLMD is triggered by a medical condition, such as kidney disease, diabetes or iron deficiency. Even certain medications, such as Haldol and amitriptyline, have been linked with PLMD. But in many cases there is no related condition or medicine.

Even though PLMD may come with RLS, your symptoms do not sound like RLS. With that condition, people trying to go to sleep feel tingling, pulling or crawling sensations in their legs along with a strong urge to move the legs. Moving the legs relieves the urge. This happens while awake. And while unpleasant, it’s not painful. And it’s not accompanied by involuntary movement (unless the person also has PLMD).

If you haven’t already, discuss your symptoms with your doctor. He or she might suggest a sleep study and consultation with a sleep specialist.

If PLMD is confirmed, treatment options include:

  • Sedatives (benzodiazepines), such as clonazepam (Klonopin)
  • Medicines that increase dopamine, such as levodopa/carbidopa (Sinemet) and pergolide (Permax)
  • Gabapentin (Neurontin), a drug commonly taken for nerve disorders
  • Muscle relaxers, especially Baclofen (Lioresal)

Treatment for PLMD is often effective, but it does not cure the disorder. You will usually need ongoing treatment.

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