ICD-10: G47.61

Periodic limb movement disorder

Additional Information

Description

Periodic Limb Movement Disorder (PLMD), classified under ICD-10 code G47.61, is a sleep-related movement disorder characterized by involuntary, repetitive movements of the limbs, typically occurring during sleep. This condition can significantly disrupt sleep quality and is often associated with other sleep disorders, such as restless legs syndrome (RLS) and obstructive sleep apnea (OSA).

Clinical Description

Definition and Symptoms

PLMD is defined by the occurrence of periodic limb movements (PLMs), which are typically described as jerking or twitching movements of the legs, although they can also involve the arms. These movements usually occur in clusters and can happen every 20 to 40 seconds during sleep, leading to frequent awakenings and fragmented sleep. Patients may not be aware of these movements, but they often report excessive daytime sleepiness, fatigue, and difficulty concentrating due to poor sleep quality[1][2].

Diagnosis

The diagnosis of PLMD is primarily based on clinical history and polysomnography (sleep study). During polysomnography, the characteristic limb movements can be recorded, along with their frequency and duration. The International Classification of Sleep Disorders (ICSD) outlines specific criteria for diagnosing PLMD, which include the presence of PLMs occurring at least 15 times per hour of sleep in adults or 5 times per hour in children[3][4].

Associated Conditions

PLMD is often associated with other conditions, including:
- Restless Legs Syndrome (RLS): Many individuals with PLMD also experience RLS, which is characterized by an uncontrollable urge to move the legs, typically accompanied by uncomfortable sensations.
- Obstructive Sleep Apnea (OSA): There is a notable overlap between PLMD and OSA, where the presence of one condition may exacerbate the symptoms of the other[5][6].

Treatment Options

Lifestyle Modifications

Initial management of PLMD may involve lifestyle changes, such as:
- Improving sleep hygiene
- Reducing caffeine and alcohol intake
- Establishing a regular sleep schedule

Pharmacological Treatments

In cases where lifestyle modifications are insufficient, pharmacological treatments may be considered. Medications that have shown efficacy include:
- Dopaminergic agents: Such as pramipexole and ropinirole, which are commonly used for RLS and may help alleviate PLMD symptoms.
- Benzodiazepines: These can help improve sleep quality but should be used cautiously due to potential dependency issues.
- Anticonvulsants: Medications like gabapentin may also be beneficial in managing symptoms[7][8].

Conclusion

Periodic Limb Movement Disorder (ICD-10 code G47.61) is a significant sleep-related movement disorder that can lead to considerable sleep disruption and daytime impairment. Understanding its clinical features, diagnostic criteria, and treatment options is essential for effective management. If you suspect you or someone you know may be suffering from PLMD, consulting a healthcare professional for a comprehensive evaluation and tailored treatment plan is advisable.

Clinical Information

Periodic Limb Movement Disorder (PLMD), classified under ICD-10 code G47.61, is a sleep-related movement disorder characterized by involuntary, repetitive movements of the limbs, typically occurring during sleep. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with PLMD is crucial for accurate diagnosis and effective management.

Clinical Presentation

Definition and Overview

PLMD is defined by the occurrence of periodic limb movements (PLMs) during sleep, which can lead to sleep disturbances and excessive daytime sleepiness. These movements are usually rhythmic and can involve flexion of the toes, ankles, knees, and hips, often occurring in clusters throughout the night[1][2].

Typical Patient Profile

Patients with PLMD often present with the following characteristics:
- Age: While PLMD can occur at any age, it is more commonly reported in middle-aged and older adults[3].
- Gender: There is a slight male predominance in the prevalence of PLMD[4].
- Comorbidities: Many patients with PLMD also have other sleep disorders, such as obstructive sleep apnea or restless legs syndrome (RLS), and may have underlying conditions like diabetes or neurological disorders[5][6].

Signs and Symptoms

Primary Symptoms

  1. Involuntary Limb Movements: The hallmark of PLMD is the presence of involuntary movements, primarily affecting the legs, but can also involve the arms. These movements typically occur every 20 to 40 seconds and can last for a few seconds to minutes[7].
  2. Sleep Disruption: Patients often report fragmented sleep due to the frequent movements, leading to difficulty in achieving restorative sleep[8].
  3. Daytime Sleepiness: Excessive daytime sleepiness is a common complaint, resulting from poor sleep quality at night[9].

Associated Symptoms

  • Restlessness: Patients may experience a sensation of restlessness or discomfort in the limbs, particularly when trying to fall asleep, which can overlap with symptoms of RLS[10].
  • Fatigue: Chronic sleep disruption can lead to fatigue and decreased cognitive function during the day[11].
  • Mood Changes: Some patients may exhibit mood disturbances, including irritability or anxiety, as a result of sleep deprivation[12].

Diagnosis

Diagnostic Criteria

The diagnosis of PLMD is primarily based on clinical history and polysomnography (sleep study), which can objectively document the frequency and nature of limb movements during sleep. The following criteria are typically considered:
- Frequency: The presence of at least 15 PLMs per hour of sleep[13].
- Impact on Sleep: Evidence that these movements are associated with arousals or sleep fragmentation[14].

Differential Diagnosis

It is essential to differentiate PLMD from other conditions, such as RLS, which involves similar symptoms but occurs primarily during wakefulness and is often relieved by movement[15].

Conclusion

Periodic Limb Movement Disorder (ICD-10 code G47.61) is a significant sleep disorder characterized by involuntary limb movements that disrupt sleep and lead to daytime consequences. Understanding the clinical presentation, including the signs and symptoms, as well as the typical patient characteristics, is vital for healthcare providers to ensure accurate diagnosis and effective treatment. Patients presenting with symptoms of PLMD should be evaluated for comorbid conditions and may benefit from a comprehensive sleep assessment to guide management strategies.

Approximate Synonyms

Periodic Limb Movement Disorder (PLMD), classified under the ICD-10 code G47.61, is a condition characterized by involuntary movements of the limbs during sleep. Understanding the alternative names and related terms for this disorder can enhance clarity in communication among healthcare professionals and patients alike.

Alternative Names for Periodic Limb Movement Disorder

  1. Nocturnal Myoclonus: This term is often used interchangeably with PLMD, referring to the involuntary muscle jerks that occur during sleep.
  2. Sleep-Related Leg Movements: This phrase emphasizes the leg movements that are a hallmark of the disorder, highlighting their occurrence during sleep.
  3. Restless Legs Syndrome (RLS): While RLS is a distinct condition, it is closely related to PLMD. Many individuals with RLS experience periodic limb movements, and the two disorders can co-occur, leading to some confusion in terminology.
  1. Movement Disorders: This broader category includes various conditions characterized by abnormal movements, including PLMD, RLS, and others.
  2. Sleep Disorders: PLMD falls under the umbrella of sleep disorders, which encompass a wide range of conditions affecting sleep quality and patterns.
  3. Polysomnography: This is a diagnostic test used to study sleep patterns and diagnose sleep disorders, including PLMD. It records brain waves, oxygen levels, heart rate, and breathing, as well as eye and leg movements during sleep.
  4. ICD-10 Codes: Related codes include G47.6, which covers sleep-related movement disorders, and G47.61 specifically for PLMD. Understanding these codes is crucial for accurate diagnosis and billing in healthcare settings.

Conclusion

Recognizing the alternative names and related terms for Periodic Limb Movement Disorder (ICD-10 code G47.61) is essential for effective communication in clinical settings. By understanding these terms, healthcare providers can better diagnose and treat patients experiencing this condition, ensuring they receive appropriate care and support. If you have further questions or need more detailed information about PLMD or related sleep disorders, feel free to ask!

Treatment Guidelines

Periodic Limb Movement Disorder (PLMD), classified under ICD-10 code G47.61, is characterized by involuntary movements of the limbs during sleep, which can lead to disrupted sleep and daytime fatigue. Understanding the standard treatment approaches for PLMD is essential for managing symptoms and improving sleep quality.

Overview of Periodic Limb Movement Disorder

PLMD is often associated with other sleep disorders, particularly restless legs syndrome (RLS) and can significantly impact the quality of life. Patients may experience repetitive movements, typically involving the legs, that occur every 20 to 40 seconds during sleep, leading to frequent awakenings and fragmented sleep patterns[1][6].

Diagnostic Evaluation

Before initiating treatment, a thorough diagnostic evaluation is crucial. This typically involves:

  • Polysomnography (PSG): This overnight sleep study records brain waves, oxygen levels, heart rate, and breathing, along with leg movements, to confirm the diagnosis of PLMD[2][4].
  • Clinical Assessment: A detailed medical history and symptom questionnaire can help differentiate PLMD from other sleep disorders[3][5].

Standard Treatment Approaches

1. Pharmacological Treatments

Medications are often the first line of treatment for PLMD, especially when symptoms are severe or significantly affect sleep quality. Commonly prescribed medications include:

  • Dopaminergic Agents: Medications such as pramipexole and ropinirole, which are primarily used for RLS, can also be effective for PLMD. They help reduce limb movements and improve sleep quality[1][6].
  • Benzodiazepines: Drugs like clonazepam may be prescribed to help with sleep and reduce limb movements, although they are generally considered a second-line option due to potential dependency issues[1][5].
  • Anticonvulsants: Medications such as gabapentin or pregabalin can be beneficial, particularly in patients who may not respond to dopaminergic agents[1][6].

2. Non-Pharmacological Treatments

In addition to medication, several non-pharmacological approaches can help manage PLMD:

  • Lifestyle Modifications: Encouraging regular sleep patterns, reducing caffeine and alcohol intake, and promoting physical activity can improve overall sleep quality and reduce symptoms[1][6].
  • Cognitive Behavioral Therapy for Insomnia (CBT-I): This therapeutic approach can help address sleep disturbances and improve sleep hygiene practices[1][6].
  • Leg Massages and Warm Baths: These can provide temporary relief from symptoms and promote relaxation before bedtime[1][6].

3. Management of Underlying Conditions

PLMD can be associated with other medical conditions, such as iron deficiency or peripheral neuropathy. Addressing these underlying issues through appropriate medical treatment can alleviate PLMD symptoms. For instance, iron supplementation may be beneficial in patients with low ferritin levels[1][6].

Conclusion

The management of Periodic Limb Movement Disorder involves a combination of pharmacological and non-pharmacological strategies tailored to the individual patient's needs. Early diagnosis and a comprehensive treatment plan can significantly improve sleep quality and overall well-being. If you suspect you or someone you know may have PLMD, consulting a healthcare provider for a thorough evaluation and personalized treatment plan is essential.

Diagnostic Criteria

Periodic Limb Movement Disorder (PLMD) is classified under the ICD-10 code G47.61. The diagnosis of PLMD involves specific criteria that help differentiate it from other sleep disorders and ensure accurate identification of the condition. Below are the key diagnostic criteria and considerations for PLMD:

Diagnostic Criteria for PLMD

  1. Recurrent Limb Movements: The primary criterion for diagnosing PLMD is the presence of recurrent, involuntary movements of the limbs during sleep. These movements typically occur in a rhythmic pattern, often involving the legs, and can include flexion of the toes, ankles, knees, or hips.

  2. Frequency of Movements: The movements must occur at least five times per hour during sleep. This frequency is essential for establishing the diagnosis, as it distinguishes PLMD from other conditions that may involve limb movements.

  3. Sleep Disruption: The limb movements must be associated with arousals from sleep. This means that the movements can lead to awakenings or disruptions in the sleep cycle, contributing to overall sleep disturbance.

  4. Exclusion of Other Disorders: The diagnosis of PLMD requires that the limb movements are not better explained by other sleep disorders, such as Restless Legs Syndrome (RLS) or other medical conditions. RLS, for instance, is characterized by an urge to move the legs, typically occurring during wakefulness, which differentiates it from PLMD.

  5. Polysomnography Findings: A polysomnography (PSG) study is often utilized to confirm the diagnosis. This sleep study records brain waves, oxygen levels, heart rate, and breathing, as well as eye and leg movements. The PSG can help quantify the frequency of limb movements and assess their impact on sleep quality.

  6. Clinical Symptoms: Patients may report symptoms such as excessive daytime sleepiness, fatigue, or difficulty concentrating, which can be associated with the sleep disruptions caused by PLMD. These symptoms can further support the diagnosis when combined with objective findings from sleep studies.

Conclusion

The diagnosis of Periodic Limb Movement Disorder (ICD-10 code G47.61) is based on a combination of clinical observations, patient-reported symptoms, and objective findings from polysomnography. Accurate diagnosis is crucial for effective management and treatment of the disorder, which may include lifestyle changes, medication, or other therapeutic interventions to improve sleep quality and reduce limb movements during sleep. If you suspect PLMD, consulting a healthcare professional specializing in sleep medicine is recommended for a comprehensive evaluation and diagnosis.

Related Information

Description

  • Involuntary limb movements during sleep
  • Limb movements occur in clusters every 20-40 seconds
  • Typically involves jerking or twitching of legs
  • Can also involve arms
  • May not be aware of movements but report excessive daytime sleepiness
  • Frequent awakenings and fragmented sleep
  • Poor sleep quality leads to fatigue and difficulty concentrating

Clinical Information

  • Involuntary limb movements during sleep
  • Typically affects legs, can involve arms
  • Movements occur every 20-40 seconds
  • Can last from a few seconds to minutes
  • Sleep disruption and daytime sleepiness common
  • Restlessness, fatigue, mood changes associated symptoms
  • Diagnostic criteria includes frequency and impact on sleep
  • Must have at least 15 PLMs per hour of sleep

Approximate Synonyms

  • Nocturnal Myoclonus
  • Sleep-Related Leg Movements
  • Restless Legs Syndrome (RLS)
  • Movement Disorders
  • Sleep Disorders
  • Polysomnography

Treatment Guidelines

  • Pharmacological treatments are often used first
  • Dopaminergic agents can reduce limb movements
  • Benzodiazepines may be prescribed as second-line option
  • Anticonvulsants can benefit non-responders to dopaminergic agents
  • Lifestyle modifications improve overall sleep quality
  • Cognitive Behavioral Therapy for Insomnia improves sleep hygiene
  • Leg massages and warm baths provide temporary relief

Diagnostic Criteria

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