there have been a limited number of studies that have examined the safety and efficacy of these treatments in children and adolescents.

Periodic Limb Movement Disorder

Periodic limb movement disorder is characterized by disruptions to sleep caused by periodic episodes of limb movements that occur during sleep, which cannot be explained by any other sleep disorder (AASM, 2005). Individuals with periodic limb movement disorder primarily complain of difficulty with sleep onset and sleep maintenance, insomnia, and/or hypersomnia. The periodic limb movements manifest themselves as rhythmic extensions of the big toe, dorsiflexions of the ankle, and occasional flexions of the knee and hip (Coleman, 1982). These are scored using the periodic limb movements index, which examines over the course of an hour the number of movements that are 0.5 to 5 seconds in duration, separated by an interval between 5 to 90 seconds, and in sequence of four or more an hour. An overnight index score of 5 or greater in children and 15 or greater in adults is considered pathogenic (AASM, 2005).

Periodic limb movements typically occur in the lower extremities and may result in autonomic arousal, cortical arousal, or an awakening. However, typically the individual is unaware of the movements. They are more frequent in the beginning of the night and cluster together. These events are associated with a fast heart rate, followed by a period of slow heart rate (Friedland et al., 1985). Periodic limb movements disorder is associated with above average rates of depression, memory impairment, attention deficits, oppositional behaviors, and fatigue (AASM, 2005). Similar to RLS, dopaminergic medications are helpful in alleviating the disorder’s symptoms.

Periodic limb movements are believed to be very common, especially in older persons, occurring in 34 percent of individuals over the age of 60 (AASM, 2005). However, the disorder—periodic limb movements associated with sleep disruption—is not as common. Periodic limb movements are very common in RLS, occurring in 80 to 90 percent of individuals. It is also observed in individuals with narcolepsy, REM sleep behavior disorder (Folstein et al., 1975), OSA (Montplaisir et al., 1996), and hypersomnia (Whitehouse et al., 1982). Children with ADHD have an increased prevalence of periodic limb movements (Picchietti et al., 1998), and children with periodic limb movement disorders are more likely to have ADHD (Picchietti et al., 1999; Ozminkowski et al., 2004). Sleep-disordered breathing may be a modulator that increases the association between periodic limb movements and ADHD (Chervin and Archbold, 2001).

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