Periodic Limb Movements while Awake (PLMA) as a Manifestation of Wearing-Off in Parkinson's Disease: A Case Series and Review of the Literature

Sohaila Alshimemeri; Daniel G Di Luca; Diana A Olszewska; Eoin Mulroy; Kailash P Bhatia; Susan H Fox; Anthony E Lang

doi:10.1002/mdc3.13487

Periodic Limb Movements while Awake (PLMA) as a Manifestation of Wearing-Off in Parkinson's Disease: A Case Series and Review of the Literature

Mov Disord Clin Pract. 2022 Jun 10;9(5):652-658. doi: 10.1002/mdc3.13487. eCollection 2022 Jul.

Authors

Sohaila Alshimemeri^{1

2}, Daniel G Di Luca¹, Diana A Olszewska¹, Eoin Mulroy³, Kailash P Bhatia³, Susan H Fox¹, Anthony E Lang¹

Affiliations

¹ Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology University of Toronto Toronto Ontario Canada.
² Division of Neurology, Department of Medicine King Saud University Riyadh Saudi Arabia.
³ Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London United Kingdom.

Abstract

Background: Periodic limb movements while awake (PLMA) are similar to Periodic limb movements in sleep (PLMS) but occurring during wakefulness and seen in association with restless leg syndrome (RLS).

Objectives: To describe PLMA as a wearing-off phenomenon in Parkinson's Disease (PD).

Methods: We describe four individuals with PD and PLMS, who had associated similar periodic and stereotypic lower extremity movements during wakefulness, thought to be secondary to PLMA, and were highly responsive to dopaminergic treatment.

Results: Despite the prevalence of RLS and PLMS in individuals with PD, the presence of similar movements during wakefulness has not been well characterized. The lack of a specific diagnostic criteria poses a significant diagnostic challenge.

Conclusions: We describe, for the first time to our knowledge, PLMA as a wearing-off phenomenon in PD. This entity could be classified in the spectrum of "low-dose dyskinesia," as we found that it was highly responsive to dopaminergic treatment.

Keywords: Low‐dose dyskinesia; Parkinson's disease; Periodic limb movements while awake; Wearing off.