Periodic limb movement disorder in children: A systematic review

Area of Science:

• Neurology
• Sleep Medicine
• Pediatrics

Background:

• Periodic Limb Movement Disorder (PLMD) in children is rare, affecting approximately 0.3% of the pediatric population.
• Diagnostic criteria for PLMD have evolved, requiring polysomnography and a Periodic Limb Movement index (PLMS index) of ≥5 since 2003.
• Clinical consequences such as insomnia, hypersomnia, and fatigue are necessary for diagnosis, excluding sleep disruption from comorbidities.

Approach:

• A systematic review following PRISMA guidelines and PICOS criteria was conducted.
• Literature searches were performed across PubMed, EMBASE, and Scopus, identifying 17 relevant studies from 331 initial articles.
• Study quality was generally good, though weaknesses in sample size justification and potential biases were noted.

Key Points:

• The Periodic Limb Movement index (PLMS index) demonstrates high sensitivity but low specificity, emphasizing the importance of strict adherence to diagnostic criteria.
• Comorbidities, particularly Attention-Deficit/Hyperactivity Disorder (ADHD), present diagnostic challenges due to overlapping symptoms and bidirectional relationships.
• Challenges also arise from conditions like sleep-disordered breathing, psychotropic medication use, and non-adherence to diagnostic criteria.

Conclusions:

• Standardized approaches are needed for diverse symptom metrics and treatment assessments, particularly for iron supplementation.
• Further research with precise methodologies is recommended to address diagnostic and treatment complexities in pediatric PLMD.
• Comprehensive studies quantifying PLMS and objectively assessing sleep parameters are crucial for advancing the understanding and management of pediatric PLMD.