Stellate ganglion block for refractory periodic limb movement disorder: case report

Periodic limb movement disorder (PLMD) involves periodic, stereotypic movements of upper/lower extremities during sleep. Propriospinal myoclonus (PSM) involves repetitive, irregular, myoclonic jerks starting in the midthoracic region and propagating to adjacent segments through propriospinal pathways. Limited evidence exists for interventional modalities. This report discusses the utility of stellate ganglion block (SBG) for PLMD.

A review of one patient record who underwent SGB for PLMD.

We present a case of successful treatment of refractory PLMD with SGB.

This case demonstrates complicated PLMD that was refractory to numerous treatment modalities. However, SGB was shown to significantly improve the patient's painful nocturnal spasms. The hallmark of PLMD is myoclonic movement of upper and lower extremity thought to be due to hyperactivity of propriospinal neurons. The stellate ganglion is thought to be the source of a sympathetic nervous system activation and blocking the ganglion with local anesthetic reduces sympathetic activity. SGB for PLMD has not been previously described. However, our results indicate that communication between motor neurons and sympathetic nervous system is possible due to the plasticity of propriospinal interneurons. While the indication for SBG is rapidly expanding, its application for PLMD is truly novel. Further research is desperately needed to establish SGB as a solid treatment modality for PLMD.