Movimenti periodici agli arti inferiori durante sonno (PLMs) ed epilessia: Associazione o comorbidità?

Objective: only a few studies have documented the presence of pathological periodic leg movements during sleep (PLMs) in patients with epilepsy. The aim of this retrospective analysis was to evaluate the existence of association between PLMs and epilepsy. Materials and methods: patients monitored with Video-Polysomnography in our hospital in the last year with diagnosis of epilepsy, were screened retrospectively for the presence of PLM index > 5. Criteria of exclusion were: age over 60 and the presence of Obstructive Sleep Apnea (OSA), Restless Legs Syndrome (RLS), REM Sleep Behaviour Disorder (RBD), Neurodegenerative Disease or therapy with antidepressant and/or antidopaminergic drugs. Results: we considered 85 patients with epilepsy. Nine patients (20%) had pathological PLMs (12 women, 5 men; age of 42,4±9,8 years). Twelve of them (70%) had a temporal lobe epilepsy, two (11%) had frontal lobe epilepsy and three (17%) had juvenile myoclonic epilepsy. Myoclonic movements occurred mainly in the first half of the night, coinciding with N2, with mild to moderate severity. They had a distribution that made them more similar to PLMs in RLS, than those associated with neurodegenerative diseases. Discussion and conclusions: our study confirms the presence of PLMs in patients with epilepsy. It could be explained by the fragmented structure of sleep often found in epileptic patients and secondary to epileptic discharges. Given the dopaminergic nature of PLMs, their presence in epilepsy could strengthen the role of dopamine in the pathophysiology of epilepsy.