Case series of painful legs and moving toes: Clinical and electrophysiologic observations

Abstract

We present a retrospective review of cases of painful legs and moving toes (PLMT) syndrome. Out of 4,780 database patients with movement disorders diagnosed at Mayo Clinic Arizona from 1996 to 2006, we identified 14 cases of PLMT and its variants (6 men, 8 women). Ages ranged from 25 to 84 years (mean, 69 years). Movements were bilateral in 12 and unilateral in 2. Pain preceding the movements was most commonly burning; movements consisted of flexion/extension, abduction/adduction, fanning, or clawing of toes, fingers, and sometimes the foot or hand. The most common predisposing factors were neuropathy and radiculopathy. Surface electromyography showed movements suggestive of both chorea and dystonia. Movements were partially suppressible and were diminished but still apparent during light sleep. GABAergic agents were most effective in controlling the pain and the movements.

Movement disorders in patients with diabetes mellitus

“…The pain is usually described as burning, numb, dull, sharp, shooting, crushing, throbbing or aching pain [47,52]. Treatment includes oral medications such as gabapentin, pregabalin, amitriptyline, quetiapine, carbamazepine, baclofen and clonazepam [47,52]. Botulinum toxin injections have been reported to be useful in a few patients [47,52].…”

“…Although rare, movement disorders secondary to peripheral neuropathies can also be seen in diabetic patients. These include painful legs moving toes (PLMT) [47] and restless legs syndrome (RLS) [48][49][50][51]. To our knowledge, neuropathic tremor has not been described in patients with diabetic neuropathy.…”

“…Pain is usually the first symptom and may precede involuntary movements by days to years though the reverse may occur [52]. In PLMT, pain is usually the most debilitating symptom and is the reason for medical treatment rather than the movement itself [47]. The pain is usually described as burning, numb, dull, sharp, shooting, crushing, throbbing or aching pain [47,52].…”

“…In PLMT, pain is usually the most debilitating symptom and is the reason for medical treatment rather than the movement itself [47]. The pain is usually described as burning, numb, dull, sharp, shooting, crushing, throbbing or aching pain [47,52]. Treatment includes oral medications such as gabapentin, pregabalin, amitriptyline, quetiapine, carbamazepine, baclofen and clonazepam [47,52].…”

Painful leg and moving toes syndrome in secondary tethered cord syndrome

“…In PLMT, it is more phasic bursts of activities of varying duration (50 msec to 1 second), but there is no single electrophysiological signature. 2,10 In published research, nerve conduction studies were normal in 33 out of 63 cases and there was evidence of peripheral neuropathy in 9 patients and chronic radiculopathy in 14 cases. 2 In the remaining patients there was evidence for cramps, fasciculation, fibrillation and mono-neuropathy.…”