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LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1436-1437

Sensory Trick in Painful Legs and Moving Toes Syndrome


1 Department of Clinical Neurological Sciences, Western University, London, ON, Canada; Department of Neurology, All India Institute of Medical Sciences, Rishikesh, India
2 Department of Clinical Neurological Sciences, Western University, London, ON, Canada

Date of Submission02-Sep-2017
Date of Decision05-May-2019
Date of Acceptance08-Aug-2019
Date of Web Publication30-Oct-2021

Correspondence Address:
Mandar Jog
339 Windermere Road, A10-026, Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, Associate Scientific Director, Lawson Health Research Institute, London - N6A 5A5, ON
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329607

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How to cite this article:
Kumar N, Murgai AA, Jog M. Sensory Trick in Painful Legs and Moving Toes Syndrome. Neurol India 2021;69:1436-7

How to cite this URL:
Kumar N, Murgai AA, Jog M. Sensory Trick in Painful Legs and Moving Toes Syndrome. Neurol India [serial online] 2021 [cited 2021 Dec 3];69:1436-7. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1436/329607




Painful legs and moving toes (PLMT) is an uncommon movement disorder predominantly involving the legs and is characterized by pain along with abnormal stereotypic toe movements.[1],[2] Painless variants have also been reported infrequently.[2] PLMT may be unilateral at onset and become bilateral with progression in more than half the cases.[2] Although voluntary suppressibility has been reported in PLMT,[2],[3],[4] a classical sensory trick has been seldomly reported. We report a case with PLMT showing momentary improvement in pain and movements with a classical sensory trick.

A 75-year-old left-handed woman with no pertinent past medical illness or family history presented with a 2-year history of spontaneous, involuntary, pseudo-rhythmic abduction--adduction movements of left toes [Video 1] along with dull aching pain in the foot suggestive of PLMT syndrome. Although there was no specific aggravating factor for the pain or movements, extending the ankle and toes or touching dorsum of left foot relieved pain and stopped the movements momentarily. Neurological examination revealed a positive straight-leg-raising test on the left side along with reduced touch and pinprick sensation in the left S1 dermatome and absent bilateral ankle jerks. Lumbosacral spine magnetic resonance imaging confirmed left S1 radiculopathy [Figure 1]. Trials with clonazepam, gabapentin, pregabalin, and botulinum toxin injection in foot muscles failed to relieve her symptoms.
Figure 1: Axial T2 sequence in MRI Lumbosacral spine showing left S1 radicle compression (white arrow)

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PLMT commonly affects middle-aged females.[2] While peripheral neuropathy, a prior history of trauma and radiculopathy accounts for almost half the cases, more than 40% remain cryptogenic.[2] Pain is usually the initial and most troublesome symptom in PLMT.[2],[3] Dull aching, cramping, and shooting pain is reported most commonly, with frequent association with tingling and numbness.[2],[3] Our case initially noticed abnormal toe movements along with a dull aching pain in the toes and ankle.

The digit movements in PLMT commonly resemble chorea and/or dystonia.[3] While flexion/extension movements are seen most commonly, affecting more than 50% of cases in a series,[2] abduction/adduction, fanning, clawing, and writhing movements of the toes have also been described.[2],[3] The abnormal movements may be continuous or discontinuous.[2] In addition to voluntary suppressibility, several physical maneuvers including local pressure, change of foot posture, and use of orthotics may transiently improve the pain and movements.[2],[3],[4] Ankle and toes extension improved the pain and movements in our patient. Although the toe movements in our case resembled chorea, it improved with a slight touch on dorsum of the left foot, thereby suggesting a possibility of abnormal sensorimotor integration in PLMT.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Spillane JD, Nathan PW, Kelly RE, Marsden CD. Painful legs and moving toes. Brain 1971;94:541-56.  Back to cited text no. 1
    
2.
Hassan A, Mateen FJ, Coon EA, Ahlskog JE. Painful legs and moving toes syndrome. Arch Neurol 2012;69 (8):1032-8.  Back to cited text no. 2
    
3.
Alvarez MV, Driver-Dunckley EE, Caviness JN, Adler CH, Evidente VGH. Case series of painful legs and moving toes: Clinical and electrophysiologic observations. Mov Disord 2008;23(14):2062-6.  Back to cited text no. 3
    
4.
Dressler D, Thompson PD, Gledhill RF, Marsden CD. The syndrome of painful legs and moving toes. Mov Disord 1994;9 (1):13-21.  Back to cited text no. 4
    


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