Sympathetic nervous system involvement in the syndrome of painful legs and moving toes

Spinal-generated movement disorders: a clinical review

Spinal-generated movement disorders (SGMDs) include spinal segmental myoclonus, propriospinal myoclonus, orthostatic tremor, secondary paroxysmal dyskinesias, stiff person syndrome and its variants, movements in brain death, and painful legs-moving toes syndrome. In this paper, we review the relevant anatomy and physiology of SGMDs, characterize and demonstrate their clinical features, and present a practical approach to the diagnosis and management of these unusual disorders.

Spontaneous aching pain and peculiar involuntary movements: a case report of painful legs and moving toes and review of the literature

Painful legs and moving toes (PLMT) is a rare syndrome characterized by spontaneous neuropathic pain and peculiar involuntary movements in the lower limbs, especially the toes and feet. As it is a relatively rare disorder worldwide, the exact pathophysiology still remains a mystery. Until recently, numerous methods of clinical treatments have been tried; however, the success rate of the therapies is still very low. Here, we report a case of PLMT and also summarize the recent clinical and research literatures regarding clinical presentation, electrophysiological features, etiology, treatment methods, and prognosis of this disorder. Doctors should be aware of this rare syndrome in a patient with painful and/or restless legs. On the other hand, multiple clinical treatments should be tried, even those which usually produce a poor outcome.

A disturbance in sensory processing on the affected side of the body increases limb pain in complex regional pain syndrome

OBJECTIVES

The aim of this study was to determine whether a central disturbance in somatosensory processing contributes to limb pain in complex regional pain syndrome (CRPS).

METHODS

In 37 patients with CRPS, the effect of cooling the ipsilateral forehead on pain in the affected limb was compared with the effect of cooling the contralateral forehead. In addition, symptoms associated with cold-evoked limb pain were explored.

RESULTS

Limb pain generally increased when the ipsilateral side of the forehead was cooled but did not change when the contralateral side of the forehead was cooled. Increases were greatest in patients with heightened sensitivity to cold, brushing, and pressure-pain in the ipsilateral forehead, in patients with heightened sensitivity to pressure-pain in the limbs, and in patients with chronic symptoms. In contrast, sensitivity to light touch was diminished in the CRPS-affected limb of patients whose limb pain remained unchanged or decreased during ipsilateral forehead cooling.

CONCLUSIONS

These preliminary findings suggest that a central disturbance in sensory processing and pain modulation, which extends beyond the affected limb to the ipsilateral forehead, contributes to symptoms in a subgroup of patients with CRPS.

Painful legs and moving toes

The syndrome of painful legs-moving toes (PLMT) is an adult-onset, rare disorder characterized by pain, typically of a neuropathic quality, in the feet or legs, associated with writhing movements of one or more toes. It is the pain which usually brings the patient to medical attention. The syndrome may be unilateral or bilateral. Identical toe movements may occur without pain, referred to as: "painless legs-moving toes," and a similar condition affects the upper limbs: "painful arms-moving fingers." The pathophysiology of PLMT and its variants is not known but most reports suggest an association with a peripheral lesion, usually at the level of the root or nerve, though in many cases no cause is found. It has been suggested that a peripheral lesion causes aberrant input leading to "central reorganization," probably at the level of the spinal cord, and that the latter is responsible for the pain and movement. Treatment is often unsatisfactory and many drugs commonly used for neuropathic pain have been reported anecdotally to help (e.g., gabapentin). Other anecdotal therapies include spinal blocks, spinal cord stimulation, and local injection of botulinum toxin.

[Painful legs and moving toes syndrome associated with lumbar radiculopathy]

INTRODUCTION

Painful legs and moving toes (PLMT) is a rare syndrome characterized by spontaneous neuropathic pain in the lower limbs associated with peculiar involuntary movements of the toes. It has been associated with a variety of peripheral and central nervous system diseases. Pathophysiology is unclear and treatment approaches remain largely empirical.

CLINICAL CASE

We report a case of a 42-year-old women with typical presentation of PLMT syndrome, associated with lumbar (L5) disc prolapse. Oxcarbazepine gave a partial improvement.

CONCLUSION

Clinical presentations and etiological aspects of the PLMT syndrome are described and pathophysiological mechanisms and therapeutic possibilities discussed.

Painful limbs/moving extremities

Painful limbs/moving extremities (PLME) is a disorder characterized by spontaneous, complex, slow (1-2 Hz) involuntary toe or finger movements. The movements that can be bilateral or unilateral are usually accompanied by pain in the affected limbs. Painless variants are less common. PLME has been associated with peripheral and central nervous system disease although idiopathic cases have been reported. Its etiopathogenesis is unknown and treatment approaches remain largely empirical. Nerve blocks and botulinum toxin type A injections as well as oral medication have had some measure of success. Current theories suggest that central oscillator(s) at the spinal or supraspinal levels may be involved. Future research in PLME should include prospective electrophysiological and functional imaging studies as well as clinical trials with botulinum toxin injections and oral pharmacological agents.