Painful legs and moving toes syndrome evaluated through brain single photon emission computed tomography: a case series

A case of painful legs and moving toes syndrome mimicking somatic symptom disorder

“…However, according to previous case series, conditions such as depression and suicidal attempts are concurrent with PLMT, indicating that psychiatric disorders are prevalent comorbidities associated with PLMT. 1,2 It is crucial for clinicians to recognize that while 'pulling' is not a typical description of pain, 3 out of 76 patients in a study described their pain as 'pulling'. 1 Secondly, the results of neurological examinations in patients with PLMT are widely different among individuals.…”

“…1,2 These studies indicate that PLMT predominantly affects middle-aged females, with most patients reporting pain prior to the onset of involuntary movements. 1,2 The pain associated with PLMT manifests in various forms including tingling, numbness, and aching. 1 Typically, the involuntary movements comprise a combination of flexion/extension, abduction/adduction, and wriggling/dystonia/writhing.…”

“…1 She could be diagnosed with a clinically probable PD based on the Movement Disorder Society criteria. 2,3 Her primary complaint was pain, rather than tremor, rigidity, or stiffness, a pain-focused medication regimen. Therefore, a pain-focused medication regimen based on a diagnosis of PLMT was suggested.…”

“…1 While no definitive biomarkers have been established for the PLMT diagnosis, neurophysiological and functional studies such as electromyography (EMG), somatosensory evoked potentials (SSEP), and single-photon emission computed tomography (SPECT) have been proposed as potential diagnostic tools. 1,2 Conversely, magnetic resonance imaging (MRI) of the brain and spinal cord is typically within normal limits in most cases of PLMT, suggesting that PLMT may be a functional disorder. 1 The pathophysiology of PLMT remains incompletely understood; however, several hypotheses have been proposed: (1) damage to peripheral nerves or nerve roots due to trauma, autoimmune processes, or neurodegeneration; (2) functional alterations in afferent input to the brainstem and subcortical areas; (3) subsequent remodelling of the central nervous system, leading to dysfunctions within the pain matrix, and (4) ultimately resulting in excitatory and inhibitory imbalances in lower motor neurons.…”

No efficacy with non-invasive brain stimulation for painful legs and moving toes: A Case report

“…For example, gabapentin, pregabalin, clonazepam, pramipexole, and botulinum toxin injections have shown some benefit in PLMT [ 2 ]. Brain imaging has shown that central mechanisms may contribute to the symptoms [ 3 ], which suggests that brain stimulation treatment might be useful, but there are no reports of noninvasive brain stimulation to treat PLMT. Here, we describe a patient who received noninvasive brain stimulation with multiple different treatment protocols.…”