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Moving Fingers Moving Toes : A Heterogeneous Entity

Painful legs and moving toes is a rare movement disorder. It can be associated with peripheral neuropathy, trauma, radiculopathy or autonomic disturbances. Variants of the phenomenon involving fingers and arms, with or without pain were described. The electrophysiological studies show several patterns, such as repetitive spontaneous discharges and complex alternating patterns in agonist and antagonist muscles. We describe two patients who presented with progressive, painless, involuntary movements of fingers and toes. The movements were also present during sleep. There was no significant history of trauma or other neurological disease. Myokymic discharges in doublets, triplets and multiplets were seen on electromyography. We postulate that in a subgroup of patients moving fingers and toes is a focal neuromyotonia and autoimmunity may play a role in its pathogenesis.