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Painful Legs and Moving Toes Syndrome: Putative Underlying Pathophysiology as a Hint for Combined Pharmacological Treatment?

Painful legs and moving toes (PLMT) syndrome is a rare movement disorder. PLMT is characterized by pain to one or more limbs associated with involuntary movements of digits or near segments. Involvement of the lower limbs is more common than that of the upper limbs. An underlying lesion in the peripheral or central nervous system is identified in some cases, although many of them remain idiopathic. There is no agreement on PLMT treatment, and response to drugs is usually poor. We report on a case of idiopathic PLMT syndrome. Based on electrophysiological evidence of central hyperexcitability and the temporal correlation with peripheral trauma, the patient was treated with combined treatment to reduce spinal excitability and block peripheral afferents.