P341 Painful legs and moving toes syndrome associated with peripheral nerve hyperexcitability and central nervous system involvement

• Published in: Clinical neurophysiology Vol. 128; no. 9; pp. e288 - e289
• Main Authors: Cors-Serra, Sara, Lloret-Alcañiz, Ángeles, Cases-Bergón, Paula, Ipiéns-Escuer, Cristina, Mauri-Fábrega, Lara, Aiko-Gesler, Mika B.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.09.2017
• Subjects: PLMT PNH; PLMT PNH
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2017.07.349

We report a 68-year-old male patient referred for an electromyography (EMG). The patient’s clinical picture was compatible with a Painful Legs and Moving Toes (PLMT) syndrome, with added symptoms of forgetfulness, confusion and somniloquy of four-year course. He had been previously treated as a Restless Legs Syndrome without any improvement. We performed a neurophysiological exam including nerve conduction study, needle EMG, somatosensory-evoked potentials, repetitive nerve stimulation for the assessment of peripheral nerve hiperexcitability (PNH), and surface EMG recording during wakefulness and sleep. Nerve conduction study and somatosensory-evoked potentials documented no abnormalities. The EMG was also normal except for cramps and fasciculations in abductor hallucis and some fasciculations in gastrocnemius. Afterdischarges were recorded after repetitive nerve stimulation of median and tibial nerves. Surface EMG recording of leg muscles showed bursts of spontaneous activity and discharges lasting more than 10s, whose larger amplitudes corresponded with increased pain. Radiological tests documented no underlying causes. PLMT is a rare movement disorder characterized by leg pain and involuntary movement of toes. It is believed that the symptomatology can be generated both peripherally and centrally. Hence, there is no agreement on PLMT treatment and response to drugs is usually poor. We report a case of idiopathic PLMT with neurophysiological evidence of PNH and central nervous system symptomatology. The whole clinical and electrophysiological picture suggests a nervous system dysfunction with both central involvement and PNH not yet described as a cause of PLMT.