Objective: We aimed to present a case series of moving toes syndrome to show how clinical presentation and electrophysiological findings may change.

Background: The moving toes syndrome is characterized by bilateral/unilateral writhing movements of toes. It may be accompanied by pain. It is attributed to the central organization after a peripheral lesion. However, an exact cause is generally not shown.

Methods: We retrospectively retrieved the medical records of seven patients with the moving toes syndrome and analyzed their clinical and electrophysiological characteristics.

Results: There were seven patients with mean age of 37.5±24.3 years (four female). Movements were confined to toes in all patients. Four had pain. Two patients had diabetic PNP and one was receiving botulinum toxin injections for cervical dystonia. One patient reported lumbar pain radiating to the same leg with the movements and the movements and pain relieved in a specific position of lower extremities. However, no underlying cause was shown. One patient had family history of Parkinson’s disease. Surface polymyography demonstrated two different types of activity in the intrinsic foot muscles: i. irregular, single bursts of normal appearing motor unit potentials (MUPs) in all patients, and ii. MUPs sometimes grouped in a semi-rhythmical fashion mimicking low frequency (3-4 Hz) tremor in five patients. Withdrawal reflex was recorded in two patients and showed high-amplitude and long-duration responses. Symptoms did not show much improvement after clonazepam, pramipexole or gabapentin.

Conclusions:

Pure lower limb involvement without a specific underlying cause, electromyography consistent with irregular bursts of normal motor unit potential firing in varying intervals, which are common characteristics of this syndrome, are also observed in the reported patients. Despite presence of movement disorders in personal or family histories of reported patients, electrophysiological findings in this report suggest spinal origin for these movements, mimicking findings found in spinal segmental myoclonus in some of the reported patients. Movements are generally difficult to treat. However, in our opinion, treatment may focus on pain since pain is more disabling.

References: Wulff CH. Painful legs and moving toes. A report of 3 cases with neurophysiological studies. Acta Neurol Scand. 1982 Aug;66(2):283-7. Hassan A, Mateen FJ, Coon EA, Ahlskog JE. Painful legs and moving toes syndrome: a 76-patient case series. Arch Neurol. 2012 Aug;69(8):1032-8. Alvarez MV, Driver-Dunckley EE, Caviness JN, Adler CH, Evidente VG. Case series of painful legs and moving toes: clinical and electrophysiologic observations. Mov Disord. 2008 Oct 30;23(14):2062-6.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-electrophysiological-features-of-seven-patients-with-moving-toes-syndrome-is-it-a-type-of-spinal-segmental-myoclonus/