Objective: Describe and characterize our PLMT patients in terms of clinical presentation, neurophysiology, imaging, associated conditions and response to treatment.

Background: First described by Spillane in 1971, PLMT is a rare movement disorder, characterized initially by lower limb pain, followed by involuntary movement of toes and/or feet. Its incidence is unknown, as large studies are lacking, and probably underrecognized, as there is a considerable delay in diagnosis.
Ethiologically, it has been linked with peripheral neuropathies. It is currently believed that the movements are generated centrally. Multiple treatments have been tried based on evidence from small case series reports, with inconsistent outcomes.

Method: We present a case series encountered at our hospital in a 4 year period.
A descriptive study was conducted in order to characterize our PLMT patients in terms of clinical presentation, neurophysiology, imaging, associated conditions and response to treatment.

Results: The average age at diagnosis was 71 years. The average time from symptom onset to diagnosis was 6.8 years, highlighting the significant delay in diagnosis. The main reasons for consultation were abnormal movements and pain. 50% of the patients had unilateral involvement and 50% had upper limb involvement. All patients had an altered neurophysiological study. No CNS involvement was found on imaging studies. Lumbar radiculopathy (66%), and previous local surgery at the affected site (50%) were the most frequently associated conditions. Best therapeutic results were achieved on patients who received botulinum toxin. Oral pharmacotherapy presented poor results.

Conclusion: PLMT is a rare condition, with significant delay in diagnosis. It is frequently associated with peripheral neuropathy. Pain is commonly the presenting symptom, and the most troublesome to treat. We encountered a high amount of patients with upper limb involvement compared with other case series. Neurophysiologic studies are usually altered. Although a central mechanism is propposed, CNS imaging is usually normal, probably beacause of sensitization secondary to peripheral nerve disease. We obtained better treatment outcomes with botulinum toxin than with oral pharmacotherapy, as reported in some case series.
Large clinical trials are needed in order to better characterize and define treatment strategies for PLMT patients and reduce diagnosis delay.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/painful-legs-and-moving-toes-plmt-a-case-series/