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Over 90% patients predominantly experience persistent pain in the legs for a long duration, prior to onset of motor symptoms in PLMT syndrome.
As per
the results of a case series published in 'Journal of Neurology', painful legs
and moving toes (PLMT) syndrome is fundamentally a chronic pain disorder,
possibly relating to the central sensitization, encompassing the region of a
part of the pain matrix.
PLMT
syndrome is a clinical entity marked by persistent pain in the feet or legs and
the involuntary movements of one or more toes. The exact pathomechanisms of
PLMT are still unknown. Kenya Nishioka and researchers assessed 10 patients
clinically associated with PLMT syndrome. All the patients first presented
persistent pain preceding the onset of motor symptoms. The neurological investigation,
neuro-imaging methods comprising brain magnetic resonance imaging (MRI) and
electrophysiological techniques were used for the examination of each patient.
The brain single-photon emission computed tomography (SPECT) images of 8
patients revealed hypoperfusion of frontal lobes and cerebellum. Conjunction
analysis of brain SPECT imaging of all eight patients, using the 3D-SSP
program, compared to 34 controls pointed to significant hypoperfusion in the
prefrontal cortical, cerebellar surfaces and occipital cortical and thalamus,
and hyperperfusion in the surface of the anterior cingulate gyrus and parietal
cortices comprising primary and secondary somatosensory cortices, bilaterally.
Specific abnormalities were not indicated by other electrophysiological
examinations to describe the patients' symptoms. After treatment foot-related
motor symptoms of four out of nine patients got resolved but the sensory
symptoms were not resolved on treatment with Clonazepam. All in all, their pain
was an intractable and persistent symptom during their clinical course.
The
investigators concluded that further studies with large patient populations are
needed to verify the results of this analysis.
Journal of Neurology
Painful legs and moving toes syndrome evaluated through brain single-photon emission computed tomography: a case series
Kenya Nishioka et al.
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