Dramatic Responses to Low-Dose Pramipexole in Painful Legs and Moving Toes Syndrome

Painful legs and moving toes syndrome (PLMTS) is a rare movement disorder characterized by spontaneous abnormal, involuntary toe movements and unilateral or bilateral lower extremity pain that predominantly affects women in middle age or later. The background etiology of PLMTS includes peripheral neuropathy, a history of trauma, and nerve root damage, but the cause of the disease is often undetermined. The pain usually occurs first and is often more distressing to the patient than abnormal toe movement. Spontaneous resolution is rare, and symptomatic therapies include the oral administration of anticonvulsants, antidepressants, and various pain relievers, as well as other therapeutic interventions, including botulinum toxin injection and epidural block, but their effectiveness is uncertain. We report a case of PMLTS in which low doses of pramipexole, a non-ergot dopamine agonist, dramatically improved both abnormal toe movement and leg pain, which are documented by videography.

Automated summary

Painful legs and moving toes syndrome (PLMTS) is a rare movement disorder characterized by spontaneous abnormal toe movements and leg pain. It mainly affects middle-aged or older women. The cause of PLMTS is often unknown, but it can be related to peripheral neuropathy, trauma history, or nerve root damage. Treatment for PLMTS includes medication such as anticonvulsants and antidepressants, as well as therapeutic interventions like botulinum toxin injection and epidural block. We report a case where low doses of pramipexole, a non-ergot dopamine agonist, significantly improved both abnormal toe movement and leg pain.