Painful And Painless Legs Moving Toes Syndrome: A Polysomnographic And Polymyographic Study

Objective: To characterize the polysomnographic (PSG) and polymyographic (PMG) features of Painful and Painless Legs Moving Toes Syndrome (PPLMTS). Background PPLMTS has been described in isolated case reports in the literature and is clinically manifested as continous or semicontinous involuntary movements of the intrinsic foot muscles, with or without pain. The etiology remains unclear, but predisposing factors are usually peripheral neuropathies and radiculopathies, although central causes have been postulated in cases with antagonistic rather than co-contraction. There have not been any systematic studies elucidating the PSG/PMG findings in patients with this disorder. Design/Methods: Case series. Results: Seven patients (five women, two men) presented to our institution with PPMTS; two had pain with their symptoms and four did not. Two patients had Parkinson9s disease. All patients underwent overnight polysomnography (PSG) with specialized foot montage (extra muscle channels involving bilateral abductor digiti minimi, flexor hallucis brevis and extensor digitorum brevis. In five patients, toe movements were predominantly bilateral and noted to be most frequent in wakefulness and stage N1 as well as sleep-wake transitions. They rarely persisted into REM sleep in three of these patients and were noted to be very frequent in REM sleep in another. They were associated with cortical arousals in both REM and NREM sleep in one patient. The movements were a combination of myoclonic (less than 200 msecs) and dystonic (greater than 200 msecs) bursts, although in two patients the bursts were purely dystonic. Various combinations of synchronous and asynchronous bursts were seen. In two patients, one with Parkinson9s disease, the movements did not persist in sleep. Conclusions: PPLMTS is a clinically and neurophysiologically heterogenous syndrome, with the mixture of myoclonic, dystonic, synchronous and asynchronous patterns suggesting a complex pathophysiology determined by both peripheral afferent and efferent and supraspinal efferent control. Disclosure: Dr. Lysenko has nothing to disclose. Dr. Bhat has nothing to disclose. Dr. Hanna has nothing to disclose. Dr. Siddiqui has nothing to disclose. Dr. Chokroverty has received personal compensation for activities with Elsevier and Cephalon. Dr. Chokroverty has received personal compensation in an editorial capacity for Sleep Medicine Journal.