UNASSIGNED: Painful legs and moving toes (PLMT) is a rare neurological disorder characterized by neuropathic pain and involuntary movements in the lower limbs. The pathophysiological mechanisms are unclear, but central mechanisms might be involved, suggesting that noninvasive brain stimulation might be helpful. Thus far, no reports have been published on noninvasive brain stimulation to treat PLMT.
UNASSIGNED: A 70-year-old female had a 1-year history of PLMT. After several unsuccessful medical attempts, the patient received repetitive transcranial magnetic stimulation and transcranial direct current stimulation to alleviate the pain and involuntary movements with no benefit.
UNASSIGNED: This is the first report on noninvasive brain stimulation in a PLMT patient. Although ineffective in our patient, noninvasive brain stimulation should be further studied in this often difficult to treat and debilitating syndrome.

A 49-year-old man presented with 3 years of leg pain and involuntary toe movements. He described the pain as mild burning, radiating from the left foot upward to the leg. On examination, there were involuntary continuous flexion-extension movements of his left toes (video). Strength, sensation, and reflexes were normal. Lumbosacral MRI demonstrated diffuse degenerative disc disease with multi-level mild-to-moderate foraminal stenosis. Nerve conduction studies were normal. EMG showed neurogenic potentials and active denervation changes in the left anterior tibial and soleus muscles consistent with radiculopathy. The diagnosis of painful legs and moving toes is discussed.