Painful moving tongue in a patient with the painful legs moving toes syndrome.

摘要

The association of pain in the lower limbs with involuntary movements of the toes was described as the painful legs and moving toes syndrome (PLMT) by Spillane et al.1 The painful arm and moving fingers syndrome (PAMF) has been more recently reported and seems to be rarer.2 This is the first description of a patient who presented with a history of painful legs, moving toes, and painful arms moving fingers but with associated involuntary movements and pain of her tongue.A 62-year-old woman developed self-limiting ulcers and a sore tongue in December 2001 while awaiting a thyroidectomy for a goiter, which she went on to have in March 2002. She was initially postoperatively well, however, 4 weeks after the operation she noticed an unpleasant feeling and involuntary movements of her tongue. At the same time, she developed uncomfortable sensations in her big toes andincreased sweating of her legs. In August 2002, she noticed that her toes began to move of their own accord. This started intermittently in her left great toe and evolved over the following year to involve all toes and being present constantly. Associated with these movements was a tearing painful sensation in her toes spreading up to the thighs. Additionally, she suffered from an unbearable painful sensation in her tongue. She also noted pain in her hands and involuntary movements of her fingers. There was nothing she could do to relieve the pain, but symptoms would be aggravated after having a bath, by activity generally, and loud noises.There was no relevant past medical history or family history. Her only medication was thyroxin and she had never taken dopamine receptor blocking agents. When first seen by us in 2005, she was mostly distressed by continuous pain in her tongue and legs. Examination revealed unusual writhing movements of her tongue of irregular rhythm and slow frequency that could only be partly suppressed for a few seconds. Sinuous bilateral toe movements were more pronounced on the left side, intermittent in nature, and influenced by changes in posture. Involuntary finger movements were observed. The remainder of the neurological and general physical examination was unremarkable.