Abstract
The syndrome of “painful legs and moving toes” is characterised by spontaneous causalgic pain in the lower extremities associated with peculiar involuntary movements of the toes and feet. It has been observed after a variety of lesions affecting the posterior nerve roots, the spinal ganglia and the peripheral nerves. The pathophysiology of the syndrome is unknown. I report a patient who developed the syndrome during treatment for schizophrenia with the antipsychotic agent molindone hydrochloride. The patient’s response to the combination of clonazepam and baclofen suggests that the pathophysiology of the “painful legs and moving toes” may be linked to impairment of spinal serotonergic and GABA functions.
Sommario
La sindrome delle gambe dolorose e dei piedi inquieti è caratterizzata da dolori spontanei di tipo causalgico alle estremità inferiori associati a movimenti involontari tipici dei piedi e delle dita. È stata osservata in una varietà di lesioni interessanti le radici posteriori, i gangli spinali e i nervi periferici. La patofisiologia della sindrome è sconosciuta.
Riferisco qui di un paziente che presentò la sindrome durante un trattamento col farmaco antipsicotico molindone idrocloride.
Il paziente era schizofrenico. La risposta positiva ad una associazione di clonazepam e baclofen suggerisce che la patofisiologia di questa sindrome debba essere riferita a un interessamento delle funzioni serotoninergiche e gabaergiche spinali.
Similar content being viewed by others
References
Behrman S.:Disturbed relaxation of limbs. Br Med J, 1:454–1457, 1958.
Brennan M.J.W., Ruff P., Sandyk R.:Efficacy of a combination of sodium valproate and baclofen in Meige’s disease (idiopathic orofacial dystonia). Br Med J 285:853, 1982.
Burke R.E., Fahn S., Gold A.P.:Delayed onset dystonia in patients with “static” encephalopathy. J Neurol Neurosurg Psychiatry, 43:789–797, 1980.
Chung Hwang E., Van Woert M.H.:Antimyoclonic action of clonazepam: the role of serotonin. Eur J Pharmacol, 60:31–37, 1980.
Dejerine J., Roussy G.:Le syndrome thalamique. Rev Neurol (Paris), 14:521–532, 1906.
Ekbom K.A.:Restless legs syndrome. Neurology, 10:868–873, 1960.
Lindenberg R.:Die Schadigungsmechanismen der Substantia nigra bei Hirntraumen und das Problem des posttraumatischen Parkinsonismus. Dtsch Z Nervenheilk, 185:663, 1964.
Meller E., Friedman E.:Differential dose- and time-dependent effects of molindone on dopamine neurons of rat brain: mediation by irreversible inhibition of monoamine oxidase. J Pharmacol Exp Ther, 220:609–615, 1982.
Montagna P., Cirignotta F., Sacquegna T., Martinelli P., Ambrosetto G., Lugaresi E.:“Painful legs and moving toes” assciated with polyneuropathy. J Neurol Neurosurg Psychiatry, 46:399–403, 1983.
Nathan P.W.:Painful legs and moving toes: evidence on the site of the lesion. J Neurol Neurosurg Psychiatry, 41:934–939, 1978.
Owen R., Cole J.O.:Molindone hydrochloride: A review of laboratory and clinical findings. J Clin Psychopharmacol, 9:268–276, 1989.
Sandyk R.:Successful treatment of neuroleptic-induced akathisia with baclofen and clonazepam. Eur Neurol 24:286–289, 1985.
Schott G.D.:Painful legs and moving toes”: the role of trauma. J Neurol. Neurosurg. Psychiatry, 44:344–346, 1981.
Sheehy M.P., Marsden C.D.:Trauma and pain in spasmodic torticollis. Lancet, 1:777–778, 1980.
Spillane J.D., Nathan P.W., Kelly R.E., Marsden C.D.:Painful legs and moving toes. Brain, 94:541–556, 1971.
Van Woert M.H., Chung Hwang E.:Treatment of myoclonus. In: Barbeau A. (ed.) Disorders of Movements, MTP Press, Lancaster, England pp. 59–80, 1981.
Wulff C.H.:Painful legs and moving toes. A report of three cases with neurophysiological studies.:Acta Neurol Scand, 66:283–287, 1982.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Sandyk, R. Neuroleptic-induced “painful legs and moving toes” syndrome: successful treatment with clonazepam and baclofen. Ital J Neuro Sci 11, 573–576 (1990). https://doi.org/10.1007/BF02337440
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02337440