Objective: To characterize clinical profiles, etiological patterns, and therapeutic outcomes of Painful Legs Moving Toes syndrome [PLMTS] patients in a rural Indian neurology practice.

Background: PLMTS remains a rare neurological disorder with unclear pathophysiology. Existing literature lacks comprehensive reports from resource-limited settings, particularly regarding its diverse peripheral nervous system associations.

Method: Retrospective case series of 24 consecutive PLMTS patients (2021-2024) from a tertiary care hospital. Standardized data collection included demographic characteristics, clinical features, neurophysiological studies, etiological investigations, and treatment responses. Outcome measures included pain reduction (Visual Analog Scale) and functional improvement at 6-month follow-up.

Results: The cohort of 24 patients (mean age 54.3±15.7 years, 13 female) exhibited diverse etiologies: nutritional deficiency neuropathy (n=4), alcoholic neuropathy (n=3), drug-induced neuropathy (nitrofurantoin n=2, metronidazole n=2), Sjögren’s syndrome-associated neuropathy (n=4), diabetic lumbo-sacral-radiculo-plexus-neuropathy (n=3), paraneoplastic neuropathy (n=2), spinal cord lymphoma (n=1), prolapsed intervertebral disc-associated radiculopathy (n=1), post-herpes zoster radiculopathy (n=1), and IgG4-associated neuropathy (n=1). Pain severity (measured by Visual Analog Scale) ranged from 6-9/10. All patients demonstrated spontaneous repetitive discharges on electromyography. Targeted therapies achieved >50% symptom reduction in 15/24 patients (62.5%), with combination neuropathic pain management (pregabalin, pramipexole, carbamazepine, tramadol) providing partial relief in remaining cases.

Conclusion: This rural Indian case series demonstrates PLMTS as a manifestation of diverse peripheral nerve insults. Systematic etiological evaluation enabled cause-specific management with favourable outcomes despite resource constraints, underscoring the syndrome’s recognition value in developing region settings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/painful-legs-moving-toes-syndrome-in-rural-western-india-etiological-spectrum-and-outcomes-in-24-cases/