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Painful legs and moving toes syndrome associated with herpes zoster myelitis

Kazuyo Ikeda1, Kazushi Deguchi, Tetsuo Touge

  • 1Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, 761-0793 Kagawa, Japan.

Journal of the Neurological Sciences
|March 31, 2004
PubMed

Insights

Painful legs and moving toes syndrome (PLMT) can develop months after herpes zoster (HZ) myelitis. This suggests neural pathway plasticity may underlie PLMT development following HZ myelitis.

Area of Science:

  • Neurology
  • Neuroscience
  • Clinical Medicine

Background:

  • Herpes zoster (HZ) myelitis is an inflammation of the spinal cord due to the varicella-zoster virus.
  • Painful legs and moving toes syndrome (PLMT) is a rare neurological condition characterized by neuropathic pain and involuntary movements.

Observation:

  • A 75-year-old woman presented with PLMT 16 months post-HZ myelitis.
  • MRI revealed transient, eccentric lesions near the posterior horn in HZ myelitis, which resolved by PLMT onset.
  • Somatosensory evoked potentials showed selective tibial nerve abnormalities, indicating lower leg sensory pathway involvement.

Findings:

  • The case suggests a potential link between HZ myelitis and the subsequent development of PLMT.
  • Selective somatosensory abnormalities point to specific alterations in the ascending pathways from the lower legs.
  • Resolution of initial HZ lesions prior to PLMT suggests a delayed or secondary mechanism.

Implications:

  • The findings propose that neural plasticity in the somatosensory pathway, potentially involving interneuron networks, may contribute to PLMT development after HZ myelitis.
  • This case highlights the complex and long-term neurological sequelae that can follow viral infections like HZ.
  • Further research into neuroplasticity mechanisms is warranted for understanding and managing such conditions.

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