THE SYNDROME OF PAINFUL LEGS AND MOVING TOES
THE SYNDROME OF PAINFUL LEGS AND MOVING TOES
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DOI：
10.1002/mds.870090104
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发表时间：
1994-01-01
影响因子：
8.6
通讯作者：
MARSDEN, CD
中科院分区：
文献类型：
--
作者：
DRESSLER, D;THOMPSON, PD;MARSDEN, CD
临床表现，症状和体征在20个新的病人与疼痛的腿和运动脚趾综合征。下肢疼痛和脚趾移动可能发生在脊髓和马尾损伤、腰神经根损伤、足部骨或软组织损伤和周围神经病变的情况下。在本研究的20例中，有4例未找到明确的原因，18例在脚趾运动开始前出现疼痛，2例出现相反的顺序。疼痛有许多特征性头痛，但没有一个病人表现出反射性交感神经营养不良的全貌，只有5例外周创伤是触发因素。一些患者报告称，脚趾运动的发生与疼痛密切相关，尽管腰交感神经阻滞疼痛的消除与运动的消失不一定相关。有几个特征表明这些运动有一个中心起源。症状可能开始于一侧并变为双侧;运动可能因随意动作而暂时受到抑制或因改变姿势而加剧;肌电图显示复杂的节律性活动模式，运动单位正常募集，涉及几个肌节。另外三名患者也有类似的脚趾移动，但没有疼痛。在没有疼痛的情况下出现类似的运动，这就提出了一种可能性，即这些病例代表了一系列疾病的一端，另一端是疼痛（头痛），而腿痛和脚趾移动综合征介于两者之间。常见的促发因素是外周组织、神经或神经根损伤，这可能导致传入感觉信息的改变，随后重组节段或超节段传出运动活动。改变的感觉输入可能会导致疼痛，异常传出运动活动，或通过节段或超节段感觉运动回路两者兼而有之。
The clinical presentation, symptoms, and signs in 20 new patients with the painful legs and moving toes syndrome are presented. Painful legs and moving toes may develop in the setting of spinal cord and cauda equina trauma, lumbar root lesions, injuries to bony or soft tissues of the feet, and peripheral neuropathy. In 4 of the 20 cases in the present study, no definite cause was found. Pain preceded the onset of toe movements in 18 cases, but in 2 the reverse sequence occurred. The pain had many of the characteristics of causalgia, but none of the patients exhibited the full picture of reflex sympathetic dystrophy, and peripheral trauma was the trigger in only 5 cases. Several patients reported that the occurrence of toe movements was closely related to the pain, although abolition of pain with lumbar sympathetic blocks was not necessarily associated with disappearance of the movements. Several features suggest a central origin for the movements. Symptoms may begin on one side and become bilateral; movements may be momentarily suppressed by voluntary action or exacerbated by changing posture; and electromyography reveals complex patterns of rhythmic activity with normal recruitment of motor units involving several myotomes. Three other patients with similar moving toes but no pain are also described. The occurrence of similar movements in the absence of pain raises the possibility that these cases represent examples at one end of a spectrum of disorders, with pain alone (causalgia) at the other end and the syndrome of painful legs and moving toes in between. Common precipitating factors are peripheral tissue, nerve, or root injury, which may lead to alterations in afferent sensory information with subsequent reorganisation of segmental or suprasegmental efferent motor activity. The altered sensory input may result in pain, abnormal efferent motor activity, or both via segmental or suprasegmental sensorimotor circuits.