Neuroleptic-induced “painful legs and moving toes” syndrome: successful treatment with clonazepam and baclofen


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.


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.

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Correspondence to R. Sandyk M.D., M.Sc..

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Sandyk, R. Neuroleptic-induced “painful legs and moving toes” syndrome: successful treatment with clonazepam and baclofen. Ital J Neuro Sci 11, 573–576 (1990).

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  • “Painful legs and moving toes”
  • molindone
  • clonazepam
  • baclofen