I read with great interest the article by Alvarez et al. 1 In their review, they confirmed that Painful Legs and Moving Toes (PLMT's) etiology is diverse although the majority of patients had evidence of peripheral nerve involvement or radiculopathy. However, in some patients, namely in patients with Wilson's disease 2 and myelitis, 3 a structural central nervous system lesion is evoked to be associated with the development of PLMT. We reported a patient with Hashimoto's disease 4 who developed slight dystonia and bradykinesia and presented PLMT. The patient had any electrophysiological signs of neuropathy or any clinical sign indicative of a root or nerve disorder. MRI brain scan showed several small subcortical white matter fronto-parietal lesions, without diffusion restriction. Discrete and diffuse high signal in periventricular white matter was visible in T2-weighted images. These aspects are frequently found in Hashimoto's encephalopathy. 5 We also believe that at least in some cases PLMT has a central origin and is composed of a variety of dystonic movements. In our reported case, 4 we think PLMT was associated with Hashimoto's encephalopathy.