Movement disorders in early MS and related diseases

Abstract

BackgroundLittle is known about the true prevalence and clinical characteristics of movement disorders in early multiple sclerosis (MS) and related demyelinating diseases. We conducted a prospective study to fill this knowledge gap.MethodsA consecutive patient sample was recruited from the MS clinic within a 1-year-period. Patients diagnosed over 5 years before the study start date were excluded. Each eligible patient was interviewed by a movement disorder neurologist who conducted a standardized movement disorder survey and a focused examination. Each patient was followed prospectively for 1–4 follow-up visits. Movement disorders identified on examination were video-recorded and videos were independently rated by a separate blinded movement expert.ResultsSixty patients were included (56.6% female, mean age 38.3 ± 12.7 years). Eighty percent reported one or more movement disorders on the survey and 38.3% had positive findings on examination. After excluding incidental movement disorders (e.g., essential tremor), 58.3% were thought to have demyelination-related movement disorders. The most common movement disorders in a descending order were restless legs syndrome, tremor, tonic spasms, myoclonus, focal dystonia, spontaneous clonus, fasciculations, pseudoathetosis, hyperekplexia, and hemifacial spasm. The movement disorder started 5 months following a relapse on average but in 8 patients it was the presenting symptom of a new relapse or the disease itself. The majority of movement disorders occurred secondary to spinal (85.7%) or cerebellar/brainstem lesions (34.2%). Spinal cord demyelination was the only statistically significant predictor of demyelination-related movement disorders.ConclusionMovement disorders are more common than previously thought even in early MS. They typically begin a few months after spinal or brainstem/cerebellar relapses but may occasionally be the presenting symptom of a relapse.

Phenome-wide examination of comorbidity burden and multiple sclerosis disease severity

“…Disorders of fluid, electrolyte, and acid-base as a category of comorbid metabolic disturbance also commonly occur in patients with heart diseases or renal failure and may also reflect poor diet, fluid intake, or swallowing difficulties in severe MS. 28 Indeed, another reported finding is nausea and vomiting, which could contribute to metabolic disturbance. Finally, abnormal movement was a reported finding that warrants targeted investigation, particularly given report of increased frequency of movement disorder even early in MS. 29 Although we set out to investigate the comorbidity burden associated with MS severity, we found an interesting inverse association between MS severity and certain cancers, including benign neoplasm of the skin. Prior studies reported a lower incidence of all-cause cancers among people with MS relative to matched general population.…”

“…Disorders of fluid, electrolyte, and acid-base as a category of comorbid metabolic disturbance also commonly occur in patients with heart diseases or renal failure and may also reflect poor diet, fluid intake, or swallowing difficulties in severe MS. 28 Indeed, another reported finding is nausea and vomiting, which could contribute to metabolic disturbance. Finally, abnormal movement was a reported finding that warrants targeted investigation, particularly given report of increased frequency of movement disorder even early in MS. 29 …”

Paroxysmal dystonia as an initial presentation of multiple sclerosis posing a diagnostic challenge

“…5 Most of the literature showed association of PD with spinal cord lesions. 4 The presumed lesion responsible for this acute presentation of PD in our patient is the only enhancing lesion in right hemisphere located at corona radiata. An ephaptic axonal activation at a non-synaptic contact site within a partial demyelinated plaque at any level in motor pathway is considered the most likely pathophysiological explanation for PD.…”

“…Typically MS has a relapsing, remitting course presenting with ataxia, hemiplegia, optic neuritis or brainstem syndromes. Movement disorders are traditionally thought to be rare in MS but recently there is more recognition of these paroxysmal disorders presenting as first episode of MS. 4,5 Their prevalence is reported less than 2% in the literature. 2 Recognition of paroxysmal phenome as an initial presentation of MS is of utmost importance as it helps not only in timely diagnosis of the primary disease but long term management with DMDs to avoid permanent brain damage as well.…”

Symptomatic and restorative therapies in neuromyelitis optica spectrum disorders

“…Focal spinal cord disease can cause a variety of involuntary movements including tonic spasms, paroxysmal or fixed focal dystonia, spinal myoclonus, spontaneous or triggered clonus, spinal tremor, and secondary restless leg syndrome (RLS) [33][34][35]. Some of these movement disorders, in particular tonic spams and paroxysmal dystonia, are thought to be more common in NMOSD than other demyelinating diseases and they can be painful [36][37][38][39].…”