A unique case of coincidence of early onset Parkinson's disease and multiple sclerosis

Abstract

We report on a patient who developed left arm rest/postural tremor at age 24 and responded well to trihexyphenidyl. One year later spastic paraparesis appeared, and multiple sclerosis was diagnosed on the basis of clinical, radiological, and laboratory evidence. Although paraparesis improved after immunosuppressant therapy, a complete picture of an asymmetric parkinsonian syndrome gradually developed. Excellent response to levodopa, drug-induced dyskinesias, and DaTSCAN revealing pathology congruent with Parkinson's disease (PD) indicate a coincidental etiopathogenetic relationship of both clinical entities: multiple sclerosis and PD. Genetic analyses focusing on autosomal recessive parkinsonism (parkin, DJ1, and PINK1) were negative. To the best of our knowledge, only 15 cases of parkinsonism in association with multiple sclerosis have been reported, and their relationship has been interpreted to be either causal or coincidental. This is the first report of a coincidence of both entities, in which the parkinsonian syndrome developed first and before age 30.

Multiple sclerosis and risk of Parkinson's disease: a Danish nationwide cohort study

“…Several case reports and a Swedish cohort study have suggested a co‐occurrence of PD amongst persons with MS . Controversy remains, however, regarding the possible link between these two neurological diseases .…”

Primary progressive multiple sclerosis developing in the context of young onset Parkinson’s disease

“…9 In 2007 Valkovic and colleagues published a review of 15 cases of concurrent PD and MS and since then only three further cases have been described. [10][11][12] The majority are thought to be due to coexistence of idiopathic PD and MS in the same patient. This notion is supported by abnormal DAT scans in the absence of corresponding demyelinating lesions within the basal ganglia on MRI.…”

Parkinsonism and multiple sclerosis—Is there association?

“…There are two main hypotheses that try to explain this association. The first one is that it is purely accidental 3,5,6 . The best documented case of coincidental MS and PD in the same patient is that reported by Valkovic et al 6 .…”

“…The first one is that it is purely accidental 3,5,6 . The best documented case of coincidental MS and PD in the same patient is that reported by Valkovic et al 6 . The authors base their conclusion on negative response of parkinsonian symptoms to immunosuppressive therapy or steroids, and findings of neuroimaging studies (MRI with absent lesions in the basal ganglia and a characteristic finding on DAT scan).…”