Movement Disorders in Multiple Sclerosis and Other Demyelinating Diseases

Abstract

Background: Movement disorders (MDs) have been described in demyelinating diseases (DDs). However, data is lacking in the effective treatment of these MD as well as in a potential correlation between DD lesions localization and the phenomenology of the MD and its response to treatment. Methods: Retrospective review of 185 patients with MD and DD seen at our center over a period of 7 years. Clinical imaging, medications, and therapeutic responses to both MD and DD treatments were reviewed. Results: Of the 185 patients, 62 were excluded because of a diagnosis of spasticity without any other MD. One hundred twenty three patients with DD (75% female, age 48.8±12.8 y) had one or more MD. The most common MD was ataxia followed by isolated tremor. Forty-two patients (34%) received any treatment for MD, 29 (69%) of which responded at least partially to a first MD agent and 78.6% responded at least partially to a second or third agent. Responders to the first MD therapy were more likely to have a lesion in the basal ganglia or the cerebellum, and less likely to have a lesion in the brainstem or the spinal cord, but these results could be biased by a lower-than-expected frequency of tonic spasms in our series. No correlation between DD lesions localization and the phenomenology of the MD was discovered. Conclusions: MD are common in DD and are frequently overlooked or undertreated. MD in this sample have a 69% therapeutic response to a first trial. Greater awareness of potential therapeutic options is needed to decrease disability.

A Literature Review of Movement Disorder Associated with Medications and Systemic Diseases

“…The symptoms of MS can vary widely among individuals, and movement disorders are common manifestations of the disease. Movement disorders associated with multiple sclerosis may include spasticity, ataxia, tremors, and dystonia [117]. Also, fatigue-related movements were already described.…”

Movement Disorders in Multiple Sclerosis: An Update

“…In a recent retrospective study involving 123 patients with movement disorders and demyelinating diseases, ataxia was the most common movement disorder, followed by an isolated tremor [6]. In a study involving five MS patients who developed limb ataxia/intention tremor, a contralateral cortical MRI lesion became visible on an average of 22.3 months before the development of limb ataxia [93].…”

“…Some movement disorders present with symptoms highly suggestive of MS, which should prompt immediate diagnosis and treatment. The most prevalent movement disorders in MS include restless leg syndrome (RLS), tremor, ataxia, parkinsonism, paroxysmal dyskinesias, dystonia, chorea and ballism, facial myokymia, including hemifacial spasm and spastic paretic hemifacial contracture, tics, and tourettism [1][2][3][4][5][6].…”