Paroxysmal symptoms in multiple sclerosis masquerading as transient ischaemic attacks

Abstract

SummaryParoxysmal demyelinating events produced sudden onset, transient, recurrent symptoms that were troublesome to our patient and puzzled the referring clinician who mistook them for transient ischaemic attacks or epilepsy. It was important to recognise the true nature of the underlying problem because the symptoms could then be readily treated; this is especially critical because the symptoms, in this case, represent a relapse of multiple sclerosis and, therefore, are significant for examination during the diagnosis. BACKGROUND

Paroxysmal Symptoms As the First Manifestation of Multiple Sclerosis Mimicking a Transient Ischemic Attack: A Report of Two Cases

“…When paroxysmal symptoms are the presenting manifestation of MS, it can be challenging for clinicians to differentiate these symptoms from TIA. Several cases of paroxysmal symptoms in MS have been reportedly mistaken for TIA ( 7 , 8 ). We found in agreement with these reports that paroxysmal symptoms in MS had several typical characteristics that can be differentiated from TIA (Table 1 ).…”

“…Paroxysmal symptoms in MS are characterized by their sudden onset, brevity (usually seconds to minutes) ( 5 ), frequency (from 10 to 20 times per day up to a few hundred times per day), stereotyped fashion, and relatively long clinical course. If untreated, they tend to continue in clusters for days up to a few months before remission ( 7 ), coincident with a new episode of inflammatory demyelination. Relapses in MS have been defined as episodes of neurological disturbances last for at least 24 h. As a consequence, paroxysmal symptoms are accepted as relapses as long as they consist of multiple episodes occurring over not less than 24 h. These transient symptoms usually have a positive response to carbamazepine, while TIA does not.…”

“…The mechanisms of paroxysmal symptoms in MS are not fully understood, but are likely mediated by ephaptic transmission ( 12 ). On this basis, membrane-stabilizing drugs are effective in almost all patients ( 7 ). The paroxysmal symptoms have a tendency to occur in the early stages of the MS disease course ( 2 ).…”

Stretching the limbs? Tonic spasms in multiple sclerosis

“…Tonic spasms (TS), sometimes referred to as paroxysmal dystonia,1 2 are classically but infrequently seen in MS, although other demyelinating disorders have been associated with these phenomena, namely neuromyelitis optica (NMO) 3 4. Recognising that motor paroxysmal phenomena can be observed in the MS clinical spectrum is important to avoid misdiagnosis, prevent excessive diagnostic testing and carry out the right therapeutic choices 5. We report a paradigmatic case illustrating the clinical presentation, differential diagnosis and treatment options for this unusual condition.…”