Paroxysmal Symptoms

Although some studies report an increased prevalence of epileptic seizures compared to the general population, a recent population-based epidemiologic report from Olmsted County, Minnesota found the occurrence to be similar in MS patients and the general population (147). Recently, five patients were described who had jux-tacortical lesions in the temporal region and presented with temporal lobe epilepsy as the sole manifestation of MS (148).

In contrast to true epilepsy, many MS patients experience other types of stereotyped, repetitive paroxysmal symptoms and signs. Tonic "seizures" have been reported frequently (48,149-153). Patients suddenly experience dystonic posturing of part of the body, most typically the hand or arm, lasting 30 seconds to 2 minutes. Sometimes the attack is painful. Episodes may occur infrequently or many times a day and tend to cluster for periods of weeks to months. The anatomical lesions, apparently responsible for the dystonia, have been found in a variety of sites, including the basal ganglia, the internal capsule, the thalamus, the cerebral peduncle, and the cervical cord (154-157).

Episodes of paroxysmal dysarthria, with or without other brain stem dysfunction, have also been reported (158,159). The author has encountered a patient with episodic aphasia. Some patients experience paroxysms of itching, and this has been reported as the initial symptom of MS (160). Hemifacial spasm may occur and may be associated with lesions in or near the facial nucleus, as identified by MRI (161).

Trigeminal neuralgia is the most common paroxysmal disturbance. The clinical syndrome is usually indistinguishable from that in non-MS patients, except that onset tends to occur at an earlier age and symptoms are more frequently bilateral (162). Occasionally, the usual feature of excruciating, lancinating pain is associated with objective sensory disturbance in the MS patient.

A variety of movement disorders occasionally occur in MS. An unusual case of hemiballismus in a convincing case of infantile MS has been reported (24). Both kinesigenic dystonia (163) and paroxysmal kinesigenic choreoathetosis (164) have marked the onset of MS. Segmental myoclonus of spinal origin has been noted (165), and a rare case of trismus has been reported (166). Micrographia, a sign more typically associated with Parkinson's disease, was reported in association with an enhancing lesion in the dominant parietal white matter (167).

0 0

Post a comment