Movement disorders in multiple sclerosis and their treatment

Area of Science:

• Neurology
• Movement Disorders
• Neuroimmunology

Background:

• Hyperkinetic movement disorders, particularly tremors, are frequently observed in patients with multiple sclerosis (MS).
• Intention tremor is a characteristic feature, while rest tremors are typically absent in MS patients.
• Other rarer movement disorders include paroxysmal dyskinesias, choreoathetosis, tonic spasms, and 'brain stem fits'.

Purpose of the Study:

• To review the clinical presentation and management of hyperkinetic movement disorders in multiple sclerosis.
• To discuss the available treatment options, their efficacy, and evidence base.
• To highlight the potential for spontaneous resolution of tremors and the management of paroxysmal dyskinesias.

Main Methods:

• Literature review of hyperkinetic movement disorders in multiple sclerosis.
• Analysis of treatment modalities including surgical interventions and pharmacological approaches.
• Discussion of spontaneous remission and management of rarer movement disorders.

Main Results:

• Intention tremors are common in MS; rest tremors are rare.
• Invasive treatments like Gamma Knife surgery, thalamotomy, and deep brain stimulation are options for tremors, with deep brain stimulation suitable for bilateral cases.
• Paroxysmal dyskinesias, including choreoathetosis, respond well to carbamazepine.

Conclusions:

• Management of MS-related tremors often involves invasive procedures with limited evidence.
• Spontaneous resolution of tremors via subsequent MS lesions is possible.
• Carbamazepine is an effective treatment for symptomatic paroxysmal choreoathetosis and related disorders in MS.