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Published on: July 19, 2019
Movement Disorders in Multiple Sclerosis and Other Demyelinating Diseases: A Retrospective Review From a Tertiary
Gerson Suarez-Cedeno1, Raja Mehanna2
1Department of Neurology, University of New Mexico, Albuquerque, NM.
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.
Insights
Movement disorders are common in demyelinating diseases and often undertreated. A significant 69% of patients showed improvement with initial treatment, highlighting the need for greater awareness of therapeutic options.
Area of Science:
- Neurology
- Neuroimmunology
Background:
- Movement disorders (MDs) are recognized complications of demyelinating diseases (DDs).
- Limited data exists on effective MD treatments and lesion localization correlations in DD.
Purpose of the Study:
- To investigate the prevalence and treatment response of MDs in patients with DDs.
- To explore potential correlations between DD lesion location and MD characteristics/treatment outcomes.
Main Methods:
- Retrospective review of 185 patients with MD and DD over 7 years.
- Analysis of clinical data, imaging, medications, and treatment responses.
Main Results:
- 123 patients with DD had one or more MDs; ataxia and tremor were most common.
- 34% received MD treatment, with 69% responding to the first agent and 78.6% to subsequent agents.
- Lesion location in basal ganglia/cerebellum correlated with better initial response, but no correlation with MD phenomenology was found.
Conclusions:
- MDs are prevalent in DDs and frequently undertreated.
- A 69% response rate to initial MD therapy suggests effective treatment options exist.
- Increased awareness of therapeutic strategies is crucial to mitigate disability from MDs in DD patients.
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