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Multiple sclerosis presenting with paroxysmal symptoms: Patients at the limitations of current diagnostic criteria
Karl D Heward1, Chantal Roy-Hewitson1, Andrew J Solomon1
1Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT, USA.
Abstract:
Paroxysmal neurological symptoms in patients with multiple sclerosis (MS) have long been acknowledged. However, consideration of whether such symptoms are a clinical attack and sufficient for fulfillment of MS diagnostic criteria has varied as criteria have evolved over time. Previous studies and anecdotal reports indicate that some patients with MS first present with syndromes such as trigeminal neuralgia, Lhermitte's phenomenon, tonic spasm, and seizure years before an attack typical of MS such as optic neuritis or myelitis. We discuss four patients with presumed MS who initially presented with these syndromes with evidence of a corresponding central nervous system (CNS) lesion who, were these symptoms considered an attack, could have been diagnosed with relapsing remitting MS or clinically isolated syndrome. This case series aims to highlight the unmet need for data for such patient presentations and for clinical guidance from future MS diagnostic criteria to optimize care.
Insights
Early neurological symptoms like trigeminal neuralgia in multiple sclerosis (MS) patients may indicate an attack. Further research is needed to refine MS diagnostic criteria for these presentations.
Area of Science:
- Neurology
- Neuroimmunology
Background:
- Paroxysmal neurological symptoms are recognized in multiple sclerosis (MS).
- Diagnostic criteria for MS have evolved, impacting the classification of these early symptoms.
- Some MS patients present with syndromes like trigeminal neuralgia years before typical MS attacks.
Purpose of the Study:
- To highlight the need for data on patients presenting with early paroxysmal neurological symptoms.
- To advocate for clinical guidance in future MS diagnostic criteria for these presentations.
- To explore if these initial symptoms, with CNS lesions, could meet criteria for relapsing-remitting MS or clinically isolated syndrome.
Main Methods:
- Case series discussion of four patients with presumed MS.
- Review of initial paroxysmal neurological presentations and associated central nervous system (CNS) lesions.
- Analysis of diagnostic implications based on current and potential future MS criteria.
Main Results:
- Four patients presented with paroxysmal neurological syndromes and corresponding CNS lesions.
- These initial symptoms, if considered attacks, could have led to earlier MS diagnosis (clinically isolated syndrome or relapsing-remitting MS).
- Current diagnostic criteria may not fully capture these early presentations.
Conclusions:
- There is a need for more data on early paroxysmal neurological presentations in MS.
- Future MS diagnostic criteria should provide guidance for classifying these initial symptoms.
- Optimizing care for MS patients may depend on recognizing these early neurological events as potential diagnostic indicators.
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