Paroxysmal motor signs in multiple sclerosis: an illustrative videotaped case

Multiple sclerosis (MS) presents with a wide spectrum of neurological manifestations, among which paroxysmal motor phenomena remain a diagnostic and therapeutic challenge. We report the case of a 29-year-old male diagnosed with relapsing-remitting MS (RRMS) who exhibited episodes of paroxysmal dystonia, dysarthria-ataxia, and ptosis. Brain MRI revealed multiple demyelinating plaques, including a contrast-enhancing lesion in the right midbrain, which provides an anatomical correlation with the patient's neurological manifestation. The dystonic movements resolved with corticosteroid therapy, while symptomatic management with carbamazepine was required for dysarthria-ataxia. Ocrelizumab has been proposed as a long-term disease-modifying treatment. This case highlights the importance of recognizing paroxysmal motor signs in MS for early diagnosis and tailored management, despite their elusive pathogenesis.