Neurological manifestations of Paget's disease

The neurological features of 96 patients whose skull and spinal X-rays showed the features of Paget's disease of bone were reviewed. The clinical phenomena were compared with those in another group of patients, identified by having a normal skull X-ray. Cranial nerve lesions and spinal syndromes could be attributed to the Paget's disease in many cases but the evidence did not suggest that other clinical phenomena such as dementia and epilepsy were related to the bony changes. Amongst cranial nerve lesions deafness is certainly attributable to Paget's disease, hemifacial spasm when combined with other signs is probably related, and possibly also trigeminal neuralgia. Basilar invagination can be asymptomatic, but deafness, hemifacial spasm and pyramidal signs were more prevalent in its presence. The importance of reviewing the cause and effect relationship between Paget's disease and neurological problems is discussed in the context of the therapeutic use of calcitonin.