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Paroxysmal dystonia and paroxysmal tremor in a young patient with multiple sclerosis
N Nardocci1, G Zorzi, M Savoldelli
1Divisione di Neuropsichiatria Infantile, Istituto Nazionale Neurologico C. Besta, Milano.
Abstract:
A 16-year-old patient with multiple sclerosis (MS) showed paroxysmal movement disorders during a recurrence of the disease. The paroxysms took the form ot brief unilateral dystonic posturings of the right body suggestive of paroxysmal dystonia (PD); they completely receded with acetazolamide. A single episode of a high amplitude, rythmic slow and coarse generalized tremor, present at rest and increasing with movement, particularly involving the head in a no-no movement, occurred soon after recovery from PD and lasted three hours. The present report provides evidence that MS has to be considered in the diagnostic approach to symptomatic childhood PD and underlines the efficacy of acetazolamide in the treatment of PD attacks. It also describes a rare paroxysmal movement disorder, defined as paroxysmal dystonic tremor, that can be considered as falling within the spectrum of PD.
Insights
Multiple sclerosis (MS) in a teen presented with paroxysmal dystonia, effectively treated with acetazolamide. This case highlights MS as a cause of childhood paroxysmal dystonia and introduces paroxysmal dystonic tremor.
Area of Science:
- Neurology
- Pediatric Neurology
- Movement Disorders
Background:
- Multiple sclerosis (MS) is a demyelinating disease that can affect children and adolescents.
- Paroxysmal dystonia (PD) is characterized by brief, involuntary muscle contractions causing abnormal postures.
- Childhood-onset MS is rare, and its presentation with movement disorders requires careful consideration.
Observation:
- A 16-year-old patient with MS experienced recurrent episodes of unilateral dystonic posturing during a disease exacerbation.
- These paroxysmal dystonia episodes resolved completely with acetazolamide treatment.
- A distinct episode of generalized tremor, described as paroxysmal dystonic tremor, occurred after PD resolution.
Findings:
- The case provides evidence for considering MS in the differential diagnosis of symptomatic childhood paroxysmal dystonia.
- Acetazolamide demonstrated efficacy in managing acute paroxysmal dystonia attacks in this pediatric MS patient.
- A rare paroxysmal dystonic tremor was observed, potentially representing a variant within the spectrum of paroxysmal dystonia.
Implications:
- This report expands the understanding of MS manifestations in pediatric patients, including paroxysmal movement disorders.
- It underscores the importance of early diagnosis and targeted treatment for childhood MS.
- The findings suggest acetazolamide as a potential therapeutic option for paroxysmal dystonia in the context of MS.