Movement disorders in early MS and related diseases A prospective observational study

Background Little is known about the true prevalence and clinical characteristics of movement disorders in early multiple sclerosis (MS) and related demyelinating diseases. We conducted a prospective study to fill this knowledge gap. Methods A consecutive patient sample was recruited from the MS clinic within a 1-year-period. Patients diagnosed over 5 years before the study start date were excluded. Each eligible patient was interviewed by a movement disorder neurologist who conducted a standardized movement disorder survey and a focused examination. Each patient was followed prospectively for 1-4 follow-up visits. Movement disorders identified on examination were video-recorded and videos were independently rated by a separate blinded movement expert. Results Sixty patients were included (56.6% female, mean age 38.3 +/- 12.7 years). Eighty percent reported one or more movement disorders on the survey and 38.3% had positive findings on examination. After excluding incidental movement disorders (e.g., essential tremor), 58.3% were thought to have demyelination-related movement disorders. The most common movement disorders in a descending order were restless legs syndrome, tremor, tonic spasms, myoclonus, focal dystonia, spontaneous clonus, fasciculations, pseudoathetosis, hyperekplexia, and hemifacial spasm. The movement disorder started 5 months following a relapse on average but in 8 patients it was the presenting symptom of a new relapse or the disease itself. The majority of movement disorders occurred secondary to spinal (85.7%) or cerebellar/brainstem lesions (34.2%). Spinal cord demyelination was the only statistically significant predictor of demyelination-related movement disorders. Conclusion Movement disorders are more common than previously thought even in early MS. They typically begin a few months after spinal or brainstem/cerebellar relapses but may occasionally be the presenting symptom of a relapse.