Secondary paroxysmal dyskinesia in multiple sclerosis: Clinical-radiological features and treatment. Case report of seven patients

Secondary paroxysmal dyskinesias (SPDs) are short, episodic, and recurrent movement disorders, classically related to multiple sclerosis (MS). Carbamazepine is effective, but with risk of adverse reactions. We identified 7 patients with SPD among 457 MS patients (1.53%). SPD occurred in face (n = 1), leg (n = 2), or arm + leg (n = 4) several times during the day. Magnetic resonance imaging (MRI) showed new or enhancing lesions in thalamus (n = 1), mesencephalic tegmentum (n = 1), and cerebellar peduncles (n = 5). Patients were treated with clonazepam and then acetazolamide (n = 1), acetazolamide (n = 5), or levetiracetam (n = 1) with response within hours (acetazolamide) to days (levetiracetam). No recurrences or adverse events were reported after a median follow-up of 33 months.