Objective: To describe a unique case of Dementia with Lewy bodies (DLB) co-occurrence with Multiple Sclerosis (MS)

Background: Various movement disorders have been described in patients with MS, usually secondary to demyelinating lesions in the basal ganglia or related circuits. Reports of co-occurring Parkinson’s disease (PD) and MS are rare, and to our knowledge, we are describing the first case of co-occurring DLB and MS. This may be relevant given recent evidence supporting immune system involvement in PD and related conditions

Methods: Case Report

Results: A 64-year old woman with relapsing-remitting MS diagnosed in her thirties, treated with high dose steroids but never on immune modulating therapy was initially seen in the clinic at age 61. She had hand tremor for two months. Additionally, the family reported mild but progressive cognitive impairment and short term memory loss causing daily dysfunction. Memory was impaired on exam at that time.  She was lost to follow up until 3 years later when she presented with formed visual hallucinations and worsening memory and cognition. She had experienced an episode of increased leg stiffness and immobility after receiving quetiapine. On exam, she had rigidity in all extremities, and mild bilateral bradykinesia. There was also concurrent spasticity. MoCA was 21/30. Due to both extrapyramidal and pyramidal features, parkinsonism was considered. MRI brain with and without contrast shows chronic supratentorial and infratentorial white matter lesions consistent with MS, but no lesions within the basal ganglia.  DAT scan shows bilateral symmetric decrease in putamen uptake. She reported a robust response to carbidopa/levodopa with clear on and off time Given onset of parkinsonism and cognitive impairment within one year, with abnormal DaTscan, she was diagnosed with DLB

Conclusions: This is the first description of DLB occurring in a patient with MS. There may be shared clinical characteristics, such as tremor and increased tone, and the phenomenology of these features may be difficult to differentiate between pyramidal and extrapyramidal etiologies. Moreover, progression of motor and non-motor symptoms will be influenced by both diseases. Whether these two neurodegenerative conditions share causality, for instance immune mediated mechanisms, or are merely co-incident remains unclear. Studying a potential overlap in pathophysiology might help in future management considerations

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-dementia-with-lewy-bodies-co-occuring-with-multiple-sclerosis/