Objective: To observe the association of various movement disorder with demyelinating disease.

Background: Movement disorders in demyelinating diseases are not an unheard entity, but besides tremor other phenomenological entities are less reported and described mostly in multiple sclerosis (MS) patients. Here we are reporting ten patients who presented with movement disorders secondary to the underlying demyelinating disease.

Method: A case series from a tertiary care teaching institute.

Results: Among the ten cases, eight were female. Most patients had Relapsing-Remitting Multiple Sclerosis (70%) and were on Multiple Sclerosis specific disease-modifying therapy. Others were Neuromyelitis Optica (20%) and Myelin Oligodendrocyte Glycoprotein antibody disease (10%). All cases were positive for spinal lesions irrespective of the nature of demyelinating disease they had. The mean age of the patients was 28.8 ± 15.88 years. Brain lesions were observed in six out of seven Relapsing-Remitting Multiple Sclerosis cases. Four patients had bilateral postural tremor, two patients had dystonia with dystonic tremor and two had a tonic spasm, one patient each had intention tremor, opsoclonus, and orofacial dyskinesia with tongue tremor. Forty per cent (n=4) of patients had more than one movement disorder.

Conclusion: Similar to other reports our study also had female predominance (n=8) with the majority of the movement disorders being secondary to the spinal lesion.¹ Unlike the recent large observational study conducted by Abboud and in alignment with other previous studies, our case series also discovered tremor as the most common presentation that is also postural tremor (arms) and not the restless legs syndrome.^{1, 2} Relapsing-remitting multiple sclerosis also portrayed as more commonly associated with movement disorder than other subtypes of multiple sclerosis. Orofacial dyskinesia, tongue tremor, and opsoclonus like rare entity were also encountered. The duration after the MS presentation also has clinical value as most of the cases had the emergence of movement disorder after months/year and subsidence with a decrement in inflammatory activity.³ Except the tonic spasm which is found to emerge at the remission of the MS with steroid.⁴

References: 1. Abboud H, Yu XX, Knusel K, Fernandez HH, Cohen JA. Movement disorders in early MS and related diseases: A prospective observational study. Neurol Clin Pract. 2019 Feb;9 (1):24-31. 2. Alusi SH, Worthington J, Glickman S, Bain PG. A study of tremor in multiple sclerosis. Brain. 2001 Apr;124(Pt 4):720-30. 3. Ayache SS, Chalah MA, Al-Ani T, Farhat WH, Zouari HG, Créange A, Lefaucheur JP. Tremor in multiple sclerosis: The intriguing role of the cerebellum. J Neurol Sci. 2015 Nov 15;358(1-2):351-6. 4. Li Y, Jiang B, Chen B, Zhao M, Zhou C, Wang S, Li J, Wang R. Neuromyelitis optica spectrum disorders with multiple brainstem manifestations: a case report. Neurol Sci. 2016 Feb;37(2):309-13.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-in-demyelination-a-case-series-of-ten-patients/