Category: Rare Neurometabolic Diseases
Objective: This study aims to characterize clinicoradiological features and outcomes in patients of Osmotic Demyelination Syndrome(ODS) presenting with movement disorders(MD).
Background: ODS includes central pontine myelinolysis(CPM)and extrapontine myelinosis(EPM)based on the region of brain involved.While CPM presents with more pontine symptoms, EPM presents more with movement disorders( parkinsonism, dystonia, chorea). They share a common etiopathogenesis and clinical manifestation.(1)
Method: Retrospective electronic record review of clinical, demographic, radiological data and follow-up of patients of diagnosed ODS with movement disorder admitted in the department of neurology at the Institute of Neuroscience, Kolkata, between 2019 to 2024.
Results: Nine patients (six males,Mean age 58.2±7.51)were included.Precipitating factors were vomiting-5/9(55%),drugs-22.3%.Concomitant hypokalemia was noted in 3 patients.Mean lowest sodium was 103±4.34 mmol/lit.Mean increase of Sodium was 25.87 mmol/lit(Range 38-16 mmol/lit)over 4 days(Δchange per day 6.46 mmol/lit/day).Symmetric bradykinetic rigid parkinsonism was the most common MD(8/9,88.9%).Other MD Dystonia( 5/9,55%) with focal dystonia(Limb 3/5 60%,craniobulbar 2/5 40%),dystonia-parkinsonism(4/9,44.4%),Vocal tics and chorea(Limb and cervical chorea in one each).Four patients had encephalopathy.MRI showed CPM in two patients,combined EPM and CPM in two and EPM in 5 patients.T2/FLAIR signal changes were noted in caudate nucleus (5/9,55%),Putamen(5/9,55%),Globus pallidus ( 3/9,33%),Pons( 2/9,22%)and trident sign was present in two patients.Repeat MRI at 2 years showed partial resolution in 77.8% patients and complete resolution after 3 years.Mean follow-up duration was 3.83 years.All patients except one had mRS <2. Triphasic course characterised by a first phase of worsening due to hyponatremia then second phase due to ODS and a delayed worsening with the appearance of new MD(dystonia-2,chorea-1,myoclonus-1) was noted in four patients.
Conclusion: Both hypokinetic and hyperkinetic movement disorders were noted in patients of ODS. EPM was more common than CPM with resolution of signal changes after at least 3 years. A triphasic course with the appearance of new MD after 18-24 months was noted possibly due to aberrant neuronal reorganization(2)(3). Overall long-term prognosis is favourable.
References: 1. Lambeck J, Hieber M, Dreßing A, Niesen W-D. Central Pontine Myelinosis and Osmotic Demyelination Syndrome. Dtsch Arztebl Int. 2019;
2. de Souza A. Movement disorders and the osmotic demyelination syndrome. Park Relat Disord [Internet]. 2013;19(8):709–16. Available from: http://dx.doi.org/10.1016/j.parkreldis.2013.04.005
3. Sindhu DM, Holla V V., Prasad S, Kamble N, Netravathi M, Yadav R, et al. The Spectrum of Movement Disorders in Cases with Osmotic Demyelination Syndrome. Mov Disord Clin Pract. 2021;8(6):875–84.
To cite this abstract in AMA style:
D. Dutta, H. Kumar, J. Ganguly, S. Mukherjee. The Clinicoradiological profile of patients with Osmotic Demyelination Syndrome and Movement Disorders [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/the-clinicoradiological-profile-of-patients-with-osmotic-demyelination-syndrome-and-movement-disorders/. Accessed October 5, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/the-clinicoradiological-profile-of-patients-with-osmotic-demyelination-syndrome-and-movement-disorders/