Acquired sexual paraphilia in patients with multiple sclerosis.
BACKGROUND
Sexual dysfunction in patients with multiple sclerosis is typically characterized by diminished libido, erectile and ejaculatory dysfunction in men, and poor lubrication and anorgasmy in women. In contrast, hypersexual behavior and paraphilias are distinctly uncommon in this population of patients, but have been associated with various focal brain lesions.


METHODS
We describe a man with clinically definite multiple sclerosis who developed profound and abrupt disinhibition and paraphilic behavior during an exacerbation.


RESULTS
Neuroimaging revealed a marked increase in the number of enhancing lesions in the right sides of the hypothalamus and mesencephalon and extending into the right sides of the red nucleus, substantia nigra, and internal capsule. The altered sexual behavior was characterized by an obsessive and insatiable desire to touch women's breasts.


CONCLUSIONS
Acquired sexual paraphilic behavior is uncommon in patients with multiple sclerosis but may occur when inflammatory demyelination involves the hypothalamic and septal regions of the basal prosencephalon. Our experience with this man illustrates the great difficulty involved in treating such patients when the paraphilic behavior becomes persistent.
Frohman
Elliot M
EM
Department of Neurology, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75235, USA. efrohm@mednet.swmed.edu
Frohman
Teresa C
TC
Moreault
Ann M
AM
D000328:Adult; D006801:Humans; D007031:Hypothalamus / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008636:Mesencephalon / Q000473:pathology; D009103:Multiple Sclerosis / Q000150:complications / Q000473:pathology / Q000523:psychology*; D010262:Paraphilic Disorders / Q000209:etiology / Q000473:pathology / Q000523:psychology*