title: [Paroxysmal dystonia and multiple sclerosis].
abstract: BACKGROUND
  Movement disorders are uncommon in multiple sclerosis, except for tremor. Patients rarely have paroxysmal dystonia (or tonic spasm), which can be the presenting manifestation of the disease.
  
  
  METHODS
  Two videotaped observations are presented. The first patient was a 27-year-old woman, treated for relapsing-remitting multiple sclerosis, who presented daily several short (<1minute) paroxysms of right hemibody dystonia. Brain MRI revealed several areas of cerebral demyelination, including the posterior limb of the left internal capsule with gadolinium enhancement. These events disappeared 7 days after corticosteroid infusion. The second patient was a 62-year-old man who presented brief episodes (<1minute) of daily painful left hemibody dystonia. Three months later, similar paroxysms affecting the right hemibody including the face occurred. At times, the two hemibodies were affected simultaneously. The brain MRI showed multiple areas of white matter hyperintensity, including two symmetrical areas in the posterior limb of the internal capsules. Multiple sclerosis was diagnosed on clinical, MRI and biological data. Four days after starting corticosteroids, these paroxysmal phenomena disappeared totally.
  
  
  CONCLUSIONS
  Dystonia is an under-recognized aspect of paroxysmal events during multiple sclerosis. It might involve ephaptic transmission among abnormal demyelinated neurons; this ectopic excitation can arise at variable levels of the corticospinal tract, but the analysis of reported cases and those described in this study shows that impairment of the posterior limb of the internal capsule seems to be a prevalent topography. Inflammation is likely to play a role because steroids often improve these phenomena. In this article, we review the clinical aspects, pathophysiology and outcome of paroxysmal dystonia in multiple sclerosis.
authors.affiliation: Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, 20360 Casablanca, Maroc. Electronic address: hichamotmani@hotmail.com.
authors.forename: H
authors.initials: H
authors.lastname: El Otmani
authors.affiliation: Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, 20360 Casablanca, Maroc.
authors.forename: Y
authors.initials: Y
authors.lastname: Benmansour
authors.affiliation: Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, 20360 Casablanca, Maroc.
authors.forename: A
authors.initials: A
authors.lastname: Araqi-Houssaini
authors.affiliation: Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, 20360 Casablanca, Maroc.
authors.forename: N
authors.initials: N
authors.lastname: Benkirane
authors.affiliation: Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, 20360 Casablanca, Maroc.
authors.forename: F
authors.initials: F
authors.lastname: Dany
authors.affiliation: Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, 20360 Casablanca, Maroc.
authors.forename: M
authors.initials: M
authors.lastname: Abdoh Rafai
authors.affiliation: Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, 20360 Casablanca, Maroc.
authors.forename: B
authors.initials: B
authors.lastname: El Moutawakil
authors.affiliation: Service de neurologie, CHU Ibn Rochd, 1, rue des Hôpitaux, 20360 Casablanca, Maroc.
authors.forename: I
authors.initials: I
authors.lastname: Slassi
mesh_terms: D000328:Adult; D004421:Dystonia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis
keywords: Capsule interne; Dystonia; Dystonie; Internal capsule; Multiple sclerosis; Pathophysiology; Physiopathologie; Sclérose en plaques; Spasme tonique; Tonic spasm