title: Neuromyelitis optica: association with paroxysmal painful tonic spasms.
abstract: BACKGROUND
  Paroxysmal painful tonic spasms (PPTS) were initially described in multiple sclerosis (MS) but they are more frequent in neuromyelitis optica (NMO). The objective is to report their presence in a series of cases of NMO and NMO spectrum disorders (NMOSD), as well as to determine their frequency and clinical features.
  
  
  METHODS
  We conducted a retrospective assessment of medical histories of NMO/NMOSD patients treated in 2 hospitals in Buenos Aires (Hospital Durand and Hospital Álvarez) between 2009 and 2013.
  
  
  RESULTS
  Out of 15 patients with NMOSD (7 with definite NMO and 8 with limited NMO), 4 presented PPTS (26.66%). PPTS frequency in the definite NMO group was 57.14% (4/7). Of the 9 patients with longitudinally extensive transverse myelitis (LETM), 44.44% (9/15) presented PPTS. Mean age was 35 years (range, 22-38 years) and all patients were women. Mean time between NMO diagnosis and PPTS onset was 7 months (range, 1-29 months) and mean time from last relapse of LETM was 30 days (range 23-40 days). LETM (75% cervicothoracic and 25% thoracic) was observed by magnetic resonance imaging (MRI) in all patients. Control over spasms and pain was achieved in all patients with carbamazepine (associated with gabapentin in one case). No favourable responses to pregabalin, gabapentin, or phenytoin were reported.
  
  
  CONCLUSIONS
  PPTS are frequent in NMO. Mean time of PPTS onset is approximately one month after an LETM relapse, with extensive cervicothoracic lesions appearing on the MRI scan. They show an excellent response to carbamazepine but little or no response to pregabalin and gabapentin. Prospective studies with larger numbers of patients are necessary in order to confirm these results.
authors: Consultorio de Neuroinmunología, Servicio de Neurología, Hospital General de Agudos Dr. Carlos G. Durand, Buenos Aires, Argentina. Electronic address: junior.carnero@hotmail.com.
authors: E
authors: E
authors: Carnero Contentti
authors: Servicio de Neurología, Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina.
authors: F
authors: F
authors: Leguizamón
authors: Consultorio de Neuroinmunología, Servicio de Neurología, Hospital General de Agudos Dr. Carlos G. Durand, Buenos Aires, Argentina.
authors: J P
authors: JP
authors: Hryb
authors: Servicio de Neurología, Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina.
authors: J
authors: J
authors: Celso
authors: Consultorio de Neuroinmunología, Servicio de Neurología, Hospital General de Agudos Dr. Carlos G. Durand, Buenos Aires, Argentina.
authors: J L Di
authors: JL
authors: Pace
authors: Servicio de Neurología, Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina.
authors: J
authors: J
authors: Ferrari
authors: Servicio de Neurología, Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina.
authors: E
authors: E
authors: Knorre
authors: Consultorio de Neuroinmunología, Servicio de Neurología, Hospital General de Agudos Dr. Carlos G. Durand, Buenos Aires, Argentina.
authors: M B
authors: MB
authors: Perassolo
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009188:Myelitis, Transverse / Q000150:complications; D009471:Neuromyelitis Optica / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D012008:Recurrence; D012189:Retrospective Studies; D013035:Spasm / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D002220:Carbamazepine
keywords: Esclerosis múltiple; Espasmos tónicos paroxísticos dolorosos; Espectro de la neuromielitis óptica; Longitudinally extensive transverse myelitis; Mielitis transversa longitudinal extensa; Multiple sclerosis; Neuromielitis óptica; Neuromyelitis optica; Neuromyelitis optica spectrum disorders; Paroxysmal painful tonic spasms