title: Rethinking the importance of paroxysmal and unusual symptoms as first clinical manifestation of multiple sclerosis: They do matter.
abstract: BACKGROUND
  Paroxysmal (PS) and unusual symptoms (US) as initial manifestation of multiple sclerosis (MS) are rare and often thought to indicate "benign" MS.
  
  
  OBJECTIVE
  To investigate prevalence and clinical disease course of patients experiencing PS or US as first clinical manifestation.
  
  
  METHODS
  Clinical, MRI and cerebrospinal fluid data of patients presenting with PS and US were obtained retrospectively and compared to patients with classical bout onset (CS).
  
  
  RESULTS
  In a cohort of 1396 relapsing onset patients, 15 (1.1%) were identified as presenting with PS and 7 (0.5%) with US. Groups were comparable regarding gender, age at onset and intrathecal immunoglobulin synthesis (p>0.05). During a mean follow-up period of 13.6 years, all patients presenting with PS or US converted to CDMS (mean duration 3.4 years; 95% CI 1.9-4.8) as compared to 1374 patients (94%) presenting with CS (mean duration 3.2 years; 95% CI 3.0-3.4; p=0.759).
  
  
  CONCLUSIONS
  In a cohort of 1396 MS patients, 1.6% presented with PS or US at disease onset. Irrespective of the initial transient symptoms, patients were at the same risk of developing CDMS as CS patients, thereby underlining the importance of identifying PS and US as possible first clinical symptoms of MS.
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Clinic for Rehabilitation Münster, Muenster, Austria. Electronic address: rainer.ehling@i-med.ac.at.
authors.forename: Rainer
authors.initials: R
authors.lastname: Ehling
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Bsteh
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Franziska
authors.initials: F
authors.lastname: Di Pauli
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Hegen
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Auer
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Karin
authors.initials: K
authors.lastname: Obermair
authors.affiliation: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Michaela
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Deisenhammer
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Reindl
authors.affiliation: Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Berger
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D010641:Phenotype; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Conversion to multiple sclerosis; Early treatment; First clinical symptom; Multiple sclerosis; Paroxysmal symptoms; Unusual symptoms