Movement Disorders Highly Prevalent in Early Multiple Sclerosis

girl in wheelchair
girl in wheelchair
Investigators observed a wide variety of movement disorders — including restless legs syndrome, tremor, and tonic spasms — associated with early demyelinating diseases.

Movement disorders appear to be highly prevalent in patients who have early demyelinating diseases, with spinal lesions a predictor of demyelination-related movement disorders, according to results of a single-center analysis published in Neurology Clinical Practice.

A total of 60 consecutive patients with movement disorders who were receiving care at the Cleveland Clinic Mellen Center for Multiple Sclerosis were enrolled. On a standardized movement disorder survey conducted by a movement disorder neurologist, approximately 80% of the study sample had 1 or more movement disorders, whereas 38.3% had positive findings on a focused examination. Patients were prospectively followed for 1 to  follow-up visits, and movement disorders were recorded on video and subsequently rated by a blinded movement disorder expert. Movement disorders were classified as spinal or infratentorial, and as demyelination-related or incidental.

More than half (58.3%) of the patients were categorized as having demyelination-related movement disorders. The most frequently recorded movement disorders in the cohort were idiopathic restless legs syndrome (38.3%), tremor (35%), tonic spasms (26.7%), myoclonus (26.7%), focal dystonia (18.3%), spontaneous ankle clonus (16.7%), fasciculations (15%), finger pseudoathetosis (13.3%), hyperekplexia (11.7%), and hemifacial spasm (3.3%). Spinal lesions were more common in patients with demyelination-related movement disorders than in patients without them (84.4% vs 56.5%, respectively; P =.048). Spinal lesions were the only predictor of demyelination-related movement disorders in the adjusted analysis (odds ratio 4.95; 95% CI, 1.32-21.78; P =.02).

Limitations of the study included the recruitment of patients from a single center, the short follow-up, and the small number of patients in the final cohort.

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“In patients with established MS,” the researchers explained, “the development of a new movement disorder can indicate a new relapse and should prompt new imaging, acute relapse management as appropriate, and consideration of [disease-modifying therapies] escalation if indicated.”


Abboud H, Yu XX, Knusel K, Fernandez HH, Cohen JA. Movement disorders in early MS and related diseases: A prospective observational study. Neurol Clin Pract. 2019;9(1):1-8.