Objective: To review the prevalence of movement disorders (MD) in patients with demyelinating diseases (DD) treated at a tertiary academic center and to characterize their therapeutic response and imaging features.

Background: MD have been reported in DD[1] but, while adding to the disability and disease burden are frequently overlooked or undertreated. Data on efficacious treatment of these MD is also sparse. 

Methods: We reviewed the chart of patients seen at our academic center between 1/1/2009 and 6/1/2016 with ICD 9 or ICD 10 codes for MD and DD or patients who were seen by both a movement disorder and a white matter disease specialist. 209 patients were identified.  We reviewed the clinical characteristics, brain and spine MRIs, medications and therapeutic responses to both MD and DD treatments. Spasticity was not included in the list of MD reviewed.

Results: Of the 209 patients reviewed, 123 patients (75% female, age 48.8 +/- 12.8 years) had one or more MD. The most common MD were ataxia, followed by isolated tremor, then ataxia and tremor in combination. Other MD reported in these patients were parkinsonism, dystonia, myoclonus, paroxysmal kinesegenic dyskinesia, restless legs syndrome and tics. The average age at diagnosis of MD was 41 years. MD were related to an acute onset in 31% of patients, and 11.3% responded to DD therapy. Only 42 patients (34%) had any treatment for MD.  Of those, 29 (69%) responded at least partially to a first MD agent and 7 patients (16.6%) responded at least partially to a 2^nd,  3^rd or 4^th agent. There was signal abnormality in the basal ganglia (BG) or the cerebellum in 58 (47%) of the patients. Patients with Parkinsonism, tics-tourettism, and myoclonus did not have any imaging involvement of the BG or cerebellum.

Conclusions: MD are commonly untreated in DD patients, but have a 69% therapeutic response to a first therapeutic trial. Greater awareness of potential therapeutic options is needed to decrease disability in these patients. 

References: [1]. Mehanna R, Jankovic J. Movement disorders in multiple sclerosis and other demyelinating diseases. J Neurol Sci. Neurol Sci. 2013 May 15; 328(1-2):1-8.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-in-demyelinating-diseases-a-retrospective-review-from-a-tertiary-academic-center/