Objective: To describe the spectrum of movement disorders that result from spinal cord demyelination.

Background: Spinal movement disorders (SMDs) secondary to cord demyelination are not well described despite their high prevalence and significant functional impact.

Methods: Pooled analysis of a prospective cohort of 60 patients with early demyelinating disease (DD) and a retrospective cohort of 37 patients with neuromyelitis optica (NMO). The prospective cohort comprised patients presenting to the neuroimmunology clinic for MS or other DD of 5-year-duration or less. Each patient filled a movement disorder survey and was evaluated by a movement disorder specialist and a neuroimmunologist over a 1-year-period. Videos of movement disorders were rated by a separate blinded movement disorder specialist.

Results: In total, there were 97 patients in the pooled analysis (68% female, mean age 45 years) of whom 46 (47.4%) had one ore more SMD (25 patient with MS, 18 with NMO, and 3 with transverse myelitis). The most common SMDs were tonic spasms (28), new-onset RLS (23), paroxysmal focal dystonia (9), spinal myoclonus (9), subjective fasciculations (9), spontaneous clonus (8), pseudoathetosis (7), spinal tremor (6), and hyperkeplexia (3). All patients had demyelinating lesions in their cervical or thoracic cord and no striatal or infratentorial lesions to explain the abnormal movements. Patients with both brain and cord lesions that can explain the abnormal movement were excluded. SMDs started on average 4 months following a spinal relapse but in 12 patients (26%), the SMD was the presenting symptom of a new relapse. In the prospective cohort, SMDs were the most common type of movement disorders and were more prevalent than cerebellar and striatal movement disorders combined by more than 2 folds.

Conclusions: SMDs are very common in DDs with a very wide presentation spectrum. Tonic spasms and RLS are the most common SMDs. They commonly occur shortly after a spinal relapse but they can be the presenting symptom of a new relapse in about a quarter of the patients. Clinicians should be familiar with the concept of SMDs in MS and other DDs.

References: Mehanna R, Jankovic J. Movement disorders in multiple sclerosis and other demyelinating diseases. J Neurol Sci 2013;328:1–8.

Abboud, H., Fernandez, H. H., Mealy, M. A. and Levy, M. (2016), Spinal Movement Disorders in Neuromyelitis Optica: An Under-recognized Phenomenon. Mov Disord Clin Pract, 3: 596–602. doi:10.1002/mdc3.12321

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MDS Abstracts - https://www.mdsabstracts.org/abstract/movement-disorders-secondary-to-spinal-cord-demyelination-an-evolving-spectrum/