Management of paroxysmal symptoms in multiple sclerosis

Christian Confavreux, Fran├žoise Bouhour and Sandra Vukusic

The first anecdotal reports on paroxysmal symptoms or signs in multiple sclerosis date back to the last century. The first comprehensive review was made by McAlpine in 1972 in his classical monograph1 devoted to multiple sclerosis with the collaboration of Lumsden and Acheson. Several other authors should also be mentioned for their pioneer work in the field. The description of tonic seizures is due to Matthews,2 paroxysmal dysarthria and ataxia to Andermann et al,3 paroxysmal akinesia to Zeldowicz,4 paroxysmal paraesthesias and pain to Espir and Millac,5 and paroxysmal hemitaxia and crossed paraesthesias, paroxysmal diplopia and paroxysmal itching to Osterman and Westerberg.6 Owing to quite similar physiopathology and response to antiepileptic drugs, the current trend is to include Lhermitte sign and trigeminal neuralgia in the list of paroxysmal symptoms and signs in multiple sclerosis. It may also be argued that epileptic manifestations, which are a classic feature in multiple sclerosis, should be included.

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