Abstract
A 16-year-old patient with multiple sclerosis (MS) showed paroxysmal movement disorders during a recurrence of the disease. The paroxysms took the form ot brief unilateral dystonic posturings of the right body suggestive of paroxysmal dystonia (PD); they completely receded with acetazolamide. A single episode of a high amplitude, rythmic slow and coarse generalized tremor, present at rest and increasing with movement, particularly involving the head in a no-no movement, occurred soon after recovery from PD and lasted three hours. The present report provides evidence that MS has to be considered in the diagnostic approach to symptomatic childhood PD and underlines the efficacy of acetazolamide in the treatment of PD attacks. It also describes a rare paroxysmal movement disorder, defined as paroxysmal dystonic tremor, that can be considered as falling within the spectrum of PD.
Sommario
Viene riportato il caso di un paziente di 16 anni affetto da sclerosi multipla che ha presentato nel corso della risoluzione dei deficit motori conseguenti ad una poussé, dei disturbi parossistici del movimento.
Gli episodi erano caratterizzati da distonie parossistiche dell'emisoma di destra, dell durata di 15–30 secondi, pluriquotidiane, regredite completamente dopo somministrazione di acetazolamide. In corso di trattamento, il paziente manifestò un unico episodio caratterizzato da tremore ampio, ritmico e grossolano, coinvolgente particolarmente il capo, presente a riposo e incrementato dal movimento, della durata di circa 3 ore, associato a retrocollo e torcicollo. Il caso descritto segnala che la sclerosi multipla deve essere considerata nell'approccio diagnostico delle distonie parossistiche sintomatiche, e sottolinea l'efficacia di acetazolamide nel trattamento di queste ultime. Descrive inoltre un raro disturbo parossistico del movimento, che in analogia con quanto segnalato in letteratura, può essere definito come un tremore parossistico di tipo distonico, e inquadrato nell'ambito delle distonie parossistiche.
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This study was partially supported by the Paolo Zorzi Association for Neurosciences, and the Harry De Jur Foundation.
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Nardocci, N., Zorzi, G., Savoldelli, M. et al. Paroxysmal dystonia and paroxysmal tremor in a young patient with multiple sclerosis. Ital J Neuro Sci 16, 315–319 (1995). https://doi.org/10.1007/BF02249107
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DOI: https://doi.org/10.1007/BF02249107