Abstract
Secondary paroxysmal dyskinesia is a rare but life-quality-compromising symptom in multiple sclerosis (MS) and might be associated with particular MS lesions. The present study intended to determine associations between paroxysmal dyskinesia and the MS-associated lesion site using a voxelwise lesion analysis. We conducted a retrospective study and sought MS patients with documented paroxysmal dyskinesia and controls without paroxysmal dyskinesia matched for age, disease severity, and disease duration in a local database. The MS lesions were analysed on T2-weighted magnetic resonance imaging scans (1.5 or 3 T), manually outlined, and transformed into stereotaxic space. We determined the lesion overlap and compared the absence or presence of paroxysmal dyskinesia voxelwise between patients with and without lesions in a given voxel using the Liebermeister test with 4000 permutations. From 15,869 MS patient records screened, we identified 25 patients with paroxysmal dyskinesia. The voxelwise analysis in 22 subjects yielded associations between paroxysmal dyskinesia and MS lesions in the internal capsule, the basal ganglia, and another prominent lesion cluster in the posterior periventricular white matter. Our voxelwise analysis shows associations between paroxysmal dyskinesia and MS lesions in the internal capsule and basal ganglia, areas contributing to motor sequence programming. This association in another lesion site located in the posterior thalamic radiation suggests that lesions in subcortical sensory pathways may also contribute to paroxysmal dyskinesia in MS.
Similar content being viewed by others
References
Nociti V, Bentivoglio A, Frisullo G, Fasano A, Soleti F, Iorio R, Loria G, Patanella A, Marti A, Tartaglione T, Tonali P, Batocchi A (2008) Movement disorders in multiple sclerosis: causal or coincidental association? Mult Scler 14:1284–1287
Eriksson M, Ben-Menachem O, Andersen O (2002) Epileptic seizures, cranial neuralgias and paroxysmal symptoms in remitting and progressive multiple sclerosis. Mult Scler 8:495–499
Matthews W (1975) Paroxysmal symptoms in multiple sclerosis. J Neurol Neurosurg Psychiatry 38:617–623
Waubant E, Alize P, Tourbah A, Agid Y (2001) Paroxysmal dystonia (tonic spasm) in multiple sclerosis. Neurology 57:2320–2321
Parees I (2017) Clinical commentary on “Paroxysmal kinesigenic dyskinesia-like phenotype in multiple sclerosis” and “Secondary paroxysmal dyskinesia in multiple sclerosis: clinical and radiological features and treatment. Case report of seven patients”. Mult Scler 23:1797–1798
Mehanna R, Jankovic J (2013) Movement disorders in multiple sclerosis and other demyelinating diseases. J Neurol Sci 328:1–8
Ciampi E, Uribe-San-Martin R, Godoy-Santin J, Cruz J, Carcamo-Rodriguez C, Juri C (2017) Secondary paroxysmal dyskinesia in multiple sclerosis. Clinical-radiological features and treatment. Case report of seven patients. Mult Scler 23:1791–1795
Osterman P, Westerberg C (1975) Paroxysmal attacks in multiple sclerosis. Brain 98:189–202
Sakurai M, Kanazawa I (1999) Positive symptoms in multiple sclerosis: their treatment with sodium channel blockers, lidocaine and mexiletine. J Neurol Sci 162:162–168
Oakes P, Srivatsal S, Davis M, Samii A (2013) Movement disorders in multiple sclerosis. Phys Med Rehabil Clin N Am 24:639–651
Rose M, Ball J, Thompson P (1993) Magnetic resonace imaging in tonic spasms in multiple sclerosis. J Neurol 1:115–117
Spissu A, Cannas A, Ferrigno P, Pelaghi A, Spissu M (1999) Anatomic correlates of painful tonic spasms in multiple sclerosis. Mov Disord 14:331–335
Libenson M, Stafstrom C, Rosman N (1994) Tonic seizures in a patient with brainstem demyelination: MRI study of brain and spinal cord. Pediatr Neurol 11:258–262
Maimone D, Reder A, Finocchiaro F, Recupero E (1991) Internal capsule plaque and tonic spasms in multiple sclerosis. Arch Neurol 48:427–429
Watson C, Chiu M (1979) Painful tonic seizures in multiple sclerosis: localization of a lesion. Can J Neurol Sci 6:359–361
Zenzola A, De Mari M, De Blasi R, Carella A, Lamberti P (2001) Paroxysmal dystonia with thalamic lesion in multiple sclerosis. Neurol Sci 22:391–394
Burguera J, Catala J, Casanova B (1991) Thalamic demyelination and paroxysmal dystonia in multiple sclerosis. Mov Disord 6:379–381
Tüzün E, Akman-Demir G, Eraksoy M (2001) Paroxysmal attacks in multiple sclerosis. Mult Scler 7:402–404
Rozza L, Bortolotti P, Sica A, Weronig S, Orrico D (1993) Kinesigenic dystonia as the first manifestation of multiple sclerosis with cervical and brainstem lesions. Eur Neurol 33:331–332
Gatto E, Zurru M, Rugilo C (1996) Medullary lesions and unusual bilateral paroxysmal dystonia in multiple sclerosis. Neurology 46:847–848
Cosentino C, Torres L, Flores M, Cuba J (1996) Paroxysma kinesigenic dystonia and spinal cord lesion. Mov Disord 11:453–455
Polman C, Reingold S, Banwell B, Clanet M, Cohen J, Filippi M, Fujihara K, Hardova E, Hutchinson M, Kappos L, Lublin F, Montalban X, O’Connor P, Sandberg-Wollheim M, Thompson A, Waubant E, Weinshenker B, Wolinsky J (2011) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69:292–302
Kurtzke J (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452
Rorden C, Karnath H, Bonilha L (2007) Improving lesion-symptom mapping. J Cogn Neurosci 19:1081–1088
McCausland Center for Brain Imaging (2007) MRIcron software. http://www.mccauslandcenter.sc.edu/mricro/mricron. Accessed 4 June 2016
Rorden C, Bonilha L, Fridriksson J, Bender B, Karnath HO (2012) Age-specific CT and MRI templates for spatial normalization. Neuroimage 61:957–965. https://doi.org/10.1016/j.neuroimage.2012.03.020
McCausland Center for Brain Imaging (2014) Clinical Toolbox for SPM8. http://www.nitrc.org/frs/?group_id=881. Accessed 4 June 2016
Wellcome Department of Cognitive Neuroscience (2012) Statistical Parametric Mapping (SPM). University College London, London
Sprenger T, Seifert CL, Valet M, Andreou AP, Foerschler A, Zimmer C, Collins DL, Goadsby PJ, Tolle TR, Chakravarty MM (2012) Assessing the risk of central post-stroke pain of thalamic origin by lesion mapping. Brain 135:2536–2545. https://doi.org/10.1093/brain/aws153
Frohlich K, Winder K, Linker RA, Engelhorn T, Dorfler A, Lee DH, Hilz MJ, Schwab S, Seifert F (2017) Supratentorial lesions contribute to trigeminal neuralgia in multiple sclerosis. Cephalalgia 38:1326–1334. https://doi.org/10.1177/0333102417737788
Yilmaz S, Serdaroglu G, Gokben S, Tekgul H (2011) Paroxysmal dystonia as a rare initial manifestation of multiple sclerosis. J Child Neurol 26:1564–1566
Aguirregomozcorta M, Ramio-Torrenta L, Gich J, Quiles A, Genis D (2008) Paroxysmal dystonia and pathological laughter as the first manifestations of multiple sclerosis. Mult Scler 14:262–265
Baguma M, Ossemann M (2017) Paroxysmal kinesigenic dyskinesia as the presenting and only manifestation of multiple sclerosis after eighteen months of follow-up. J Mov Disord 10:96–98. https://doi.org/10.14802/jmd.16055
Winder K, Linker RA, Seifert F, Deutsch M, Engelhorn T, Dörfler A, Lee DH, Hösl KM, Hilz MJ (2016) Neuroanatomic correlates of female sexual dysfunction in multiple sclerosis. Ann Neurol 80:490–498. https://doi.org/10.1002/ana.24746
Winder K, Seifert F, Ohnemus T, Sauer EM, Kloska S, Dörfler A, Hilz MJ, Schwab S, Köhrmann M (2015) Neuroanatomic correlates of poststroke hyperglycemia. Ann Neurol 77:262–268. https://doi.org/10.1002/ana.24322
Winder K, Seifert F, Köhrmann M, Crodel C, Kloska S, Dörfler A, Hösl K, Schwab S, Hilz M (2017) Lesion mapping in stroke-related erectile dysfunction. Brain 140:1706–1717
Abbruzzese G, Berardelli A (2003) Sensorimotor integration in movement disorders. Mov Disord 18:231–240
Beck S, Hallett M (2011) Surround inhibition in the motor system. Exp Brain Res 210:165–172. https://doi.org/10.1007/s00221-011-2610-6
Tamura Y, Ueki Y, Lin P, Vorbach S, Mima T, Kakigi R, Hallett M (2009) Disordered plasticity in the primary somatosensory cortex in focal hand dystonia. Brain 132:749–755. https://doi.org/10.1093/brain/awn348
Tamura Y, Matsuhashi M, Lin P, Ou B, Vorbach S, Kakigi R, Hallett M (2008) Impaired intracortical inhibition in the primary somatosensory cortex in focal hand dystonia. Mov Disord 23:558–565. https://doi.org/10.1002/mds.21870
Patel N, Jankovic J, Hallett M (2014) Sensory aspects of movement disorders. Lancet Neurol 13:100–112. https://doi.org/10.1016/s1474-4422(13)70213-8
Hinds JP, Eidelman BH, Wald A (1990) Prevalence of bowel dysfunction in multiple sclerosis: a population survey. Gastroenterology 98:1538–1542. https://doi.org/10.1016/0016-5085(90)91087-M
Felts P, Kapoor R, Smith K (1995) A mechanism for ectopic firing in central demyelinated axons. Brain 118:1225–1231
Tranchant C, Bhatia K, Marsden C (1995) Movement disorders in multiple sclerosis. Mov Disord 10:418–423
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical standards
This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Fröhlich, K., Winder, K., Linker, R.A. et al. Lesion correlates of secondary paroxysmal dyskinesia in multiple sclerosis. J Neurol 265, 2277–2283 (2018). https://doi.org/10.1007/s00415-018-8989-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-018-8989-2