Unusual Symptoms and Syndromes in Multiple Sclerosis

Alexander D. Rae-Grant, MD, FRCP(C) Multiple Sclerosis p. 992-1006 August 2013, Vol.19, No.4 doi: 10.1212/01.CON.0000433287.30715.07
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Purpose of Review In multiple sclerosis (MS), symptoms vary widely from patient to patient. Certain events in MS are well recognized (eg, optic neuritis, brainstem and spinal cord relapses) and do not lead to much clinical confusion. However, other events that occur in MS may be less expected and may be underrecognized by some clinicians and may lead to an extensive and potentially unnecessary investigation for what is a known problem in MS.

Recent Findings This article reviews Lhermitte sign, Pulfrich phenomenon, Uhthoff phenomenon, and the useless hand of Oppenheim, along with the underrecognized phenomena of transient neurologic events (including tonic spasms). Disorders of temperature regulation in MS (likely based on hypothalamic involvement) which can present with bizarre behavioral change and evade diagnosis, are also discussed. The article concludes with a review of epilepsy and sleep disorders in MS, both of which appear to occur at an increased frequency in the MS population and may have implications for therapy.

Summary This article is meant to help clinicians recognize and treat this fascinating set of underrecognized phenomena in MS and perhaps save patients trips to the emergency department, extraneous testing, and ineffective intervention.

Address correspondence to Dr Alex Rae-Grant, Mellen Center for Multiple Sclerosis, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, [email protected].

Relationship Disclosure: Dr Rae-Grant has served as a speaker for Avanir Pharmaceuticals, Inc, Biogen Idec, Novartis, and Teva Neuroscience.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Rae-Grant discusses the unlabeled use of carbamazepine, phenytoin, gabapentin, botulinum toxin injections, and thiamine for the treatment of multiple sclerosis symptoms.

© 2013 American Academy of Neurology