Prevalence and Anatomical Generators of Movement Disorders in Relapsing and Progressive Multiple Sclerosis
Hannah Kelly1, Rongyi Sun1, Mohamed Elkasaby2, Alexander Wang2, Hesham Abboud2
1Case Western Reserve University School of Medicine, 2University Hospitals Cleveland Medical Center
Objective:

To determine the prevalence and anatomic underpinnings of movement disorders in multiple sclerosis (MS) patients and compare these factors at different disease stages.

Background:

Movement disorders are more common in MS than previously thought. We conducted a prospective study of movement disorders in early MS, but the prevalence and characteristics of movement disorders at different disease stages remain unknown.

Design/Methods:

Adult MS patients seen over five years (2017-2022) were evaluated for demyelination-related movement disorders via a movement disorder survey and examination by a neurologist trained in neuroimmunology and movement disorders. We classified movement disorders based on phenomenology and identified anatomic correlates according to lesion locations on MRI and relation to relapses.

Results:

In total, 328 MS patients were screened, and 65% had demyelination-related movement disorders. Regarding phenotype, 64% had relapsing-remitting MS (RRMS) and 36% had secondary progressive MS (SPMS) or primary progressive MS (PPMS).

Spinal movement disorders were the most common and occurred in 79% of patients. Brainstem or cerebellar movement disorders occurred in 26%, and striatal or thalamic movement disorders were seen in 2% of patients. We observed 22 cases (9%) in which movement disorders represented a new relapse, two of which heralded the first MS attack.

Patients with SPMS or PPMS were older than RRMS patients (37.9, 34.1, p=0.03) and were less likely to be female (63%, 75.6%, p=0.0). Patients with progressive MS were more likely to have demyelination-related movement disorders (81.5%, 56%, p<.0) and to have spinal (67.2%, 47.8%, p<.0) and brainstem or cerebellar movement disorders (27.7%, 14.4%, p=0.0). No significant differences were observed between progressive and relapsing MS for striatal or thalamic movement disorders (4.2%, 0.96%, p=0.1).

Conclusions:

Demyelination-related movement disorders are commonly seen in patients with progressive MS and spinal cord and infratentorial lesions. In some patients, movement disorders may represent a new relapse, including the first disease presentation.

10.1212/WNL.0000000000204370