Movement disorders in early MS and related diseases A prospective observational study
Movement disorders in early MS and related diseases A prospective observational study
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DOI：
10.1212/cpj.0000000000000560
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发表时间：
2019-02-01
影响因子：
2.2
通讯作者：
Cohen, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Abboud, Hesham;Yu, Xin Xin;Cohen, Jeffrey A.
早期多发性硬化症（MS）和相关脱髓鞘疾病中运动障碍的真实患病率和临床特征尚不清楚。我们进行了一项前瞻性研究来填补这一知识空白。方法在1年内从多发性硬化症门诊连续招募1例患者。在研究开始日期之前诊断超过5年的患者被排除在外。每位符合条件的患者由一名运动障碍神经科医生进行访谈，他进行了标准化的运动障碍调查和重点检查。对每位患者进行1-4次前瞻性随访。在检查中发现的运动障碍被录像，录像由独立的盲眼运动专家独立评定。结果共纳入60例患者，其中女性56.6%，平均年龄38.3±12.7岁。80%的人在调查中报告了一种或多种运动障碍，38.3%的人在检查中有阳性结果。排除偶发运动障碍（如特发性震颤）后，58.3%被认为有脱髓鞘相关的运动障碍。最常见的运动障碍按降序排列为不宁腿综合征、震颤、强直性痉挛、肌阵挛、局灶性肌张力障碍、自发性阵挛、束状肌束、假性手足动症、丛丛性亢进和面肌痉挛。运动障碍开始于平均复发后5个月但在8个病人中它是新复发或疾病本身的表现症状。大多数运动障碍继发于脊柱（85.7%）或小脑/脑干病变（34.2%）。脊髓脱髓鞘是脱髓鞘相关运动障碍的唯一有统计学意义的预测因子。结论运动障碍比以前认为的在ms早期更常见，它们通常在脊髓或脑干/小脑复发几个月后开始，但偶尔也可能是复发的表现。
BackgroundLittle is known about the true prevalence and clinical characteristics of movement disorders in early multiple sclerosis (MS) and related demyelinating diseases. We conducted a prospective study to fill this knowledge gap.MethodsA consecutive patient sample was recruited from the MS clinic within a 1-year-period. Patients diagnosed over 5 years before the study start date were excluded. Each eligible patient was interviewed by a movement disorder neurologist who conducted a standardized movement disorder survey and a focused examination. Each patient was followed prospectively for 1-4 follow-up visits. Movement disorders identified on examination were video-recorded and videos were independently rated by a separate blinded movement expert.ResultsSixty patients were included (56.6% female, mean age 38.3 +/- 12.7 years). Eighty percent reported one or more movement disorders on the survey and 38.3% had positive findings on examination. After excluding incidental movement disorders (e.g., essential tremor), 58.3% were thought to have demyelination-related movement disorders. The most common movement disorders in a descending order were restless legs syndrome, tremor, tonic spasms, myoclonus, focal dystonia, spontaneous clonus, fasciculations, pseudoathetosis, hyperekplexia, and hemifacial spasm. The movement disorder started 5 months following a relapse on average but in 8 patients it was the presenting symptom of a new relapse or the disease itself. The majority of movement disorders occurred secondary to spinal (85.7%) or cerebellar/brainstem lesions (34.2%). Spinal cord demyelination was the only statistically significant predictor of demyelination-related movement disorders.ConclusionMovement disorders are more common than previously thought even in early MS. They typically begin a few months after spinal or brainstem/cerebellar relapses but may occasionally be the presenting symptom of a relapse.