Natural Multiple Sclerosis Treatment Book
Several clinical series have reported an association between epilepsy and multiple sclerosis (MS). In one small population-based study, patients with MS had a threefold but nonsignificant increase (SMR, 3.0 95 CI, 0.6-8.8) in the risk of epilepsy compared with the general population. In another series the cumulative risk of epilepsy in patients with MS was found to be 1.1 at 5 years, 1.8 by 10 years and 3.1 by 15 years. The mean interval until the onset of epilepsy is about 7 years after the onset of MS. Convulsive status epilepticus has been reported more frequently in patients with MS. Epilepsy is more likely to occur in large lesions and lesions which abut on to the cortex, and occasionally MS presents with an acute mass lesion with seizures. Although in some patients epilepsy precedes MS by years or decades, there is no evidence of an increased risk of epilepsy prior to the onset of the symptoms due to MS.
The patient was somnolent owing to the effect of the intravenous medications, but she was easy to rouse. There was nystagmus in all directions of movement, which had not been present during the examination on admission. The remainder of the neurological examination was remarkable only for reduced rapid alternating movements in the right foot, which from the history was a residual effect of her multiple sclerosis.
Under the vicissitudes of managed care, she was lost to follow up until 6 years later, when she was referred back to me for follow-up of her stable multiple sclerosis. In the interim, she and her husband had weathered five miscarriages to have a lovely daughter. On occasion, she has had rare attacks conforming to a clinical diagnosis of convulsive syncope, but has never had sustained shaking or repetitive attacks.
Neuropathic pain is common and occurs in many diseases such as diabetes, paraneoplastic disorders, multiple sclerosis, systemic vasculitides, human immunodeficiency virus (HIV) and as a result of chemotherapy-associated neuropathy. Several of these conditions are also associated with seizures. Gabapentin and pregabalin both appear to be very effective for neuropathic pain 97, 98 . There is also evidence that oxcarbazepine and lamotrigine are effective 99, 100 . In addition, topiramate, levetiracetam and zonisamide are used, although there is less evidence supporting their effectiveness 101-103 .
Our center has reported on a group of 33 RBD patients with PSG-docu-mented overlapping NREM-REM sleep motor parasomnias consisting of sleepwalking, sleep terrors, and RBD (Schenck et al., 1997b). Mean age was 34 14 years mean age of parasomnia onset was 15 16 years (range 1-66) 70 (n 23) were males. An idiopathic subgroup (n 22) had a significantly earlier mean age of parasomnia onset (9 7 years) than a symptomatic subgroup (n 11) (27 23 years) whose parasomnia began with neurological disorders, n 6 congenital Mobius syndrome, narcolepsy, multiple sclerosis, brain tumor (and treatment), brain trauma, indeterminate disorder (exaggerated startle response atypical cataplexy) nocturnal paroxysmal atrial fibrillation, n 1 posttraumatic stress disorder major depression, n 1 chronic ethanol amphetamine abuse and withdrawal, n 1 or mixed disorders (schizophrenia, brain trauma, substance abuse), n 2. The rate of psychiatric disorders was not elevated group scores on various psychometric tests...
RBD has been associated with brainstem lesions caused by vascular disease, trauma, and multiple sclerosis (59). In addition, RBD is common in patients with Parkinson's disease (60-62), and it has been reported in patients with narcolepsy (63). Schenk et al. followed patients who were diagnosed with RBD and found that 38 developed Parkinson's disease at an interval of 3.7 1.4 years (60).
The measurement of serum prolactin is a useful blood test in diagnosing seizure disorders. Prolactin is a polypeptide hormone produced by the anterior pituitary, involved in milk production and endocrine function. Unlike most pituitary hormones, prolactin is under negative hypothalamic control via prolactin inhibiting factor. When seizure activity influences the hypothalamic-pitu-itary axis, prolactin inhibiting factor is presumed to be inhibited itself, and prolactin is released into the circulation. Trimble (105) first showed that serum prolactin rises with generalized epileptic seizures, but not with psy-chogenic seizure-like episodes. Complex partial seizures can also raise serum prolactin. Sensitivity is approximately 90 for tonic-clonic seizures and 70 for complex partial seizures (106). Complex partial seizures originating in the frontal lobes rarely elevate serum pro-lactin (89,90), again emphasizing the difficulty in diagnosis of frontal lobe epilepsy. Several conditions can...
A number of movement disorders can imitate epilepsy. Paroxysmal choreoathetosis or dystonia, both kinesogenic and non-kinesogenic forms 72 , are movement abnormalities with striking posturing or chorea that are precipitated by sudden movement, surprise or startle, stress or rapid movement. Some forms are aggravated by alcohol, caffeine and fatigue. Whereas these may be unilateral and consciousness is preserved during the attacks, the episodes may be mistaken for focal motor seizures. Thus the description of hemi-tonic seizures with preserved consciousness should raise the possibility of a paroxysmal dyskinesia and similar symptoms might be secondary to demyelinating disease, or other primary cerebral pathologies. So-called tonic seizures of multiple sclerosis may be unilateral or bilateral, and are sometimes precipitated by movement. Occasionally these entail what is interpreted as clonic movements, particularly as the attacks resolve 73 . Inability to speak during the episode may be...
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