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Paroxysmal Symptoms of Multiple Sclerosis

While Sudden and Often Alarming, Paroxysmal Symptoms Do Not Indicate a Relapse

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Updated December 16, 2008

Many of us with multiple sclerosis (MS) have experienced the phenomenon of paroxysmal symptoms -- those that come on suddenly, bother us for a short time (seconds or minutes), and then disappear as suddenly as they came.

Whether it is an episode of double vision or a prickly feeling on my face, these moments usually lead me to wonder a number of things. Is this a relapse? How bad is this going to get? Does this mean my MS is progressing?

Eager to learn exactly what doctors know about what I experience, I reached out to the folks at UpToDate -- a trusted electronic reference undoubtedly used by many of the physicians who treat patients with these symptoms (perhaps even yours and mine).

Dig in to this excerpt yourself, then read on for answers to questions you may have about what all of this means for you.

Paroxysmal Symptoms of MS: A Definition from UpToDate

"Paroxysmal attacks of motor or sensory phenomena can occur with demyelinating lesions. These symptoms are characterized by brief, almost stereotypic, events occurring frequently and often triggered by movement or sensory stimuli. They are likely caused by ephaptic transmission of nerve impulses at sites of previous disease activity. Although troublesome to the patient, these symptoms do not indicate a true exacerbation of MS or cause a loss of myelin in the CNS.

"Within the brain stem, lesions may cause paroxysmal diplopia, facial paresthesia, trigeminal neuralgia, ataxia, and dysarthria. Additional symptoms include, but are not limited to, pain, trunk and limb paresthesia, weakness, ataxia, pruritus, akinesia, and seizures. Motor system involvement may result in dystonia characterized by painful tonic contractions of muscles of one or two (homolateral) limbs, trunk, and occasionally the face; these only rarely occur in all four limbs or the trunk."

Your Questions: Answered

Fully understanding all of this will not only give you a better grasp of what is going on, but it will help you be better able to discuss your situation with your doctor.

What Type of Symptoms Can These Be?

Almost any symptom of MS can appear and disappear in this manner, but here are the most common ones to behave this way:

  • Diplopia
    Often referred to as “double vision,” diplopia is caused by weakness in the muscles controlling the eyes, which results in the eyes not being perfectly coordinated with each other.

  • Parasthesia of the face, trunk or limbs
    These are abnormal sensations, which are typically not painful. Parasthesias can be spontaneous or evoked (caused by stimulation). They are described as tingling, burning, prickling, itching, numbness or the feeling of “pins-and-needles.”

  • Trigeminal neuralgia
    Trigeminal neuralgia, often called tic doloureux (French for “painful twitch”), is perhaps the most intensely painful MS-related symptom. It can be described as intense pain occurring in the lower part of the face, often triggered by chewing or speaking.

  • Ataxia
    Paroxysmal ataxia is a sudden unsteadiness or a lack of coordination, often causing people to stumble or drop things.

  • Dysarthria
    This is a speech disorder in which pronunciation is unclear, but the meaning of what is said is normal. This can include slurring, volume of voice or strange speech rhythms.

  • Pain
    Paroxysmal pain in MS includes trigeminal neuralgia (see above). Another common symptom in this category is l’Hermitte’s sign, which is an electric-shock type of sensation that runs down the spine when the head is bent forward.

  • Weakness
    Paroxysmal weakness usually happens in the legs and feet, although this temporary weakness can also happen in the hands and arms.

  • Pruritus
    This is severe itchiness. Again, the itching lasts only a couple of minutes and starts and ends abruptly.

  • Akinesia
    This describes a strange phenomenon of a person being unable to move, often described as “freezing in place.” This can take the form of full temporary paralysis, or mean that the person can only move slowly or with extreme difficulty.

  • Seizures
    These tend to be “tonic-clonic seizures,” which means that the person loses consciousness and falls, stiffens up, then experiences a jerking and twitching of the muscles. These can also be simple partial seizures, where consciousness is not lost, but motor activity, emotions or senses -- such as taste, smell or touch -- are altered. Complex partial seizures are also associated with MS; these involve repetitive movements and a loss of awareness, although the person remains conscious.

  • Dystonia
    Dystonia is impaired or disordered muscle tone that causes slow movement or an extended, sustained spasm in a group of muscles. Movements are often involuntary, twisting, writhing and repetitive.
How Severe Can These Symptoms Get?

While different symptoms can be very painful (trigeminal neuralgia or itching), alarming (seizures or akinesia) or socially problematic (dysarthria), they usually only last for seconds at a time. The bad news is that paroxysmal symptoms tend to recur; they can happen several times a day, or on a daily or weekly basis. However, paroxysmal symptoms tend to respond well to low doses of anticonvulsants. Often, when they are treated, they go away and don’t come back.

Do These Symptoms Signal a Relapse or That My MS Is Getting Worse?

No, they don’t. The good news is that these symptoms are probably just due to a transmission of nerve impulses across sites where they do not normally occur and where there has been previous damage. This can be caused by some sort of stimulation, such as irritating clothing or movement. An interesting note is that people often experience paroxysmal symptoms having not even been aware that they had damage before.

Want to learn more? See UpToDate’s topic, "Comorbid problems associated with multiple sclerosis in adults," for additional in-depth, current and unbiased medical information on multiple sclerosis in adults, including expert physician recommendations.

Source:

Olek, Michael J. "Comorbid problems associated with multiple sclerosis in adults." UpToDate. Accessed: December 2008.

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