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Unusual presentation of more common disease/injury
Stretching the limbs? Tonic spasms in multiple sclerosis
  1. Carlos Andrade1,2,
  2. João Massano1,2,
  3. Joana Guimarães1,2,
  4. Maria Carolina Garrett1,2
  1. 1Department of Clinical Neuroscience and Mental Health, Faculty of Medicine University of Porto, Porto, Portugal
  2. 2Department of Neurology, Centro Hospitalar São João, Porto, Portugal
  1. Correspondence to Maria Carolina Garrett, garrett.mc51{at}


A 23-year-old man with a clinically isolated syndrome (right optic neuritis) diagnosed 6 months before, presented with recurrent, brief, painful, stereotyped, involuntary posturing movements of the left upper limb. The neurological examination was otherwise unremarkable (except for right optic atrophy). Intravenous methylprednisolone was initiated; the paroxysms persisted and worsened 7 days later, as the left lower limb and hemiface became affected. A video-EEG showed no epileptiform activity despite the movements. Brain MRI revealed new lesions affecting the right pyramidal tract, contralateral to the clinical manifestations. Valproate was prescribed and the paroxysms were completely resolved 5 days later. Tonic spasms are classically, although infrequently, seen in multiple sclerosis, and may clinically resemble primary paroxysmal dyskinesias or even focal motor epileptic seizures.

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