Contributions
Abstract: EP1446
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Comorbidity
Method/Results (Case Series Report): The first patient presented aged 64 with a 5 year history of tremor in her right hand, worst at rest. She was found to have cog wheeling and bradykinesia, with reduced arm swing. She had an MRI brain which showed involutional changes, with nonspecific T2 changes in bilateral white matter sparing bilateral basal ganglia. She was subsequently treated with increasing dopaminergic treatment with good clinical response. Her extrapyramidal features fulfilled criteria for diagnosis of idiopathic Parkinson's disease as per UK Brain Bank criteria. DATscan showed changes consistent with idiopathic Parkinson's disease. 4 years later, she began developing progressive right sided upper motor neurone signs. Repeat MRI showed progressive T2 white matter changes withT3/T4 cord lesion suspicious of demyelination. Subsequent CSF was positive for oligoclonal bands(OCB) with negative screening tests for secondary neuroinflammation.
The second patient presented aged 61 with a three-year history of progressive limb weakness, numbness over her arms and urinary incontinence. She had a MRI brain which showed features suggestive of demyelination with positive OCB in her CSF. Eleven years after her diagnosis of progressive MS she was found to have reduced arms swing and bradykinesia. She was trialled on co-careldopa with positive response. Her extrapyramidal features were further improved following up titration of her L-dopa to 300mg/day.
The third patient presented aged 51 with a clinically isolated syndrome of diplopia. 6 years later he had another relapse with diplopia and right sided paraesthesia. MRI, CSF, evoked potential and neuroinflammation screen confirmed MS and he was started on interferon. A year later, he developed extrapyramidal features fulfilling UK Brain Bank diagnosis of IPD. He had positive DATscan. Over the last 6 years, his IPD showed sustained positive response to levodopa.
Conclusion: To date, there are 42 cases of simultaneous Parkinsonism and Multiple Sclerosis in English literature. The majority are attributed to Multiple Sclerosis and Parkinsonism, as opposed to Idiopathic Parkinson's Disease. Furthermore, many have featured patients with early onset Parkinsonism. There are very few cases of Idiopathic Parkinson's Disease and Multiple Sclerosis in patients over 60. More research is needed to decide if the relationship between the two diseases is coincidental or one unifying pathogenesis.
Disclosure: A Scarborough: Nothing to disclose
V Lester: Nothing to disclose
R Mitchener: Nothing to disclose
Y K Lee: Nothing to disclose
Abstract: EP1446
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Comorbidity
Method/Results (Case Series Report): The first patient presented aged 64 with a 5 year history of tremor in her right hand, worst at rest. She was found to have cog wheeling and bradykinesia, with reduced arm swing. She had an MRI brain which showed involutional changes, with nonspecific T2 changes in bilateral white matter sparing bilateral basal ganglia. She was subsequently treated with increasing dopaminergic treatment with good clinical response. Her extrapyramidal features fulfilled criteria for diagnosis of idiopathic Parkinson's disease as per UK Brain Bank criteria. DATscan showed changes consistent with idiopathic Parkinson's disease. 4 years later, she began developing progressive right sided upper motor neurone signs. Repeat MRI showed progressive T2 white matter changes withT3/T4 cord lesion suspicious of demyelination. Subsequent CSF was positive for oligoclonal bands(OCB) with negative screening tests for secondary neuroinflammation.
The second patient presented aged 61 with a three-year history of progressive limb weakness, numbness over her arms and urinary incontinence. She had a MRI brain which showed features suggestive of demyelination with positive OCB in her CSF. Eleven years after her diagnosis of progressive MS she was found to have reduced arms swing and bradykinesia. She was trialled on co-careldopa with positive response. Her extrapyramidal features were further improved following up titration of her L-dopa to 300mg/day.
The third patient presented aged 51 with a clinically isolated syndrome of diplopia. 6 years later he had another relapse with diplopia and right sided paraesthesia. MRI, CSF, evoked potential and neuroinflammation screen confirmed MS and he was started on interferon. A year later, he developed extrapyramidal features fulfilling UK Brain Bank diagnosis of IPD. He had positive DATscan. Over the last 6 years, his IPD showed sustained positive response to levodopa.
Conclusion: To date, there are 42 cases of simultaneous Parkinsonism and Multiple Sclerosis in English literature. The majority are attributed to Multiple Sclerosis and Parkinsonism, as opposed to Idiopathic Parkinson's Disease. Furthermore, many have featured patients with early onset Parkinsonism. There are very few cases of Idiopathic Parkinson's Disease and Multiple Sclerosis in patients over 60. More research is needed to decide if the relationship between the two diseases is coincidental or one unifying pathogenesis.
Disclosure: A Scarborough: Nothing to disclose
V Lester: Nothing to disclose
R Mitchener: Nothing to disclose
Y K Lee: Nothing to disclose