Tourettism secondary to multiple sclerosis

Case presentation: Previously healthy adolescent, started at age 15 with limitation of abduction of the right eye, with spontaneous improvement after two months. A brain magnetic resonance imaging was performed, which showed multiple supratentorial and infratentorial demyelinating lesions, without gadolinium enhancement, and prednisone 60 mg/day was started. After 6 months, she was admitted to the service, due to suppressable involuntary cervical hyperkinetic movements, with an increase in frequency for 3 days. Neurological examination showed hemiparesis predominantly crural, with suppressable tics in the neck, simple vocal tics, incomplete hemihypoesthesia on the right and horizontal diplopia on the right. A pulse with methylprednisolone 1 g/day was performed for 5 days, with no improvement in the tics.

Discussion: The term Tourettism refers to symptoms similar to Tourette Syndrome (TS) that appear secondary to the effects of a substance or a general medical condition. Tourettism is rarely associated with Multiple Sclerosis, with few reports in the literature. The patient in question does not meet the DSM V criteria for ST because she has symptoms secondary to an underlying medical condition, and at age 15 she started experiencing motor and vocal tics after a multiple sclerosis outbreak. There are hypotheses that Tourettism and Multiple Sclerosis may be related due to diffuse white matter, irreversible axonal loss, and progressive atrophy can impair the cortico-striatal-thalamo-cortical circuits at various levels, consistently implicated in the pathogenesis of TS.

Final comments: Tourettism in multiple sclerosis is a rare event, but the correlation must be remembered.

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Artikel online veröffentlicht:
18. September 2023