Rethinking the importance of paroxysmal and unusual symptoms as first clinical manifestation of multiple sclerosis: They do matter

- Paroxysmal and unusual symptoms are rare and clinical characteristics are not well defined.
- PS are thought to indicate “benign” MS, but data on clinical disease course is missing.
- Prevalence, clinical characteristics and disease course of patients with PS/US are reported.
- Patients with PS/US have the same risk to develop CD MS as patients with “classical” symptoms.
- Patients presenting with PS/US should be evaluated for DMT initiation early.

BackgroundParoxysmal (PS) and unusual symptoms (US) as initial manifestation of multiple sclerosis (MS) are rare and often thought to indicate “benign” MS.ObjectiveTo investigate prevalence and clinical disease course of patients experiencing PS or US as first clinical manifestation.MethodsClinical, MRI and cerebrospinal fluid data of patients presenting with PS and US were obtained retrospectively and compared to patients with classical bout onset (CS).ResultsIn a cohort of 1396 relapsing onset patients, 15 (1.1%) were identified as presenting with PS and 7 (0.5%) with US. Groups were comparable regarding gender, age at onset and intrathecal immunoglobulin synthesis (p>0.05). During a mean follow-up period of 13.6 years, all patients presenting with PS or US converted to CDMS (mean duration 3.4 years; 95% CI 1.9-4.8) as compared to 1374 patients (94%) presenting with CS (mean duration 3.2 years; 95% CI 3.0-3.4; p=0.759).ConclusionIn a cohort of 1396 MS patients, 1.6% presented with PS or US at disease onset. Irrespective of the initial transient symptoms, patients were at the same risk of developing CDMS as CS patients, thereby underlining the importance of identifying PS and US as possible first clinical symptoms of MS.