Exercise-induced focal hand dystonia secondary to cervical lesion in relapsing-remitting MS

Abstract

: Multiple sclerosis(MS)-related dystonia has frequently been reported as a initial symptoms due to the lesions of basal ganglia, thalamus, cerebral peduncle of internal capsule or spinal cord. We reported a patient with relapsing-remitting MS whom developed focal hand dystonic movements during exacerbation of cervical lesion. Case : A-40-year-old woman with relapsing-remitting MS(RRMS) of spinal form was admitted with acutely developed lower extremity motor weakness and focal dystonic movement in left hand. She had four other episodes at age 29,35,36 and 39. Dystonic posture showed only in left hand and induced by exercise. Each episode lasted 10 to 15 seconds. Neurological examination showed left lower limb weakness and hypesthesia in T5 level. Laboratory studies including routine chemistries were all normal. CSF examinations showed 64mg/dL protein level and 0.74 IgG index without oligoclonal band. T2-weighted cervical MRI showed multiple hyperintense lesions from C2 to T2 but brain MRI showed normal. Cervical lesion areas in MRI were more extended than previous. This kinesigenic dystonia was improved after daily treatment with 1,000mg of methylprednisolone and cervical MRI was performed after improvement which showed lesions had become less intense