The Spectrum of Movement Disorders in Cases with Osmotic Demyelination Syndrome

Overview

Journal Mov Disord Clin Pract

Publisher Wiley

Specialty Neurology

Date 2021 Aug 18

PMID 34405095

Citations 3

Authors

Dodmalur Mallikarjuna Sindhu

Vikram V Holla

Shweta Prasad

Nitish Kamble

Manjunath Netravathi

Ravi Yadav

Pramod K Pal

Affiliations

Soon will be listed here.

Abstract

Background: Osmotic demyelination syndrome (ODS) can be a central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) based on the regions involved even though they share the same disease process, aetiopathogenesis and time course.

Objectives: Present study aims to characterize the clinical, radiological features and the outcome of patients with ODS with movement disorders as the forthcoming manifestation.

Methods: Chart review of patients with ODS with movement disorders. Demographic, clinical and radiological details of the patients were reviewed.

Results: Eleven patients (six females; mean age: 48.3 ± 17.6 years) were included in the study. Parkinsonism alone and parkinsonism with dystonia was noted in four patients each (36.4%) while dystonia alone was noted in the other 3 (27.3%). Five patients (45.5%) had postural tremors. While 5 patients had dystonia early in the course of illness (3-7 days), it was delayed (6-9 months) in the other 2. A triphasic course was noted in two patients. The first phase of hyponatremia induced neurological impairment was followed by a second phase of worsening due to the immediate effect of ODS and a third delayed phase of worsening due to delayed effect of ODS. MRI showed both EPM and CPM in eight patients, EPM alone in two patients and CPM alone in 1 patient. Nine patients had a good outcome with mRS < 3.

Conclusion: Parkinsonism and dystonia are important manifestations of ODS. Triphasic course with a delayed phase of worsening of movement disorders is probably due to the maladaptive neuronal repair. The concept of triphasic ODS is first being described in our series.

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