psychiatric ONSET IN Multiple sclerosis
Background/ Aims
In our study we want to show the presence of clinical cases of multiple sclerosis (MS) in which the clinical symptoms are of a psychiatric nature.
Methods
Into our practice we have had 10 patients (6 women and 4 men), aged between 30 and 55 years, without any pathological history, 2 of them having relatives diagnosed with MS, who came into the neurologist's office, some of them at the beginning of some psychic atypical disorders, 121b17b (3 patients), others under psychiatric medication, (6 patients) in order for a neurological examination, which was needed due to the unsatisfactory evolution after the psychiatric therapy.
Due to the patients' age, to the presence of an atypical psychic picture and also to the unsatisfactory results under psychiatric therapy, the presence of some minor and transitory neurological signs, without any correspondence into the patients' clinical subjective symptomatology, we had to suspect these patients as suffering of MS and further investigate them towards the presence of MS.
Results
Regarding the psychic symptoms, the patients complained of insomnias, depressive disorders, fatigue, cognitive disorders and one of them even a suicide attempt. The diagnosis established on the Psychiatry department was settled as depressive periodic disorders, neurasthenia, thymus disorders, conversion disorders, pre-dementia and anxiety.
According to McDonald's criteria regarding the diagnose of MS, we purchased to the following para-clinical investigations: the exam of the cerebrospinal liquid (CSL), nuclear magnetic resonance (MRI), visually-evoked potential (VEP). The CSL exam was typical to MS (reduced protein content into the CSL and lymphocytosis) at 7 patients, a decreased VEP under 100 m/sec at 6 patients, although only 2 of them presented visual disorders. On MRI was noted the presence of over 9 cerebral T2 lesions, which were situated mostly supra and less infra-tentorial. The supra tentorial ones were dominantly situated into the white matter of the frontal lobe and into the hypo campus. All these made us diagnose the MS at all the 10 patients.
Considering that all patients were having a progressive, secondarily evolutional form of MS, we therefore have initiated therapies with mitoxantrone 12 mg/square meter at each three months, without overreaching a total dose of 140 mg/square meter.9 of the patients presented an improved status, without having followed any psychiatric medication, having a shorted duration of the disease evolution. The 10th patient presented a longer duration of years of the evolution of the disease, with a smaller response to the mitoxantrone therapy, which needed besides that medication also psychiatric therapy.
Our cases are relevant to MS also for their favorable response to mitoxantrone therapy.
Conclusions
We may say for sure that there are cases of MS which, during their debut or evolution show a psychiatric picture. Our cases, after lab investigations could have been diagnosed as MS according to McDonald's criteria. The clinical psychiatric picture derives from the fact that the lesions into the central nervous system were situated into the frontal lobe and hypo campus. Also pleading for a positive MS diagnose are the positive results after the response to the mitoxantrone therapy.
Into the specialty literature we have found published 4 cases of elder patients who came for a psychiatric evaluation for memory loss with a dementia debut, and who, after further medical investigations were detected with an inflammatory sufferance of the central nervous system, which was considered classifiable as MS positive diagnose. (LEYNET T. ET AL 2004) [1].
1. LEYNET T. et al - Dementia as primary symptom in late onset multiple sclerosis Nervenaryt, 2004; 1: 13-16.
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