Painful Tonic Seizure in Multiple Sclerosis

Abstract

"Painful tonic seizure" (PTS) affected 11 of 64 consecutive Japanese patients with multiple sclerosis; a higher incidence than that reported in Western countries. Other paroxysmal disturbances were not as frequent. No patient had impaired consciousness or an electroencephalographic abnormality during the attack, and all patients had clinical evidence of severe spinal cord disease. The occurrence and "trigger zone" of the PTS were closely correlated with sensory impairment of cord origin, including Lhermitte sign. An autopsied case revealed extensive demyelinating lesions in the spinal cord, involving the gray matter as well. These facts lead us to postulate a spinal cord reflex mechanism for this praoxysmal disturbance. A double blind control study demonstrated that carbamazepine (Tegretol) suppresses this paroxysmal phenomenon.