A Case of Devic's Syndrome Presenting with Tonic Spasm: Response to Levetiracetam Treatment

Abstract

Neuromyelitis optica or Devic's syndrome is a rare autoimmune disorder which is characterized by inflammatory demyelination of the optic nerves and the spinal cord. Clinically, it causes visual loss in one or both eyes, and numbness or paralysis of the arms and legs. Although tonic spasm is the most frequent movement disorder occuring in MS, it has not been definetely described clinical entity for Devic's syndrome. We hereby describe a case of Devic's syndrome with tonic spasms treated with levetiracetam as a new approach and discussed the results of the treatment. A 52-year-old woman with Devic's syndrome with the complaint of painful tonic spasms primarily affecting the abdomen was given levetiracetam therapy. Levetiracetam therapy resulted in a good response in our patient. Levetiracetam can be a new choice for the treatment of painful tonic spasm with Devic's syndrome. However, more detailed studies are necessary to investigate efficacy of levetiracetam.

Keywords

• Levatiracetam, tonic spasm, devic's syndrome

A Case of Devic's Syndrome Presenting with Tonic Spasm: Response to Levetiracetam Treatment

Öz

Kaynakça

1. Matthews WB. Symptoms and signs. In: Matthews WB et al. McAlpine’s multiple sclerosis. Churchill Livingstone, Edinburgh, 1991;61-3.
2. Josef Spatt, Robert Chaix, Bruno Mamoli. Epileptic and non-epilep- tic seizures in multiple sclerosis. J Neurol 2001;248:2-9. [CrossRef]
3. Gatto EM, Zurru MC, Rugilo C. Medullary lesion and unusual bilateral paroxysmal dystonia in multiple sclerosis. Neurology 1996;46:847-8.
4. Shibasaki H,Kuroiwa Y. Painful tonic seizures in multiple sclerosis. Arch Neurol 1974;30:47-51.
5. Lugaresi A,Uncini A, Gambi D. Basal ganglia involvement in mul- tiple sclerosis with alternating side paroxysmal dystonia. J Neurol 1993;240:257-8. [CrossRef]
6. Verheul GAM, Tyssen CC. Multiple sclerosis occurring with parox- ysmal dystonia. Mov Disord 1990;5:352-5.
7. Maimone D, Reder AT, Finocchiaro F, Recupero E. Internal cap- sule plaque and tonic spasm in multiple sclerosis. Arch Neurol 1991;48:427-9.
8. Burghera JA, Català J, Casanova B. Thalamic demyelination and paroxysmal dystonia in multiple sclerosis. Mov Disord 1991;6:379-81.

9. Rose MR, Ball JA, Thompson PD. MR imaging in tonic spasm of MS. J Neurol 1993;241:115-7. [CrossRef]
10. Waubant E, Alize P, Tourbah A, Agid Y. Paroxysmal dystonia (ton- ic spasm) in multiple sclerosis Neurology 2001;57:2320-1.
11. Konitsiotis S, Pappa S, Mantas C, Mavreas V. Levetiracetam in tar- dive dyskinesia: an open label study. Mov Disord. 2006;21:1219-21. [CrossRef]
12. Deleu D. Levetiracetam in the treatment of idiopathic hemifacial spasm. Neurology. 2004;62:2134-5.
13. Costa J, Espírito-Santo C, Borges A, Ferreira JJ, Coelho M, Moore P et al. Botulinum toxin type A for hemifacial spasm. Co- chrane Database Syst Rev 2005;25:CD004899
14. Biagio Carrieri P, Petracca M, Montella S. Efficacy of levetirace- tam in hemifacial spasm: a case report. Clin Neuropharmacol. 2008;31:187-8. [CrossRef]
15. Glass GA, Stankiewicz J, Mithoefer A, Freeman R, Bergethon PR. Levetiracetam for seizures after liver transplantation. Neurology. 2005;64:1084-5.
16. Twomey JA, Espir MLE. Paroxysmal symptoms as the first mani- festations of multiple sclerosis. J Neurol Neurosurg Psychiatry 1980;43:296-304. [CrossRef]
17. Espir MLE, Millac P. Treatment of paroxysmal disorders in mul- tiple sclerosis with carbamazepin. J Neurol Neurosurg Psychiatry 1970;33:528-31.50411. [CrossRef]
18. Solaro C, Lunardi GL, Capello E, Inglese M, Messmer Uccelli M et al. An open-label trial of gabapentin treatment of paroxysmal symp- toms in multiple sclerosis patients. Neurology 1998;51:609-11.
19. Kahn OA. Treatment of paroxysmal symptoms in multiple sclerosis with bromocriptine. J Neurol Neurosurg Psychiatry 1995;58:253.
20. Kahn OA. Treatment of paroxysmal symptoms in multiple sclero- sis with ibuprofen. Neurology 1994;44:571-2.
21. Hawker K, Frohman E, Racke M. Levetiracetam for Phasic Spasticity in Multiple Sclerosis. Arch Neurol. 2003;60:1772-4. [CrossRef] 101 2011; 28: 99-101 Leventoğlu et al.
22. Tonic spasm in Devic’s Syndrome: Response to Levetiracetam