Dados do Trabalho

Título

TOURETTISM SECONDARY TO MULTIPLE SCLEROSIS

Apresentação do caso

Previously healthy adolescent, started at age 15 with limitation of abduction of the right eye, with spontaneous improvement after two months. A brain magnetic resonance imaging was performed, which showed multiple supratentorial and infratentorial demyelinating lesions, without gadolinium enhancement, and prednisone 60 mg/day was started. After 6 months, she was admitted to the service, due to suppressable involuntary cervical hyperkinetic movements, with an increase in frequency for 3 days. Neurological examination showed hemiparesis predominantly crural, with suppressable tics in the neck, simple vocal tics, incomplete hemihypoesthesia on the right and horizontal diplopia on the right. A pulse with methylprednisolone 1g/day was performed for 5 days, with no improvement in the tics.

Discussão

The term Tourettism refers to symptoms similar to Tourette Syndrome (TS) that appear secondary to the effects of a substance or a general medical condition. Tourettism is rarely associated with Multiple Sclerosis, with few reports in the literature. The patient in question does not meet the DSM V criteria for ST because she has symptoms secondary to an underlying medical condition, and at age 15 she started experiencing motor and vocal tics after a multiple sclerosis outbreak. There are hypotheses that Tourettism and Multiple Sclerosis may be related due to
diffuse white matter, irreversible axonal loss, and progressive atrophy can impair the cortico-striatal-thalamo-cortical circuits at various levels, consistently implicated in the pathogenesis of TS.

Comentários finais

Final Comments: Tourettism in Multiple Sclerosis is a rare event, but the correlation must be remembered.

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