Paroxysmal symptoms or symptoms that come in waves occur relatively uniquely in MS. They can be confused with seizures such as those seen in epilepsy, but are not associated with a short circuiting of brain waves as is epilepsy. Most commonly is seen a spasm of an arm or leg which recurs every few seconds or minutes and lasts for seconds each time. Sometimes the spasm affects the muscles used to produce speech and there is a "paroxysm" of slurring. This can also occur with swallowing. Occasionally, numbness or pain occurs in a wave (see also Chapter 15 on pain).
These symptoms can be frightening and often are misdiag-nosed as something else. What is important to recognize is that they are usually fairly easily treated, but do require the use of appropriate medication. The older anti-epilepsy drugs phenytoin (Dilantin®), valproate (Depakote®), and carbamazepine (Tegretol®) still are useful but now many more medications are available, including gabapentin (Neurontin®), tigabine (Gabitril®), levetiracetam (Keppra®), and oxcarbazepine (Trileptal®). There are also improved versions of older treatments, including Carbitrol® for carba-mazepine and Depakote ER® for Depakote®.
The appropriate dose for each drug varies with the individual, and an experienced clinician should manage each treatment to ensure appropriate use of the agents. While the symptoms can be frightening, they are usually self limiting and will go away on their own with time; these symptoms are not likely to require a lifetime of treatment. The drugs should be tapered after the symptoms are controlled to see if they still are necessary. If the symptoms recur, the treatment should be continued.
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