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MS – Paroxysmal Symptoms Treatment — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – Paroxysmal Symptoms TreatmentSCE Neurology

A 42-year-old woman with MS has intermittent episodes of trigeminal neuralgia-like pain in the right face lasting 1-2 seconds. She also experiences paroxysmal episodes of tonic spasm in her left arm lasting 10 seconds. Both types of episodes occur multiple times daily. What is the recommended treatment for these paroxysmal symptoms?

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Correct answer: D — Carbamazepine or oxcarbazepine

Paroxysmal symptoms in MS (trigeminal neuralgia, tonic spasms, dysarthria-ataxia, itching) are caused by ephaptic transmission between adjacent demyelinated axons. They respond well to sodium channel blockers — carbamazepine and oxcarbazepine are first-line. These are distinct from epileptic seizures and occur without EEG correlate. Low doses are often sufficient. A: Gabapentin is an alternative but less effective for paroxysmal MS symptoms. C: Baclofen treats spasticity, not paroxysmal symptoms. D: Steroids treat acute relapses, not paroxysmal symptoms. E: Botulinum toxin is for focal spasticity.

Reference: NICE NG100 MS (2022); ABN MS Guidelines (2022)