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MS spasticity — SCE Neurology MCQ

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HardMSMS spasticitySCE Neurology

A patient with stable progressive multiple sclerosis has painful nocturnal lower-limb spasms, velocity-dependent tone and ankle clonus. What diagnosis should guide treatment?

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Correct answer: B — Multiple-sclerosis-related spasticity with painful flexor spasms, after excluding the closest mimic

The best answer is “Multiple-sclerosis-related spasticity with painful flexor spasms, after excluding the closest mimic”. Velocity-dependent hypertonia and clonus identify pyramidal spasticity; management begins by addressing triggers and functional goals before targeted treatment. “Restless legs syndrome without upper-motor-neuron findings” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Peripheral neuropathic pain causing areflexia” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Dystonia with fixed posturing independent of movement velocity” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Functional movement disorder diagnosed from symptom severity alone” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here.

Reference: NICE NG220 multiple sclerosis recommendations: https://www.nice.org.uk/guidance/ng220/chapter/Recommendations