ArticleFrontiers in medicine2026
Neuromyelitis optica spectrum disorder with painful tonic spasms as the first symptom: a case report.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Painful tonic spasms (PTS) are an underrecognized initial manifestation of neuromyelitis optica spectrum disorder (NMOSD), presenting before classic neurological deficits in rare cases. Case presentation: A 51-year-old man presented with progressive right lower limb PTS lasting ≤10 s, spreading bilaterally and impairing mobility within 1 month. Neurological examination showed bilateral hyperreflexia and myoclonus. Spinal MRI revealed longitudinally extensive T2 hyperintensity and gadolinium enhancement at T1-T6 levels. Serum aquaporin-4 immunoglobulin G (AQP4-IgG) antibody was positive (1:100), while cerebrospinal fluid AQP4-IgG analysis was negative. Methylprednisolone (0.5 g/day for 3 days, tapered to oral prednisolone) and intravenous immunoglobulin (0.4 g/kg/day for 5 days) significantly reduced spasms. At discharge, he ambulated independently without PTS on prednisolone (60 mg/day), oxcarbazepine (450 mg twice daily), and baclofen (10 mg twice daily). Conclusion: Isolated PTS serves as a potential harbinger of NMOSD, and early diagnosis and precise immunotherapy enables rapid symptom control and attack prevention.
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