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Reyes-Méndez C, Gómez-Bautista D, Yáñez-Téllez G, Rodríguez-Chávez E, Moreno-Villagómez J. Neuropsychological profile of a patient with multiple sclerosis and psychiatric symptoms that masked and delayed the diagnosis. A case report using teleneuropsychology. Clin Neuropsychol 2024:1-23. [PMID: 38914594 DOI: 10.1080/13854046.2024.2370963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Objective: Multiple sclerosis (MS) may include not only severe neurological signs and symptoms, but also cognitive and psychiatric disturbances. When psychiatric symptoms precede or are comorbid with MS, it poses a clinical challenge, because it may lead to a mistaken diagnosis of MS as a psychiatric disorder, delaying proper treatment. We describe the neuropsychological profile of a female patient with MS whose diagnosis was delayed due to neuropsychiatric symptoms. Method: A comprehensive analysis of the medical history and the results of a teleneuropsychological assessment of a 36-year-old Mexican woman with a diagnosis of relapsing--remitting MS (RRMS) was performed. Results: The patient indicates a long history of psychotic, anxious, and depressive features years before the first neurological symptom that led to MS going unnoticed for several years. Language, attentional, perceptual, motor, and learning skills were found to be preserved. Short-term memory and spatial orientation problems were identified, with decreased processing speed and executive dysfunction, including working memory and planning deficits. Conclusions: The patient has a non-typical presentation of neuropsychological alterations with cognitive and behavioral symptoms that resemble dorsolateral frontal lobe syndrome. This case study highlights the importance of considering MS in differential diagnosis of patients with psychiatric symptoms, even in the absence of obvious neurological signs.
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Affiliation(s)
- Carolina Reyes-Méndez
- Clinical Neuropsychology Residency Program, Research and Postgraduate Division, Interdisciplinary Investigation Unit in Health and Education Sciences. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Denise Gómez-Bautista
- Clinical Neuropsychology Residency Program, Research and Postgraduate Division, Interdisciplinary Investigation Unit in Health and Education Sciences. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Guillermina Yáñez-Téllez
- Clinical Neuropsychology Residency Program, Research and Postgraduate Division, Interdisciplinary Investigation Unit in Health and Education Sciences. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Emmanuel Rodríguez-Chávez
- Neurology Department, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Julieta Moreno-Villagómez
- Clinical Neuropsychology Residency Program, Research and Postgraduate Division, Interdisciplinary Investigation Unit in Health and Education Sciences. Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
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Özbudak P, Erçelebi H, Gücüyener K. Psychosis: a rare onset symptom of pediatric multiple sclerosis. Neurocase 2021; 27:474-476. [PMID: 34927555 DOI: 10.1080/13554794.2021.2016859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neuropsychiatric symptoms are common in multiple sclerosis (MS), but it is rarely associated with psychosis as the initial manifestation. Fourteen-year-old boy admitted with auditory hallucinations. His neurological examination was normal. Brain magnetic resonance imaging (MRI) showed multiple demyelinating lesions in the mesencephalon and periventricular regions. His IgG index was high and the oligoclonal band was positive. MS was diagnosed and pulsed corticosteroids were given and his psychotic symptoms regressed. After 22months, the patient presented with hemi-hypoesthesia, and repeated MRI showed new contrast enhancing lesion detected. His complaints completely resolved with pulse corticosteroid therapy. Increasing morbidity due to delay in MS treatment underlines the need to consider MS in the differential diagnosis of pediatric cases presenting with psychosis.
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Affiliation(s)
- Pınar Özbudak
- Department of Pediatrics, Division of Child Neurology, Gazi University Medical School, Ankara, Turkey
| | - Hakan Erçelebi
- Department of Pediatrics, Division of Child Neurology, Gazi University Medical School, Ankara, Turkey
| | - Kıvılcım Gücüyener
- Department of Pediatrics, Division of Child Neurology, Gazi University Medical School, Ankara, Turkey
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Evagorou O, Arvaniti A, Angelopoulou C, Mavraki E, Mikellides G, Samakouri M. "Sleeping Beauty Syndrome" and Psychosis as Precursory Symptoms of Multiple Sclerosis: A Rare Case and Literature Review. J Nerv Ment Dis 2021; 209:933-935. [PMID: 34846357 DOI: 10.1097/nmd.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Frequently, patients with multiple sclerosis (MS) experience comorbid psychiatric symptoms. Mental disorders primarily occur simultaneously with or after an MS diagnosis; however, the probability of them being the initial manifestation of the disease is rare. We describe the case of a 22-year-old man who had previously been hospitalized because a single psychotic episode alongside symptoms of Kleine-Levin syndrome and a diagnosis of "acute and transient psychotic disorders." Two years later, he was diagnosed with MS. A literature review of the possibility of a psychiatric episode overshadowing an MS diagnosis is then presented. Clinicians should always consider the possibility of an underlying organicity in a case of psychiatric presentation with atypical features, with special attention being given during the investigation process. This approach will lead to the early diagnosis of an organic disease, which can be treated accordingly and as early as possible.
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Affiliation(s)
- Olympia Evagorou
- Department of Psychiatry, Medical School, Democritus University of Thrace
| | | | | | - Eleni Mavraki
- Neurology, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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Pfaff L, Gounot D, Chanson JB, de Seze J, Blanc F. Emotional experience is increased and emotion recognition decreased in multiple sclerosis. Sci Rep 2021; 11:21885. [PMID: 34750435 PMCID: PMC8575874 DOI: 10.1038/s41598-021-01139-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
Emotional disorders in multiple sclerosis (MS) are frequently described as difficulties in recognizing facial expressions, rarely in the experience dimension. Moreover, interaction between emotional disorders and cognitive or psychological disorders remains little documented. The aim of this study is to explore emotions in MS in emotion recognition and emotional experience and compare these data with cognitive, psychological, and disease aspects. Twenty-five women with MS (MS group) and 27 healthy controls (control group) matched for age, sex, and education were assessed for emotion recognition (Florida Affect Battery) and emotional experience (International Affective Picture System Photographs). Participants were also assessed for cognitive and psychological aspects. Compared to the control group, the MS group had more difficulty in recognizing emotions, and their subjective evaluations when presented IAPS pictures were more scattered, globally increased. Emotional dimensions were each correlated with executive functions but neither correlated with alexithymia, depression, anxiety, or MS characteristics. In conclusion, MS patients present difficulties in identifying emotion and their emotional experience appears to be increased. These disorders are correlated with cognition but remain independent of psychological or disease aspects. Considering the implications that emotional disorders may have, it seems essential to take these aspects into account in clinical practice.
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Affiliation(s)
- Line Pfaff
- University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto, Strasbourg, France. .,CIC (Clinical Investigation Centre) INSERM 1434 and Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.
| | - Daniel Gounot
- University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto, Strasbourg, France
| | - Jean-Baptiste Chanson
- CIC (Clinical Investigation Centre) INSERM 1434 and Neurology Department, University Hospitals of Strasbourg, Strasbourg, France
| | - Jérôme de Seze
- CIC (Clinical Investigation Centre) INSERM 1434 and Neurology Department, University Hospitals of Strasbourg, Strasbourg, France.,University Hospital of Strasbourg, Strasbourg, Biopathology of Myelin, Neuroprotection and Therapeutic Strategies, INSERM U1119, Strasbourg, France
| | - Frédéric Blanc
- University of Strasbourg and French National Centre for Scientific Research (CNRS), ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS/Neurocrypto, Strasbourg, France.,Geriatrics Department, University Hospitals of Strasbourg, CMRR (Memory Resources and Research Centre), Geriatric Day Hospital, Strasbourg, France
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Pfaff L, Lamy J, Noblet V, Gounot D, Chanson JB, de Seze J, Blanc F. Emotional disturbances in multiple sclerosis: A neuropsychological and fMRI study. Cortex 2019; 117:205-216. [DOI: 10.1016/j.cortex.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/02/2018] [Accepted: 02/20/2019] [Indexed: 01/21/2023]
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Chalah MA, Ayache SS. Psychiatric event in multiple sclerosis: could it be the tip of the iceberg? ACTA ACUST UNITED AC 2017; 39:365-368. [PMID: 28355344 PMCID: PMC7111399 DOI: 10.1590/1516-4446-2016-2105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 11/23/2016] [Indexed: 01/10/2023]
Abstract
Multiple sclerosis (MS) is a chronic progressive inflammatory disease of the central nervous system. Psychiatric comorbidities are highly prevalent in patients with MS, and can have drastic impact on quality of life and interpersonal relationships. Despite this high prevalence, whether psychiatric manifestations may represent the first signs of MS is still debatable. This constitutes an important issue, since early diagnosis of "psychiatric-onset MS" would result in prompt management, which usually ameliorates long-term prognosis. Here, we discuss clinical and radiological hints that suggest a diagnosis of psychiatric-onset MS. Briefly, this entity should be considered in healthy patients presenting with late-onset psychiatric symptoms, with or without cognitive decline, and with negative family history of psychiatric diseases. A thorough neurological exam is crucial to detect any subtle neurological signs. Brain magnetic resonance imaging is recommended to rule out frontotemporal lesions that might explain the clinical picture. Poor response to standard psychiatric treatments provides additional evidence for the diagnosis of an organic disease (e.g., MS). Combining psychopharmaceuticals with intravenous corticosteroids would result in good outcomes, but patients should be monitored carefully for possible psychiatric exacerbation, a common side effect of steroids.
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Affiliation(s)
- Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France.,Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Neurology Division, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon
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The varieties of psychosis in multiple sclerosis: A systematic review of cases. Mult Scler Relat Disord 2017; 12:9-14. [DOI: 10.1016/j.msard.2016.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
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Banwell B, Giovannoni G, Hawkes C, Lublin F. Editors' Welcome. Mult Scler Relat Disord 2016; 6:A1-A2. [DOI: 10.1016/j.msard.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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