Multiple sclerosis and related disorders · 2026
Painful tonic spasms in neuromyelitis optica spectrum disorders: Prevalence, clinical phenotype, symptomatic management, and patient-reported burden in a Chinese cohort.
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Luo Wenjing, Du Yi, Wei Zhenshen, Huang Shuxin, Tang Jingqun, Tang Yulan, Wu Yuan
Аннотация
BACKGROUND: Tonic spasms in neuromyelitis optica spectrum disorder (NMOSD) range from painless tonic posturing to painful tonic spasms (PTS). However, the real-world management, tolerability, and patient-reported burden of PTS remain insufficiently described.
METHODS: We screened consecutive patients with NMOSD at a tertiary center in China between January 2020 and July 2025. PTS were identified through medical record review and a structured questionnaire. We described their clinical features, timing in relation to myelitis, magnetic resonance imaging findings, symptomatic treatments, patient-reported response, tolerability, and daily-life burden.
RESULTS: PTS were identified in 77 of 229 patients (33.6%). They were more frequent in aquaporin-4 immunoglobulin G (AQP4-IgG)-positive NMOSD than in AQP4-IgG-negative NMOSD (72/183, 39.3% vs 5/46, 10.9%; p < 0.001). Forty-six of 77 patients (59.7%) reported PTS onset after the first myelitis attack. Marked or partial improvement with symptomatic treatment was reported by 64 of 77 patients (83.1%). Combination pharmacotherapy was common (59/77, 76.6%), and 9 of 77 patients (11.7%) discontinued at least one symptomatic medication because of adverse effects. PTS also imposed a substantial burden, with effects on mood, sleep, and work productivity each reported by approximately one-quarter of patients.
CONCLUSIONS: PTS are common after myelitis in NMOSD. Most patients report improvement with symptomatic therapy, but polypharmacy and treatment intolerance are frequent, and the daily-life burden is substantial. Routine screening after spinal cord attacks and pragmatic comparative studies that address both effectiveness and tolerability are needed.
METHODS: We screened consecutive patients with NMOSD at a tertiary center in China between January 2020 and July 2025. PTS were identified through medical record review and a structured questionnaire. We described their clinical features, timing in relation to myelitis, magnetic resonance imaging findings, symptomatic treatments, patient-reported response, tolerability, and daily-life burden.
RESULTS: PTS were identified in 77 of 229 patients (33.6%). They were more frequent in aquaporin-4 immunoglobulin G (AQP4-IgG)-positive NMOSD than in AQP4-IgG-negative NMOSD (72/183, 39.3% vs 5/46, 10.9%; p < 0.001). Forty-six of 77 patients (59.7%) reported PTS onset after the first myelitis attack. Marked or partial improvement with symptomatic treatment was reported by 64 of 77 patients (83.1%). Combination pharmacotherapy was common (59/77, 76.6%), and 9 of 77 patients (11.7%) discontinued at least one symptomatic medication because of adverse effects. PTS also imposed a substantial burden, with effects on mood, sleep, and work productivity each reported by approximately one-quarter of patients.
CONCLUSIONS: PTS are common after myelitis in NMOSD. Most patients report improvement with symptomatic therapy, but polypharmacy and treatment intolerance are frequent, and the daily-life burden is substantial. Routine screening after spinal cord attacks and pragmatic comparative studies that address both effectiveness and tolerability are needed.