Jacksonian seizure as the relapse symptom of multiple sclerosis
A 46-year-old woman complained of the sudden appearance of muscle twitching or contractions of the fingers of right hand, spreading to arm and face on the same side. Seizure was happened three to four times per day as reported by herself. This is sometimes felt as a tingling sensation of right lower and then upper extremity. The seizures usually lasted 30-60 s. There was no loss of awareness, alertness, or consciousness during seizures.\nIn October 2000, a previously healthy 34-year-old woman complained of the acute onset of paresthesia, numbness, and tingling of lower and upper extremities. She had unsteadiness gait with fatigability. These symptoms continued at least 2-3 months and then followed by a focal motor or sensory seizures of hands occasionally.\nOn neurologic examination right-side finger to nose dysmetria and hyper reflexia was detected. Routine laboratory tests were normal except mild anemia. Brain MRI was showed low signal nonenhancement lesions on T1-weighted and some high signal changes of white matter on T2-weighted. The possible MS was suggested and the patient followed.\nDuring 2001-2008 the patient did not complain of any symptom referable to MS and EDSS (expanded disability status scale) was zero. The patient received no treatment for MS during this period.\nThe second MS relapse occurred in May 2009 and was characterized by blurred vision and diplopia. Neurological examination disclosed a mild right internuclear ophthalmoparesis and MRI revealed the absence of new T2-w or Gd-enhancing lesions []. A course of methyl-prednisolone 1 g/day for 5 days was administered and symptoms subsided in 4 weeks. The patient was not received beta interferons because of she had past history of seizures.\nThe third MS relapse occurred 3 years later (September 2012) and was characterized by focal motor seizures of right hand, reduction of vision of both eyes, and diplopia.\nIn neurologic examination, the limitation of ocular motility with multidirectional nystagmus and mild-to-moderate optic atrophy of both eyes together with dysmetria and tandem gait ataxia is reported. In addition, memory, attention, and problem solving were mildly reduced, and EDSS score increased to 2 []. MRI activities emerged, showing new T2-W lesions in brain and Gd- enhancing T1-W brain lesions [Figures and ]. Brain MRI with T2-W and FLAIR conditions show multiple high-signal-intensity plaques in the periventricular, semi-oval, cortico-medullary junction regions [Figures and ].\nA new course of methyl-prednisolone 1 g/day for 5 days was administered and symptoms subsided in 4 weeks.\nIn October 2000, 6 months after the appearance of the sensory and visual disturbance syndrome, the patient presented a focal epileptic seizure. Interictal EEG was normal. No specific treatment for seizures was initiated. Recurrent simple partial seizures especially focal motor type was occasionally happened between 2000 and 2012; however, because of lack of abnormal EEG patterns patient did not receive any antiepileptic drug.\nIn September 2013, the third and the last attack of MS relapse presented with recurrent focal motor seizures (Jacksonian type). The stepwise focal motor seizures confirmed the Jacksonian type.