Unveiling the mosaic: Exploring various movement disorders in osmotic demyelination syndrome
Osmotic demyelination syndrome (ODS) is characterized by noninflammatory demyelination within the central nervous system with symmetrical lesions in the pontine and extrapontine regions, such as the caudate, putamen, midbrain, thalamus, cerebellum, and corpus callosum. Clinical manifestations of ODS...
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Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Annals of Movement Disorders |
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| Online Access: | https://doi.org/10.4103/aomd.aomd_43_24 |
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| author | Ankit Panjwani Sanaullah Mudassir Nitin Pandey |
| author_facet | Ankit Panjwani Sanaullah Mudassir Nitin Pandey |
| author_sort | Ankit Panjwani |
| collection | DOAJ |
| description | Osmotic demyelination syndrome (ODS) is characterized by noninflammatory demyelination within the central nervous system with symmetrical lesions in the pontine and extrapontine regions, such as the caudate, putamen, midbrain, thalamus, cerebellum, and corpus callosum. Clinical manifestations of ODS can be highly variable, including encephalopathy, bradykinesia, spastic quadriparesis, rigidity, dyskinesias, tremor, choreoathetoid movements, mutism, dysarthria, dysphagia, and ophthalmoparesis. Our study included 11 patients with ODS of whom 9 were male individuals (81.81%). The mean and median ages of the patients were 46 ± 19 years and 57 years, respectively. Most patients (90.9%) had hyponatremia, while one patient (9.1%) had hypernatremia. Magnetic resonance imaging findings were observed in 81.81% (n = 9) patients at presentation. Parkinsonism was the most common manifestation observed in 10 patients (90.9%), all of whom most commonly exhibited rigidity and bradykinesia. Postural tremor was observed in four patients (36.36%), masked facies in six patients (54.54%), dystonia in four patients (36.36%), perioral dyskinesias in three patients (27.27%), and choreoathetoid movements were observed in one patient (9.09%). ODS is typically associated with rapid correction of hyponatremia, especially in patients with predisposing factors. However, in this study, gradual hyponatremia correction was performed at a rate <8 mEq/L/24 hours in three patients who later developed ODS. Individuals with ODS may exhibit symptoms of both hypokinetic and hyperkinetic movement disorders due to changes in direct and indirect pathways. Extrapontine involvement can be attributed to either presynaptic striatal dopamine transporter depletion or a deficiency of postsynaptic dopamine receptors. In this study, both hypokinetic and hyperkinetic movement disorders can be observed in ODS; however, hypokinetic movement disorders in the form of parkinsonism were more common. |
| format | Article |
| id | doaj-art-8de9c905670b40caac953afbec501574 |
| institution | DOAJ |
| issn | 2590-3446 2590-3454 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Movement Disorders |
| spelling | doaj-art-8de9c905670b40caac953afbec5015742025-08-20T03:09:46ZengWolters Kluwer Medknow PublicationsAnnals of Movement Disorders2590-34462590-34542025-01-0181535610.4103/aomd.aomd_43_24Unveiling the mosaic: Exploring various movement disorders in osmotic demyelination syndromeAnkit PanjwaniSanaullah MudassirNitin PandeyOsmotic demyelination syndrome (ODS) is characterized by noninflammatory demyelination within the central nervous system with symmetrical lesions in the pontine and extrapontine regions, such as the caudate, putamen, midbrain, thalamus, cerebellum, and corpus callosum. Clinical manifestations of ODS can be highly variable, including encephalopathy, bradykinesia, spastic quadriparesis, rigidity, dyskinesias, tremor, choreoathetoid movements, mutism, dysarthria, dysphagia, and ophthalmoparesis. Our study included 11 patients with ODS of whom 9 were male individuals (81.81%). The mean and median ages of the patients were 46 ± 19 years and 57 years, respectively. Most patients (90.9%) had hyponatremia, while one patient (9.1%) had hypernatremia. Magnetic resonance imaging findings were observed in 81.81% (n = 9) patients at presentation. Parkinsonism was the most common manifestation observed in 10 patients (90.9%), all of whom most commonly exhibited rigidity and bradykinesia. Postural tremor was observed in four patients (36.36%), masked facies in six patients (54.54%), dystonia in four patients (36.36%), perioral dyskinesias in three patients (27.27%), and choreoathetoid movements were observed in one patient (9.09%). ODS is typically associated with rapid correction of hyponatremia, especially in patients with predisposing factors. However, in this study, gradual hyponatremia correction was performed at a rate <8 mEq/L/24 hours in three patients who later developed ODS. Individuals with ODS may exhibit symptoms of both hypokinetic and hyperkinetic movement disorders due to changes in direct and indirect pathways. Extrapontine involvement can be attributed to either presynaptic striatal dopamine transporter depletion or a deficiency of postsynaptic dopamine receptors. In this study, both hypokinetic and hyperkinetic movement disorders can be observed in ODS; however, hypokinetic movement disorders in the form of parkinsonism were more common.https://doi.org/10.4103/aomd.aomd_43_24movement disordersosmotic demyelination syndromeparkinsonism |
| spellingShingle | Ankit Panjwani Sanaullah Mudassir Nitin Pandey Unveiling the mosaic: Exploring various movement disorders in osmotic demyelination syndrome Annals of Movement Disorders movement disorders osmotic demyelination syndrome parkinsonism |
| title | Unveiling the mosaic: Exploring various movement disorders in osmotic demyelination syndrome |
| title_full | Unveiling the mosaic: Exploring various movement disorders in osmotic demyelination syndrome |
| title_fullStr | Unveiling the mosaic: Exploring various movement disorders in osmotic demyelination syndrome |
| title_full_unstemmed | Unveiling the mosaic: Exploring various movement disorders in osmotic demyelination syndrome |
| title_short | Unveiling the mosaic: Exploring various movement disorders in osmotic demyelination syndrome |
| title_sort | unveiling the mosaic exploring various movement disorders in osmotic demyelination syndrome |
| topic | movement disorders osmotic demyelination syndrome parkinsonism |
| url | https://doi.org/10.4103/aomd.aomd_43_24 |
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