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Dystonia and multiple sclerosis

      I read the case report entitled “Dystonia in a 13-year-old boy with secondary progressive multiple sclerosis” with great interest [
      • Shiraishi K.
      • Higuchi Y.
      • Ozawa K.
      Dystonia in a 13-year-old boy with secondary progressive multiple sclerosis.
      ]. This case is very unlikely to have multiple sclerosis (MS). MS, already uncommon in children and adolescents, very rarely presents with seizures or with basal ganglia involvement, and is extremely rare to undergo a secondary progressive course in this age group. This patient might have another disorder, perhaps in the mitochondrial or vasculitic category. Not all patients who fulfill the McDonald criteria have MS. Indeed, the original article underlines: “Alternative diagnoses must be considered. There must be no better explanation for the clinical picture” [
      • McDonald W.I.
      • Compston A.
      • Edan G.
      • Goodkin D.
      • Hartung H.P.
      • Lublin F.D.
      • et al.
      Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis.
      ]. Before deciding on the co-occurrence of multiple small possibilities, we should look into more common conditions that might explain the findings and might be treated differently.
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      References

        • Shiraishi K.
        • Higuchi Y.
        • Ozawa K.
        Dystonia in a 13-year-old boy with secondary progressive multiple sclerosis.
        Brain Dev. 2004; 26: 539-541
        • McDonald W.I.
        • Compston A.
        • Edan G.
        • Goodkin D.
        • Hartung H.P.
        • Lublin F.D.
        • et al.
        Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis.
        Ann Neurol. 2001; 50: 121-127