Researchers from Nepal described the case of a 68-year-old patient with neuromyelitis optica spectrum disorder (NMOSD) and painful tonic spasms who was successfully treated with eslicarbazepine.

“Painful tonic spasms initially described in association with multiple sclerosis are actually more common in patients with neuromyelitis optica spectrum disorder,” the researchers wrote. “Early recognition of painful tonic spasms and appropriate therapeutic medications can significantly decrease the impact it can have on the quality of life among neuromyelitis optica spectrum disorder patients.”

The patient presented here came to the hospital with painful tonic spasms and burning and tingling sensations in both legs 2 months after being diagnosed with NMOSD. 

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A neurological exam showed spastic paraparesis, brisk reflexes, and bilateral plantar clonus. The patient had delayed P100 latency in both eyes but normal N75-P100 amplitude, which is suggestive of a bilateral conduction defect.

He was given 900 mg of oral gabapentin 3 times a day. The next day, 4 mg of tizanidine 3 times a day was added. On the third day, a 5-mg diazepam injection 3 times a day was added. Finally, on the fourth day, 20 mg of oral baclofen 3 times a day was added. Seven days after admission, 200 mg of eslicarbazepine once a day was added. This led to significant reductions in the amplitude and frequency of the spasms, which eventually disappeared altogether.

“In order to decrease the impact on patients’ quality of life, [painful tonic spasms] should be recognized early, regarded as a paroxysmal symptom, and treated with appropriate therapeutic medications from various available treatment options,” the researchers concluded.

The case study was published in SAGE Open Medical Case Reports.

Painful tonic spasms are characterized by fierce pain and tonic posture of the limbs. They are common in patients with NMOSD during the recovery phase after the first myelitis episode.


Aryal R, Homagian S, Shrestha S, et al. Painful tonic spasms in a patient with neuromyelitis optica spectrum disorder: a case report. SAGE Open Med Case Rep. Published online April 20, 2023. doi:10.1177/2050313X231167937