Successful treatment of paroxysmal ataxia and dysarthria in multiple sclerosis with levetiracetam

Background Paroxysmal ataxia and dysarthria (PAD) is a relatively rare symptom in Multiple Sclerosis patients. PAD involves transient dysfunction in control, coordination and initiation of speech and/or limb movements. Objective To describe the successful use of levetiracetam for the treatment of PAD. Methods Case report. Results A 37-year-old woman with MS developed PAD approximately 3 months after a multifocal MS relapse. Brain MRI showed a lesion in the posterior aspect of the midbrain as well as in the right posterior internal capsule, both of which were adjacent to the red nucleus. Attack frequency was reduced after starting levetiracetam at a dose of 500 mg twice daily, and attacks stopped completely once the dose was increased to 750 mg twice daily. Conclusions Given its advantages (in terms of side effects, safety profile and ease of use compared to other anticonvulsants), we suggest that levetiracetam be considered for management of PAD, and perhaps for other paroxysmal MS symptoms as well.