The Neuropsychiatric Interface in Multiple Sclerosis and Three Neurodegenerative Disorders

Background:

The sequele of symptoms that accompany MS are common among many neurological and psychiatric problems, and can be seemingly transient depending on disease activity.  As a result, diagnosis can be difficult.  We describe 3 cases, all with confirmed multiple sclerosis and subsequent to the diagnosis of MS, each patient was diagnosed with a second neurodegenerative disease similar in presentation to MS.  We present a case of a patient with MS and Huntington’s disease, MS and Primary Progressive Aphasia, and a patient with MS and Parkinsonism in an attempt to highlight the overlap in psychiatric symptoms in the relative rarity of comorbidity of the diagnoses and emphasize the benefit of integrated behavioral medicine throughout diagnosis and treatment.

Objectives:

To describe 3 cases of patients with rare comorbid Multiple Sclerosis and second neurodegenerative disease. To highlight the overlap in psychiatric symptoms in the relative rarity of comorbidity of an MS diagnosis and second neurodegenerative disease.To emphasize the benefit of integrated behavioral medicine throughout diagnosis and treatment.

Methods:

Case review of patient with Multiple Sclerosis and Huntington’s Disease, patient with Multiple Sclerosis and Primary Progressive Aphasia, and patient with Multiple Sclerosis and parkinsonism.

Results:

Case reviews illustrate enhanced benefit of integrated behavioral medicine in caring for patients with complex neurological conditions presenting with concomitant cognitive, behavioral, and emotional disturbances. 

Conclusions:

Behavioral medicine played a significant role in each of these cases.  However, behavioral medicine integrated into the care team was only present with the case with the patient with Huntington’s disease.  The other two cases had contact with psychology and neuropsychology services through independent outside providers and had records forwarded for treatment by neurology teams, often limiting the availability for direct consultation between providers.   Behavioral medicine as part of a care team can be especially helpful with assessing the emotional and cognitive symptoms in relationship with neurological symptoms, and developing a treatment strategy that is informative to the other disciplines while considering the needs of the patient.  This can lead to a faster and more accurate diagnostic picture and provides a framework for treatment as symptoms change in a timely manner.