{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:15:52Z","timestamp":1778130952591,"version":"3.51.4"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Painful tonic spasms (PTS) are an underrecognized initial manifestation of neuromyelitis optica spectrum disorder (NMOSD), presenting before classic neurological deficits in rare cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 51-year-old man presented with progressive right lower limb PTS lasting \u226410\u202fs, spreading bilaterally and impairing mobility within 1\u202fmonth. Neurological examination showed bilateral hyperreflexia and myoclonus. Spinal MRI revealed longitudinally extensive T2 hyperintensity and gadolinium enhancement at T1\u2013T6 levels. Serum aquaporin-4 immunoglobulin G (AQP4-IgG) antibody was positive (1:100), while cerebrospinal fluid AQP4-IgG analysis was negative. Methylprednisolone (0.5\u202fg\/day for 3\u202fdays, tapered to oral prednisolone) and intravenous immunoglobulin (0.4\u202fg\/kg\/day for 5\u202fdays) significantly reduced spasms. At discharge, he ambulated independently without PTS on prednisolone (60\u202fmg\/day), oxcarbazepine (450\u202fmg twice daily), and baclofen (10\u202fmg twice daily).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Isolated PTS serves as a potential harbinger of NMOSD, and early diagnosis and precise immunotherapy enables rapid symptom control and attack prevention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1814265","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:56:29Z","timestamp":1778129789000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Neuromyelitis optica spectrum disorder with painful tonic spasms as the first symptom: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Feng","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]},{"name":"Department of Neurology, The People's Hospital of Dehong Prefecture","place":["Mangshi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiajun","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Neurology, The People's Hospital of Dehong Prefecture","place":["Mangshi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linjie","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaolei","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1212\/wnl.0000000000001729","article-title":"International consensus diagnostic criteria for neuromyelitis optica spectrum 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