Secondary paroxysmal dyskinesias (SPDs) are short, episodic, and recurrent movement disorders, classically related to multiple sclerosis (MS). Carbamazepine is effective, but with risk of adverse reactions. We identified 7 patients with SPD among 457 MS patients (1.53%). SPD occurred in face (n = 1), leg (n = 2), or arm +leg (n = 4) several times during the day. Magnetic resonance imaging (MRI) showed new or enhancing lesions in thalamus (n = 1), mesencephalic tegmentum (n = 1), and cerebellar peduncles (n = 5). Patients were treated with clonazepam and then acetazolamide (n = 1), acetazolamide (n = 5), or levetiracetam (n = 1) with response within hours (acetazolamide) to days (levetiracetam). No recurrences or adverse events were reported after a median follow-up of 33 months.
