Author Of 1 Presentation
P1125 - Hypersexual Behavior and Multiple Sclerosis: A Systematic Review (ID 1780)
Abstract
Background
Multiple Sclerosis (MS) is associated with a wide range of behavioral disturbances. Sexual dysfunction is very common, especially in association with depression, spinal cord and autonomic dysfunction, and significantly affects the quality of life. Hypersexuality spectrum and paraphilias have been rarely reported, being more commonly linked to dementia and/or severe cognitive or psychiatric co-morbidities.We have previously reported a case of episodic hyperlibidinism in MS (Gondim, Mult Scler 2001;7:67 ).
Objectives
We conducted a systematic review of the XX and XXI century medical literature about hypersexuality and paraphilias in MS.
Methods
We separately analyzed references from older pre-neuroimaging era and more recent neuroimaging eras. Our initial Pubmed search included the words: hypersexuality, hyperlibidinism, paraphilias, sexual disorders and multiple sclerosis. Thereafter, we searched the references (including old literature) written in English, French, German, Spanish and Portuguese about the subject.
Results
In the older (pre neuroimaging) literature, 12 patients from 8 papers (2 articles in German and 1 in French) were found and in the recent literature, additional 7 reports on 7 patients (all written in English). There is a single autopsy report: of an 11-year-old girl with weight loss, disinhibition, masturbation and demonic possession-like behavior in the presence of widespread cortical and subcortical disease affecting the limbic system (Salguero. JNNP 1969;32:572). The older literature comprised obsessions, exhibitionism, erotomaniac delusions, disinhibition, episodical sexual assaults, gender-identity disorder, prostitution, pedophilic tendencies, delusional disorder and incest. The recent literature review revealed isolated hyperlibidinism, paraphilias, fetishism and pedophilia. Lesion analysis from the neuroimaging era and based on the single autopsy and localization based on neurological findings from the ancient literature revealed widespread disease in most instances, without good correlation between phenomenology and specific localization. In most instances, associated symptoms was suggestive of frontal lobe dysfunction. Several described pathological conditions are currently not classified as diseases according to newer DSM criteria. However, several may fulfill criteria for compulsive sexual behavior disorder.
Conclusions
In summary, hypersexuality, paraphilias and variants are rare complications of MS that are usually associated with widespread MS, without good correlation on lesion analysis, and not linked to MS relapses. Evolving pathological classification from newer DSM criteria has also compromised the interpretation of the phenomenology. Further studies are necessary to establish whether those conditions (especially milder forms) are not underreported in MS patients due to obvious social stigmata brought to the affected individuals.