Nocturnal Motor Improvement in Multiple Sclerosis During Circadian Body Temperature Dipping

A 78-year-old man with a 40-year history of primary progressive multiple sclerosis associated with severe left hemiparesis reported a significant improvement in motor function (improved strength and flexibility) in his left lower limb occurring between 2 AM and 4 AM. This improvement occurred regardless of whether he had previously been sleeping. Continuous core body temperature monitoring showed that the timing during which we reported improvement corresponded with his core body temperature nadir, as determined by his circadian rhythm. The conductive properties of demyelinated axons are known to be sensitive to temperature fluctuations. This observation suggests the possibility that lower nighttime core body temperature driven by the patient’s circadian rhythm improved conduction along demyelinated motor axons, possibly explaining the patient’s improvement.
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