Confabulation and multiple sclerosis: a rare association

Background: Fantastic confabulation in the context of Multiple Sclerosis (M S) has not previously been reported in the literature. The association is o f interest because clearly demonstrable brain Pathology in MS together with other cognitive and behavioural correlates may further our understanding o f the neural basis underlying confabulation. Methods: A single case report with magnetic resonance imaging of the brain and detailed neuropsychologica l evaluation. Results: Confabulation occurred together with disinhibited an d stimulus bound behaviour While the patient's physical and emotional state limited the range of psychometric tests administered, the results revealed an inability to maintain focused, regulated information Processing. Althou gh memory difficulties were present they were not in the nature of a severe amnesic disorder. The patient appeared to have a brood fund of knowledge, but the associations binding the information together and Putting it into c ontext were loose. All three features of a triad of responses previously de scribed in confabulating Patients were present, namely on inability to with hold answers, to monitor one's own responses and provide verbal self correc tions. MRI of the brain showed bilateral periventricular lesions and discre te frontol lesions with 53% of the total lesion volume distributed in front al areas. Cortical atrophy, most marked in frontal regions also was conspic uous. Conclusions: Confabulation linked to frontal lobe involvement may occ ur as part of the changes in mentation found in MS. It is, however, rare an d although associated with impaired memory, may be found in the absence of a severe amnesic disorder. This conclusion is discussed in the light of obs ervations from the literature suggesting that frontal involvement is a Prer equisite before fantastic confabulation occurs.