Neurological complications of Paget’s disease of bone; a narrative overview

Paget’s disease of bone (PDB) is an osteopathy that progressively affects one or multiple bones, often involving the neurological system. The disease can impact the spinal cord, cauda equina, brain, and cranial nerves due to their proximity to affected bones. The involvement of the cranial nerve may lead to vision, hearing or speech loss. Radiological identification includes features like hypertrophic bones and cortical thickening. Neurological symptoms such as headaches, dementia, cranial neuropathies, and spinal issues may arise, though many cases are asymptomatic and discovered incidentally. The skull is frequently involved, leading to abnormal bone growth. Neurological deficits are often caused by spinal hypertrophy, direct compression, or pathologic fractures. Diagnostic tools like magnetic resonance imaging (MRI), CT-myelography, and bone X-rays are essential for locating lesions and guiding treatment. Treatment varies based on the severity and progression of the neurologic deficit, with bisphosphonates commonly used for progressive or chronic cases.