Paroxysmal attacks ore short, frequent and stereotyped symptoms that can be observed in multiple sclerosis (MS) patients. We evaluated retrospectively the clinical and neuroradiological findings of patients, who developed any paroxysmal attacks during the course of their disease. EDSS scores, MS clinical types and disease durations of 59 patients with paroxysmal attacks (Group I) were compared to 586 consecutive patients without paroxysmal attacks recorded in our MS database (Group 2). Anatomical and clinical correlation was attempted in 31 of the patients who had MRI examinations performed within 6 months of the paroxysmal attacks. EDSS scores of patients in Group 1 at the time of the paroxysmal attacks were significantly lower than the scores at their lost clinic visit, whereas there were no significant differences for other parameters. Our results demonstrate that paroxysmal attacks occur early in the course of the disease, when there is little or no neurologic disability and associated tissue damage.