A disease of the skeletal system producing as much disturbance, especially of the external conformation of the skull, as osteitis deformans would naturally lead one to question its effects on the nervous system. A priori, one would expect mental symptoms to be a frequent concomitant. Actually in reviewing the literature, one is struck by the rarity of such symptoms in these patients.
In his original article in 1876, Paget1 stated that "even when the skull is hugely thickened and all its bones exceedingly altered in structure, the mind remains unaffected."
Wyllie2 maintained that the nervous system is rarely affected. According to him, the capacity of the cranium is actually increased; the anteroposterior and transverse diameters are greater. The vertical measurements, however, especially around the foramen magnum, are decreased. The neural foramens are narrowed, and symptoms may thus arise. He mentioned two cases of pressure on the optic nerves
KAUFMAN MR. PSYCHOSIS IN PAGET'S DISEASE (OSTEITIS DEFORMANS). Arch NeurPsych. 1929;21(4):828-837. doi:10.1001/archneurpsyc.1929.02210220099004