Epileptic seizures in multiple sclerosis: prevalence, competing causes and diagnostic accuracy

Abstract

Background Multiple sclerosis (MS) is accompanied by an increased risk of epileptic seizures, but data with a detailed description of the competing causes are lacking. Methods We aimed to describe a cohort of patients with both MS and epileptic seizures in a retrospective, population-based study. Results We included 59 out of 2285 MS patients who had at least one epileptic seizure. Out of them, 22 had seizures before the diagnosis of MS, whereas epileptic seizures occurred after MS diagnosis in 37 patients, resulting in a total prevalence of epileptic seizures in MS of 2.6%. Competing causes could be found in 50.8% (30/59) of all patients, with 40.9% (9/22) compared to 56.8% (21/37) of the MS patients with seizures before vs after MS diagnosis. The main alternative causes were traumatic brain injury and cerebral ischemia accounting for more than 30% of the patients, with no difference between the subgroups. 33.3% and 55.6% of MS patients with seizures before/after MS diagnosis had documented pathological EEG alterations. Conclusion A remarkable percentage of MS patients with epileptic seizures do have alternative competing causes at the time of the first seizure. A detailed diagnostic setup including patient history, EEG and MRI is recommended in the evaluation and choice for the best treatment.

Seizures and epilepsy in multiple sclerosis, aquaporin 4 antibody‐positive neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody‐associated disease

“…They can be the principal, initial, or even the sole presentation of an MS attack, and are commonly accompanied by other symptoms of the demyelinating disease (e.g., visual, spinal, and brainstem manifestations). 11,23,33,35,[75][76][77][78] By contrast, chronic epilepsy is more common in the advanced stage of MS and may be associated with a physical disability, decreased cognitive ability, and high EDSS score (≥6). 12,23,31,74,[79][80][81] S4).…”

“…In addition, epilepsia partialis continua (EPC), musicogenic epilepsy, and nonconvulsive SE, for example, aphasia, have also been described. 82,83 Notably, seizures can be the only initial presentation of MS. 23 The diagnosis is much more difficult in such circumstances, and requires a combination of ancillary tests such as neuroimaging, electroencephalogram (EEG), and cerebrospinal fluid (CSF) to exclude AE, infectious encephalitis/meningitis (particularly opportunistic infections), poisoning, genetic-metabolic diseases (e.g., mitochondrial diseases, such as mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes), neoplasms, and other CNS demyelinating diseases (especially MOGAD and AQP4-NMOSD 75 ). Accompanying symptoms indicative of MS include visual loss, limb weakness or sensory disturbances, ataxia, and bladder/bowel dysfunction.…”

Seizures and multiple sclerosis‑more than an epidemiological association (Review)

“…According to another study conducted by Koch et al (36) on 19,804 patients, the estimated prevalence of epileptic seizures ranged from 0.5 to 8.3%, with an average of 2.3%. Table I summarized the most relevant data from the abovementioned studies and other significant research related to this topic that was conducted during the last two decades (37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50).…”

“…Moreover, cumulative seizure incidence is directly related to MS duration, reaching almost 6% in patients with MS with a disease duration of >30 years (56). Finally, epileptic seizures can also occur before MS is diagnosed, with different percentages depending on the study group (50). However, it is still debatable if an epileptic event without a clear cause should be considered a retrospective relapse or an associated disorder.…”

Altered grey matter integrity and network vulnerability relate to epilepsy occurrence in patients with multiple sclerosis

“…Seizures and epilepsy may occur during the course of multiple sclerosis (MS). Their prevalence is estimated to be 1.5%-2.6% [1,2] and 0.9%-3.1% [1], respectively, which is approximately seven times higher than in the general population [3]. The underlying causes of a higher susceptibility to epilepsy occurrence in MS patients are poorly understood, however, an earlier onset of MS, longer disease duration, and greater disability have been suggested as predisposing factors [4].…”