Seizures in multiple sclerosis

Purpose: In patients with multiple sclerosis (MS), epileptic seizures occur more frequently than in the general population. The aim of this study was to analyze clinical characteristics of epilepsy in patients with MS, potent ial correlation between the semiology of seizures, EEG and magnetic resonan ce imaging (MRI) findings in these patients, as well as to examine the resp onse to anticonvulsant therapy. Methods: In a series of 268 consecutive patients with definite MS hospitali zed at the Institute of Neurology, Belgrade, we identified 20 (7.5%) patien ts with seizures or epilepsy. All patients with seizures or epilepsy were s ubmitted to standard EEG and brain MRI with gadopentetate dimeglumine. Results: In four patients, epilepsy occurred 1-5 years before other clinica l manifestations of MS. Eight patients had seizures only during MS relapses (provoked seizures). In two of them, seizures were the only manifestations of relapse. In 12 patients, seizures occurred regardless of the phase of M S (chronic epilepsy). In the majority of patients, seizures were partial wi th secondary generalization. Five patients experienced episodes of status e pilepticus, and they all had dementia. Abnormal EEG pattern was found in 11 patients. Brain MRI disclosed cortical-subcortical lesions in nine patient s and focal cortical atrophy in one, whereas in the remaining patients, fin dings were inconclusive. Probable EEG-MRI-seizure type correlation existed in 10 patients. Conclusions. Our data suggest that epilepsy may represent an initial sympto m of MS and a single clinical manifestation of a relapse, and further suppo rt the assumption of the existing correlation between the presence of corti cal-subcortical lesions and epileptic seizures or epilepsy in patients with MS.