COMMENTARY

Epilepsy and Multiple Sclerosis: Is There a Link?

Epilepsy Notes

Andrew N. Wilner, MD

Disclosures

April 30, 2014

Multiple Sclerosis and Seizures: What Is the Connection?

A recent population-based record linkage study indicates that hospitalizations for epilepsy and multiple sclerosis occur together more often than would be expected by chance.[1]

The relationship between seizures and multiple sclerosis is not well understood.[2] Seizures have long been recognized as part of the spectrum of symptoms that may occur in multiple sclerosis.[3] Rarely, a seizure may even be the presenting symptom of multiple sclerosis.[4]

The likelihood of seizures in patients with multiple sclerosis is about 3 times higher than would be expected in the general population.[4] Nonepileptic paroxysmal events may also occur in patients with multiple sclerosis, and must be differentiated from epileptic seizures.

Multiple Sclerosis Treatment and Seizures

The effect of multiple sclerosis treatment must also be considered as an etiology of seizures. Interferons and glatiramer acetate can increase the occurrence of seizures.[4] Dalfampridine (Ampyra®), a US Food and Drug Administration-approved potassium-channel blocker prescribed to improve walking, may cause seizures in a dose-related manner.[4] Intrathecal baclofen has been associated with seizures and nonconvulsive status epilepticus.[4] The package inserts do not list seizures as an adverse effect of natalizumab (Tysabri®) or any of the new oral multiple sclerosis drugs: dimethyl fumarate (Tecfidera®), fingolimod (Gilenya®), or teriflunomide (Aubagio®).

Case Study: Multiple Sclerosis and New-Onset Seizures

Many years ago, I admitted a 40-year-old man with multiple sclerosis to the epilepsy monitoring unit with new-onset seizures. Despite living with multiple sclerosis for about 10 years, he had little in the way of focal neurologic deficits. However, he had suffered significant cognitive decline.

I remember being surprised at his MRI scan, which showed a large amount of global atrophy but not much in the way of typical multiple sclerosis plaques. At that time, it was taught that multiple sclerosis was a "white-matter disease," making the finding of significant neuronal loss surprising -- so much so, in fact, that we started an investigation looking for other causes of cerebral atrophy. However, gray-matter lesions are now recognized as part of the multiple sclerosis disease process[5] and were probably responsible for the development of epilepsy in this patient. What a difference a few decades makes!

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