Clinic speak: seizures and MS

Did you know that MS causes epilepsy? More bad news. #MSBlog #MSResearch

"Did you know that seizures and epilepsy (recurrent seizures) are commoner in MSers than the in the general population?"

"The reason why MS causes seizures is because it is also a gray matter disease and can irritate nerve cells to fire spontaneously that results in seizures and hence epilepsy. The superficial gray matter is on the surface of the brain and is made up of all the the cell bodies of neurones; many diseases of gray matter cause seizures including MS."

"This study shows that just over 3% of MSers presented with seizures and it was strongly associated with lesions on MRI abutting on the gray matter, i.e. the so called subcortical white matter. The incidence of epilepsy in this study is much lower than other quoted series, which is in the order of ~10%. Why? This is a cross-sectional study and a large number of the MSers in this study are yet to develop epilepsy."

"It is important that if you do develop epilepsy is that it is not assumed to be due to MS and that you are reinvestigated to exclude other causes, for example tumours and infections. Seizures are a manifestation of disease activity, i.e. new lesions, and I treat them as such. If you are on one of the more potent immunosuppressive agents you also need to consider whether or not this is a manifestation of an infection or encephalitis, for example herpes encephalitis. In the case of natalizumab (Tysabri) this could be the first manifestation of PML."

"In my experience epilepsy in MS responds to typical anti-convulsant drugs. The problem with these drugs is that they are all sedating and may make cognitive impairment worse. In general they are poorly tolerated by MSers. Anticonvulsants could also interact with your other drugs and hence needed to be considered carefully. If you are a young woman on the oral contraceptive pill you need to make sure you take one that doesn't interact with the pill otherwise you may have an unwanted pregnancy."

"The biggest problem for MSers is that if you have a seizure it is assumed that you are at risk of recurrence, i.e. they are unprovoked, and are due to your MS; hence you can't drive until you have been seizure free for a period of time (12-24 months). The exact duration of a driving ban depends on which country you live in. Other information you need to know about seizures is that you they are a cause of sudden death (SUDEP = sudden unexplained death in epilepsy), accidents and drownings. Your neurology team therefore should warn you about these things and give you advice to limit or prevent them occurring. If you do have epilepsy there is a chance of provoking your seizures by starvation or hunger, sleep deprivation or alcohol. The general rules for epileptics in regard to this should apply to MSers."

"Having a seizure is very scary and being at risk of further seizures results in anxiety. Seizures are simply another bit of bad news for MSers. The risk of seizures goes up with disease duration and is commoner in MSers with progressive disease. Therefore if we can prevent MS becoming progressive we should prevent most seizures. Seizures and epilepsy are part of the burden of the disease and are another reason for early effective treatment and suppression of all disease activity: treat-2-target of NEDA (no evidence of disease activity). "

MATERIALS AND METHODS: This study is a cross-sectional study which was conducted by reviewing the clinical records of MSers with a definite diagnosis of MS according to McDonald's criteria from March 2007 to June 2011, who referred to the MS clinic of the university.

RESULTS: A total of 920 MSers with a diagnosis of MS were identified, among whom 29 MSers (3.15%) with seizure activity (case) due to MS with the mean age of 32.6 ± 6.23 years were analyzed. Also, fifty MS MSers without any seizure occurrence with the mean age of 33.7 ± 7.4 years were used as our control group. In the case group, seizures were generally tonic-clonic in 23 MSers (79.3%), complex partial in four (13.8%), and simple partial in two (5.9%). The 26 available interictal EEGs in MSers showed abnormal EEG pattern in 22 (84.6%) of them, including focal epileptic form discharge or focal slowing in 10 (38.5%), generalized discharge (spike-wave, polyspike, or general paroxysmal fast activity) in 10 (38.5%), and general slowing activity in 10 record (38.5%). MRI reviews of the 26 available brain MRIs showed subcortical white mater lesions in 22 (84.6%) of MSers with seizure. All MRIs were performed within one month after the first seizure episode. Amongst 48 available MRIs in our control group, 91.7% (44 cases) showed periventricular lesions and in 8.3% (4 cases) subcortical white matter lesions were reported.

CONCLUSION: The result of this study demonstrated the higher rate of subcortical white matter lesion in MSers with seizure occurrence compared to control group.

Other posts on sudden death in MS:

Multiple Sclerosis Research: Sudden death in MS or SUDMUS (1)
08 Feb 2012
"Sudden death is very topical in view of the recent death of a patient on Fingolimod and the European Medicine Agency's decision to review the safety of the drug. I would be very interested to know if the unfortunate MS'er who ...
http://multiple-sclerosis-research.blogspot.com/

Other posts on seizures:

FDA warns about seizures with MS drug Ampyra or Fampridine
27 Jul 2012
The U.S. Food and Drug Administration (FDA) on Monday said MSers who take the drug Ampyra (known as Fampridine in Europe), have a higher risk of seizures when starting the treatment. The FDA also updated the label for ...

Multiple Sclerosis Research: Research: Seizures in MS
20 May 2012
"Seizures are not uncommon in MSers and are presumably due to gray matter involvement. The most common are secondary generalised epilepsy; these start with an aura before spreading to the whole brain. Seizures in ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Symptoms in MS: tremors, seizures ...
22 Jul 2011
Re: "The fewer medicines you take, the better off you'll be." No not really; it is always a trade off between symptoms and their impact on your functioning (activities of daily living, social and occupational) and how effective they ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Research: MS brain lesions and epilepsy
16 Jan 2013
OBJECTIVES: Previous studies have reported an increased risk for epileptic seizures in MSers. However, data on the pathogenesis of seizures remain inconclusive. The aim of this study is to evaluate prevalence, clinical and ...
http://multiple-sclerosis-research.blogspot.com/