P048 - Seizures and epilepsy in multiple sclerosis patients: A Tunisian study of 9 cases

Abstract

Introduction The prevalence of seizures and epilepsy in patients with multiple sclerosis (MS) is higher than in general population. We investigated the clinical, electrical and radiological findings for Tunisian patients with MS who had experienced seizures. Methods We retrospectively reviewed the medical records of patients who had epileptic seizures and MS, over a 22-year period, from February 1992 to May 2014, at the department of neurology in Hbib Bourguiba hospital. The diagnosis of MS was made according to McDonald revised criteria. The diagnosis of epilepsy was based on the criteria proposed by the International League against Epilepsy (ILAE) 1993 and seizures were classi?ed according to the classification of ILAE, 1981. All patients with seizures or epilepsy were submitted to EEG recording and MRI imaging. Results We identified 9 patients (8 female). The mean age at the onset of MS was 47 years old. None had the history of seizure or epilepsy before clinical MS onset.7 patients had relapsing remitting MS that became secondary progressive in 3cases.The mean age at the onset of seizures was 40.6 years old. Epileptic seizures were recurrent in 3cases and 2 patients had epilepsy. The seizures occurred essentially during the course of the disease (7cases) and the delay between the onset of MS and seizures was 7.1 years. Seizures are related to a new relapse in 7 cases. The mean concomitant EDSS score was 2.9. 4 patients had partial seizures with secondary generalization in 1case. Cognitive impairment was observed in 3 cases. Interictal EEG was normal in 4 patients, focal or generalized epileptic discharges were seen in 3 patients and generalized slowing was noted in 1 patient. All patients had lesions in juxtacortical areas and in the brain stem. Gadolinium-enhancing were visible in 3 cases and cortical atrophy in 4 cases. Anti-epileptic drugs were administered in all patients and six were on monotherapy. The Carbamazepine is the most prescribed. Seizures were controlled in 5 cases, but 1 patient presented a status epilepticus. Conclusion Seizures and epilepsy are more frequent in the MS patients. The causal link between MS and epileptic seizures is unclear. The presence of cortical and juxtacortical lesions and progressive brain atrophy can probably be the pathophysiological mechanism underlying this association. The higher frequency of partial seizures and the better response to antiepileptic drugs are noted. The prevalence of seizures and epilepsy in patients with multiple sclerosis (MS) is higher than in general population. We investigated the clinical, electrical and radiological findings for Tunisian patients with MS who had experienced seizures. We retrospectively reviewed the medical records of patients who had epileptic seizures and MS, over a 22-year period, from February 1992 to May 2014, at the department of neurology in Hbib Bourguiba hospital. The diagnosis of MS was made according to McDonald revised criteria. The diagnosis of epilepsy was based on the criteria proposed by the International League against Epilepsy (ILAE) 1993 and seizures were classi?ed according to the classification of ILAE, 1981. All patients with seizures or epilepsy were submitted to EEG recording and MRI imaging. We identified 9 patients (8 female). The mean age at the onset of MS was 47 years old. None had the history of seizure or epilepsy before clinical MS onset.7 patients had relapsing remitting MS that became secondary progressive in 3cases.The mean age at the onset of seizures was 40.6 years old. Epileptic seizures were recurrent in 3cases and 2 patients had epilepsy. The seizures occurred essentially during the course of the disease (7cases) and the delay between the onset of MS and seizures was 7.1 years. Seizures are related to a new relapse in 7 cases. The mean concomitant EDSS score was 2.9. 4 patients had partial seizures with secondary generalization in 1case. Cognitive impairment was observed in 3 cases. Interictal EEG was normal in 4 patients, focal or generalized epileptic discharges were seen in 3 patients and generalized slowing was noted in 1 patient. All patients had lesions in juxtacortical areas and in the brain stem. Gadolinium-enhancing were visible in 3 cases and cortical atrophy in 4 cases. Anti-epileptic drugs were administered in all patients and six were on monotherapy. The Carbamazepine is the most prescribed. Seizures were controlled in 5 cases, but 1 patient presented a status epilepticus. Seizures and epilepsy are more frequent in the MS patients. The causal link between MS and epileptic seizures is unclear. The presence of cortical and juxtacortical lesions and progressive brain atrophy can probably be the pathophysiological mechanism underlying this association. The higher frequency of partial seizures and the better response to antiepileptic drugs are noted.