Saridas Furkan, Mesut Gizem, Ozpar Rifat, Koc Emine Rabia, Hakyemez Bahattin, Bican Demir Aylin, Turan Omer Faruk
Department of Neurology, Bursa Uludağ University Medicine Faculty, Türkiye.
Department of Neurology, Bursa Uludağ University Medicine Faculty, Türkiye.
Mult Scler Relat Disord. 2024 Dec;92:105948. doi: 10.1016/j.msard.2024.105948. Epub 2024 Oct 20.
There is evidence that the inflammatory demyelinating disorder in Multiple Sclerosis (MS) is associated with acute seizures and epilepsy. Additionally, the likelihood of developing epilepsy increases with neurodegeneration. This study aims to reveal the clinical and radiological features of MS-epilepsy/seizure coexistence.
Among all patients diagnosed with MS that we followed in our center between April 2002 and July 2023, patients with a single seizure history or diagnosed with epilepsy (MS-seizure/epilepsy) were randomized 1:1 in terms of age and gender with MS patients without a diagnosis of epilepsy or seizures. Clinical (comorbidities, annualized relapse rate, disability, seizures during attacks, initial diagnosis, disease duration, disease-modifying therapies (DMTs), refractory epilepsy, anti-seizure drugs), electroencephalography (EEG) and MRI (lesion localization and new lesion(s)) data were retrospectively evaluated.
The mean EDSS was 4.07±2.81. 29.4 % of patients had progressive MS (n = 10). Refractory epilepsy was 52.9 % (n = 18), and SE history was 14.7 % (n = 5). Pathology was detected in 69.7 % (n = 23) of patients in the EEG. The most common slow wave activation was detected in 51.5 % (n = 17). Refractory epilepsy was more common in cases under 45 and patients with lesions in thalamic localization. Lesions in the temporal and thalamic regions and cerebral atrophy were more common in the MS-seizure/epilepsy group.
Patients with demyelinating lesions in the temporal and thalamic regions should be questioned more carefully for epilepsy, and an EEG should be performed in case of clinical suspicion. Since thalamus lesions are more common in patients with refractory epilepsy, anti-seizure treatment strategies should be applied more carefully. The presence of atrophy on MRI confirms the link between neurodegeneration processes and the development of epilepsy.
有证据表明，多发性硬化症（MS）中的炎性脱髓鞘疾病与急性发作和癫痫有关。此外，随着神经退行性变，患癫痫的可能性会增加。本研究旨在揭示MS-癫痫/发作共存的临床和放射学特征。
在2002年4月至2023年7月期间我们中心随访的所有诊断为MS的患者中，有单次发作史或诊断为癫痫的患者（MS-发作/癫痫）按年龄和性别与未诊断为癫痫或发作的MS患者1:1随机分组。对临床（合并症、年化复发率、残疾、发作时的发作、初始诊断、病程、疾病修正治疗（DMTs）、难治性癫痫、抗癫痫药物）、脑电图（EEG）和MRI（病变定位和新病变）数据进行回顾性评估。
平均扩展残疾状态量表（EDSS）为4.07±2.81。29.4%的患者患有进展型MS（n = 10）。难治性癫痫为52.9%（n = 18），癫痫持续状态（SE）病史为14.7%（n = 5）。69.7%（n = 23）的患者脑电图检测到病理改变。最常见的慢波激活在51.5%（n = 17）中检测到。难治性癫痫在45岁以下患者和丘脑定位有病变的患者中更常见。颞叶和丘脑区域的病变以及脑萎缩在MS-发作/癫痫组中更常见。
对于颞叶和丘脑区域有脱髓鞘病变的患者，应更仔细地询问癫痫情况，临床怀疑时应进行脑电图检查。由于丘脑病变在难治性癫痫患者中更常见，抗癫痫治疗策略应更谨慎应用。MRI上萎缩的存在证实了神经退行性变过程与癫痫发展之间的联系。
