Pozzilli Valeria, Tortorella Carla, Prosperini Luca, D'Apolito Maria, Capone Fioravante, Celani Licia Maria, Pantuliano Maria Chiara, Cipollone Sara, Cruciani Alessandro, De Luca Giovanna, Evangelista Giacomo, Pietrolongo Erika, Haggiag Shalom, La Cesa Silvia, Ruggieri Serena, Di Lazzaro Vincenzo, Sensi Stefano L, Gasperini Claudio, Dono Fedele, Tomassini Valentina
Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy.
Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Mult Scler J Exp Transl Clin. 2025 Jul 31;11(3):20552173251359061. doi: 10.1177/20552173251359061. eCollection 2025 Jul-Sep.
Epilepsy is two to three times more common in patients with multiple sclerosis (pwMS) compared to the general population. Patients with MS and epilepsy without other identifiable causes (MS + E) show greater cortical damage than those without epilepsy (MS-E). However, it's unclear whether MS + E patients exhibit distinct cognitive and neuropsychological features requiring specific management.
In a cohort of pwMS from three MS centers, MS + E patients were identified and data on MS clinical features, epilepsy history, and treatments were collected. A matched group of MS-E patients was included. Assessments included cognitive and neuropsychiatric tests. Cognitive impairment (CI) was defined as scoring ≥1.5 standard deviations below normative values in ≥1 cognitive domain.
CI was more prevalent in MS + E (n = 33) patients than in MS-E (n = 33). MS + E patients had lower processing speed (p < 0.01) and visuospatial memory (p = 0.03). MS + E was independently associated with CI (odds ratio 3.6, 95% confidence interval 1.21-12). Somatization, phobia, anxiety, and depression were the most affected neuropsychological domains in MS + E, with global psychological distress negatively correlating with processing speed (rho -0.36, p = 0.048).
MS + E is associated with higher CI, particularly in processing speed and visuospatial memory, alongside psychological distress, highlighting the need for targeted multidisciplinary care to improve outcomes and quality of life.
与普通人群相比，多发性硬化症患者（pwMS）患癫痫的几率高出两到三倍。患有多发性硬化症且无其他可识别病因的癫痫患者（MS + E）比无癫痫的患者（MS - E）表现出更严重的皮质损伤。然而，尚不清楚MS + E患者是否表现出需要特殊管理的独特认知和神经心理特征。
在来自三个多发性硬化症中心的pwMS队列中，识别出MS + E患者，并收集有关多发性硬化症临床特征、癫痫病史和治疗的数据。纳入一组匹配的MS - E患者。评估包括认知和神经精神测试。认知障碍（CI）定义为在≥1个认知领域的得分比标准值低≥1.5个标准差。
CI在MS + E患者（n = 33）中比在MS - E患者（n = 33）中更普遍。MS + E患者的处理速度较低（p < 0.01）和视觉空间记忆较低（p = 0.03）。MS + E与CI独立相关（比值比3.6，95%置信区间1.21 - 12）。躯体化、恐惧症、焦虑和抑郁是MS + E中受影响最大的神经心理领域，总体心理困扰与处理速度呈负相关（rho -0.36，p = 0.048）。
MS + E与较高的CI相关，特别是在处理速度和视觉空间记忆方面，同时伴有心理困扰，这突出表明需要有针对性的多学科护理，以改善预后和生活质量。
