Epileptic seizures in multiple sclerosis: prevalence, competing causes and diagnostic accuracy
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Epileptic seizures in multiple sclerosis: prevalence, competing causes and diagnostic accuracy Friederike Neuß1 · Felix von Podewils1 · Zhong Irene Wang2 · Marie Süße1 · Uwe Klaus Zettl3 · Matthias Grothe1 Received: 23 October 2020 / Revised: 22 November 2020 / Accepted: 4 December 2020 © The Author(s) 2020
Abstract Background Multiple sclerosis (MS) is accompanied by an increased risk of epileptic seizures, but data with a detailed description of the competing causes are lacking. Methods We aimed to describe a cohort of patients with both MS and epileptic seizures in a retrospective, population-based study. Results We included 59 out of 2285 MS patients who had at least one epileptic seizure. Out of them, 22 had seizures before the diagnosis of MS, whereas epileptic seizures occurred after MS diagnosis in 37 patients, resulting in a total prevalence of epileptic seizures in MS of 2.6%. Competing causes could be found in 50.8% (30/59) of all patients, with 40.9% (9/22) compared to 56.8% (21/37) of the MS patients with seizures before vs after MS diagnosis. The main alternative causes were traumatic brain injury and cerebral ischemia accounting for more than 30% of the patients, with no difference between the subgroups. 33.3% and 55.6% of MS patients with seizures before/after MS diagnosis had documented pathological EEG alterations. Conclusion A remarkable percentage of MS patients with epileptic seizures do have alternative competing causes at the time of the first seizure. A detailed diagnostic setup including patient history, EEG and MRI is recommended in the evaluation and choice for the best treatment. Keyword Multiple sclerosis · Epilepsy · Seizures · Comorbidity · Epidemiology
Introduction The association between multiple sclerosis (MS) and epileptic seizures has been described for more than 30 years [1]. Several recent studies confirmed a threefold increased risk for epileptic seizures in MS patients compared to healthy controls [2–5]. Seizures can occur as first symptom in MS Uwe Klaus Zettl and Matthias Grothe contributed equally to this work. * Matthias Grothe [email protected]‑greifswald.de 1
Department of Neurology, University Medicine Greifswald, Ferdinand‑Sauerbruchstraße, 17475 Greifswald, Germany
2
Epilepsy Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
3
Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
[6–8], but the cumulative incidence rises with disease duration up to nearly 6% [2]. The underlying cause of epileptic seizures in MS is not well understood. Imaging studies in small samples of well characterized MS patients suggest grey matter pathology particularly in the temporal lobes to be associated with a higher risk of epilepsy [9–11]. On the other hand, seizures can be caused by several other brain pathologies such as traumatic injury, infection, neoplasia, or stroke [12–14], which can also occur in MS, especially with increasing disease duration [15]. In a v
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