Epilepsy in patients with multiple sclerosis: specific features of diagnosis and therapy
Objective: to specify the epidemiology of MS in the Moscow Region and management tactics for patients with MS and epileptic seizures (ES). Patients and methods. Out of 906 patients diagnosed with MS, 9 (0.99%) (4 men and 5 women; mean age 28.62+4.59 years) were observed to have ES. The annual MS exacerbation rate was 1.2+1.19. Two MS patients were untreated for MS; 7 took MS-modifying drugs: interferon-ß1a (n=2) or glatiramer acetate (n=5). The course of epilepsy and MS was retrospectively assessed. Two patient groups were identified: the first diagnosis was epilepsy (Group 1) and MS (Group 2). The patients were followed up jointly by a MS center physician and an epileptologist. If they had any indications, the patients underwent brain contrast-enhanced magnetic resonance imaging (MRI) (at least 1.5 T) and electroencephalography (EEG), EDSS health assessment, antiepileptic therapy (AET) analysis and correction. Results. The incidence rate of ES in MS patients is about 1%, which is 2.5 times greater than that for the adult population in the Moscow Region. ESs are accompanied by secondary generalization in more than 60% of the cases; serial and status convulsive seizures are recorded in one third of the patients. More than half of ES cases are associated with MS exacerbations. Conclusion. The use of AET after the first ESs is justified due to a high risk of recurrent seizures. Complete ES control can be achieved by AET as monotherapy in more than 70% of cases. If EP occurs, the patients with MS should undergo contrast-enhanced MRI of the brain to rule out an exacerbation.