Seizure Disorders in Multiple Sclerosis Patients

Seizure disorders represent an important comorbidity in multiple sclerosis (MS), with an estimated prevalence ranging from 2 % to 7 % compared with about 1 % in the general population. These events most often arise in patients with active cortical demyelination, where inflammatory plaques and neurodegenerative changes create focal hyperexcitability. Seizure types are typically focal in onset, often evolving to bilateral tonic-clonic activity, and may precede or follow the formal diagnosis of MS. Electroencephalography (EEG) and magnetic resonance imaging (MRI) are essential for distinguishing MS-related seizures from alternative causes such as stroke or traumatic injury. Clinically, seizure occurrence may signal an aggressive disease phenotype, influencing both prognosis and treatment choices. Management involves balancing disease-modifying therapies with antiseizure medications, mindful of drug interactions and side-effect profiles. As survival and quality of life improve for MS patients, understanding the mechanisms linking demyelination, grey matter pathology and neuronal hyperexcitability has become a priority. Emerging work on ion-channel dysfunction, cortical atrophy and network reorganisation promises to inform earlier detection, tailored pharmacotherapy and future neuroprotective strategies.

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Seizure Disorders in Multiple Sclerosis Patients publication trend

The graph below shows the total number of articles in seizure disorders in multiple sclerosis patients across all publications each year (not limited to Nature Index journals).

Technical terms

Demyelination: Loss of the myelin sheath insulating neuronal axons, leading to impaired nerve conduction and potential focal hyperexcitability.

Grey matter: Brain tissue containing neuronal cell bodies and synapses, whose involvement in MS is linked to cognitive and motor deficits and seizure generation.

Electroencephalography (EEG): Recording of electrical activity along the scalp used to detect abnormal brain rhythms and epileptiform discharges.

Epileptiform discharges: Paroxysmal EEG waveforms indicative of neuronal network instability and potential seizure focus.

Antiseizure medication (ASM): Pharmacological agents prescribed to reduce seizure frequency and severity by modulating neuronal excitability.

Relapsing-remitting MS (RRMS): MS subtype characterised by episodes of neurological dysfunction followed by periods of recovery.

Secondary progressive MS (SPMS): Phase of MS marked by gradual neurological decline with or without superimposed relapses.

Status epilepticus: Seizure activity persisting beyond five minutes or recurrent seizures without recovery, requiring urgent intervention.

References

1. Multiple sclerosis and seizures: incidence and prevalence over 40 years. Acta Neurologica Scandinavica (2014).
2. Epileptic seizures in multiple sclerosis: prevalence, competing causes and diagnostic accuracy. Journal of Neurology (2020).
3. Retention of antiseizure medications for epilepsy in multiple sclerosis: A retrospective observational study. Epilepsy & Behavior (2021).
4. Electroencephalographic evidence of gray matter lesions among multiple sclerosis patients. Medicine (2021).
5. The Cross Talk between Underlying Mechanisms of Multiple Sclerosis and Epilepsy May Provide New Insights for More Efficient Therapies. Pharmaceuticals (2021).