Abstract：
Although more common than in the general population, seizures are an atypical manifestation of multiple sclerosis (MS) and their pathophysiology is not well understood. This study aims to examine the prevalence, clinical characteristics, brain imaging findings and course of epilepsy, presenting in patients with MS.
Observational retrospective study of MS patients evaluated at a single MS reference center in Buenos Aires, Argentina, between 2011 and 2022, focusing on those who developed epilepsy (EMS). Clinical, demographic, and prognostic factors were evaluated and compared to a control group of non-epileptic MS patients (NEMS). To analyze specific epilepsy characteristics, a second control group of patients with non-lesional focal epilepsy (FNLE) was also included.
Twenty-five patients (18 women), were diagnosed with epilepsy, corresponding to a prevalence of 1.95%. Comparison of brain imaging characteristics between EMS and NEMS patients showed brain atrophy (32% vs 6.1%, p<0.01), as well as cortical (26% vs 4%, p=0.03) and juxtacortical lesions (84% vs 55%, p=0.05), were more frequent in EMS patients. However, after multivariate analysis, cortical atrophy was the only variable linked to a significant increase in risk of epilepsy (OR 24, 95%CI=2.3-200, p<0.01). No significant differences in clinical characteristics, disease activity, disability levels, response to disease modified treatment (DMT) or lack of DMT efficacy were observed between MS patients with or without epilepsy. Most patients received anti-seizure medication (ASM), and seizure control was better in EMS than in FNLE patients (92% vs 58%, p=0.022) with no differences found in drug resistance. We did not find predictors of seizure recurrence in the population studied.
We observed a lower prevalence of epilepsy in this group of MS patients, compared to other reported cohorts. Although epilepsy seems to have a benign course in MS patients, cortical atrophy appears to be an important contributor to the development of secondary epilepsy in MS patients. Further investigations will be necessary to identify risk factors or biomarkers predicting increased epilepsy risk in MS.
Observational retrospective study of MS patients evaluated at a single MS reference center in Buenos Aires, Argentina, between 2011 and 2022, focusing on those who developed epilepsy (EMS). Clinical, demographic, and prognostic factors were evaluated and compared to a control group of non-epileptic MS patients (NEMS). To analyze specific epilepsy characteristics, a second control group of patients with non-lesional focal epilepsy (FNLE) was also included.
Twenty-five patients (18 women), were diagnosed with epilepsy, corresponding to a prevalence of 1.95%. Comparison of brain imaging characteristics between EMS and NEMS patients showed brain atrophy (32% vs 6.1%, p<0.01), as well as cortical (26% vs 4%, p=0.03) and juxtacortical lesions (84% vs 55%, p=0.05), were more frequent in EMS patients. However, after multivariate analysis, cortical atrophy was the only variable linked to a significant increase in risk of epilepsy (OR 24, 95%CI=2.3-200, p<0.01). No significant differences in clinical characteristics, disease activity, disability levels, response to disease modified treatment (DMT) or lack of DMT efficacy were observed between MS patients with or without epilepsy. Most patients received anti-seizure medication (ASM), and seizure control was better in EMS than in FNLE patients (92% vs 58%, p=0.022) with no differences found in drug resistance. We did not find predictors of seizure recurrence in the population studied.
We observed a lower prevalence of epilepsy in this group of MS patients, compared to other reported cohorts. Although epilepsy seems to have a benign course in MS patients, cortical atrophy appears to be an important contributor to the development of secondary epilepsy in MS patients. Further investigations will be necessary to identify risk factors or biomarkers predicting increased epilepsy risk in MS.
摘要：
目标：虽然比一般人群更常见，癫痫发作是多发性硬化症（MS）的非典型表现，其病理生理学尚不清楚。这项研究旨在检查患病率，临床特征,脑成像结果和癫痫的病程，出现在MS患者身上。
方法：在布宜诺斯艾利斯的单一MS参考中心评估的MS患者的观察性回顾性研究，阿根廷,在2011年至2022年之间，重点关注那些患有癫痫（EMS）的人。临床,人口统计学,和预后因素进行了评估，并与非癫痫性MS患者（NEMS）的对照组进行了比较。分析癫痫的具体特点，第二个对照组为非病灶局灶性癫痫(FNLE)患者.
结果：25名患者（18名女性），被诊断为癫痫，相应的患病率为1.95%。EMS和NEMS患者的脑影像学特征比较显示脑萎缩（32％vs6.1％，p<0.01),以及皮质(26%对4%，p=0.03）和近区病变（84%vs55%，p=0.05)，在EMS患者中更为常见。然而,经过多变量分析，皮质萎缩是与癫痫风险显著增加相关的唯一变量(OR24,95CI=2.3-200,p<0.01).临床特征无显著差异，疾病活动,残疾水平,在有或没有癫痫的MS患者之间观察到疾病改良治疗(DMT)的反应或缺乏DMT疗效.大多数患者接受了抗癫痫药物（ASM），EMS患者的癫痫发作控制优于FNLE患者(92%vs58%，p=0.022），耐药性没有差异。我们在研究人群中没有发现癫痫发作复发的预测因素。
结论：我们观察到此组MS患者的癫痫患病率较低，与其他报告的队列相比。虽然癫痫在MS患者中似乎有良性病程，皮质萎缩似乎是MS患者继发性癫痫发展的重要因素.需要进一步的研究来确定预测MS癫痫风险增加的风险因素或生物标志物。
方法：在布宜诺斯艾利斯的单一MS参考中心评估的MS患者的观察性回顾性研究，阿根廷,在2011年至2022年之间，重点关注那些患有癫痫（EMS）的人。临床,人口统计学,和预后因素进行了评估，并与非癫痫性MS患者（NEMS）的对照组进行了比较。分析癫痫的具体特点，第二个对照组为非病灶局灶性癫痫(FNLE)患者.
结果：25名患者（18名女性），被诊断为癫痫，相应的患病率为1.95%。EMS和NEMS患者的脑影像学特征比较显示脑萎缩（32％vs6.1％，p<0.01),以及皮质(26%对4%，p=0.03）和近区病变（84%vs55%，p=0.05)，在EMS患者中更为常见。然而,经过多变量分析，皮质萎缩是与癫痫风险显著增加相关的唯一变量(OR24,95CI=2.3-200,p<0.01).临床特征无显著差异，疾病活动,残疾水平,在有或没有癫痫的MS患者之间观察到疾病改良治疗(DMT)的反应或缺乏DMT疗效.大多数患者接受了抗癫痫药物（ASM），EMS患者的癫痫发作控制优于FNLE患者(92%vs58%，p=0.022），耐药性没有差异。我们在研究人群中没有发现癫痫发作复发的预测因素。
结论：我们观察到此组MS患者的癫痫患病率较低，与其他报告的队列相比。虽然癫痫在MS患者中似乎有良性病程，皮质萎缩似乎是MS患者继发性癫痫发展的重要因素.需要进一步的研究来确定预测MS癫痫风险增加的风险因素或生物标志物。
