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Seizures and epilepsy in multiple sclerosis: epidemiology and prognosis in a large tertiary referral center

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Abstract

Background

Seizures and epilepsy may substantially add to the burden of disease in multiple sclerosis (MS), whereas the exact prevalence and prognosis of seizures and epilepsy in patients with MS remains largely unknown.

Objectives

We aimed to investigate the epidemiology and prognosis of seizures and epilepsy in MS.

Methods

We retrospectively analyzed a cohort of 4078 MS patients from a single tertiary referral clinic.

Results

After excluding 37 patients with unconfirmed MS and alternative seizure etiologies, we found seizures attributable to MS in 1.5% and epilepsy in 0.9% of patients. 40.4% of patients with a follow-up of at least twelve months experienced only a single seizure and 59.6% had recurring seizures. 39% of patients with recurrent seizures were considered drug-resistant, with 9.7% experiencing status epilepticus. Seizure recurrence after a first seizure depended significantly on the MS subtype and was seen more often if the first seizure occurred simultaneously with a MS relapse than in the absence of a relapse.

Conclusion

Our study shows a lower number of seizures and epilepsy in MS than previously reported. While a single seizure in MS usually has a good prognosis, relapse-associated seizures and established epilepsy in MS may not be as benign as previously assumed.

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Notes

  1. *Served as a wildcard character.

Abbreviations

CIS:

Clinically isolated syndrome

CNS:

Central nervous system

DMT:

Disease-modifying therapy

ICD:

International Classification of Diseases

MS:

Multiple sclerosis

PPMS:

Primary progressive multiple sclerosis

RRMS:

Relapsing-remitting multiple sclerosis

SPMS:

Secondary progressive multiple sclerosis

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Funding

This work was supported by the medical Faculty of the University of Münster (17-003 and 18-002 fellowship to SK and JK) and Ursula von Euch Stipend (fellowship to SK).

Author information

Author notes

  1. Lisa Langenbruch, Julia Krämer, Sven G. Meuth, and Stjepana Kovac contributed equally to this article.

Authors and Affiliations

  1. Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany

    Lisa Langenbruch, Julia Krämer, Sati Güler, Gabriel Möddel, Nico Melzer, Christian E. Elger, Heinz Wiendl, Sven G. Meuth & Stjepana Kovac

  2. Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, 48149, Münster, Germany

    Sophia Geßner

  3. Beta Neurologie, Kompetenzzentrum für Epileptologie, Joseph-Schumpeter-Allee 15, 53277, Bonn, Germany

    Christian E. Elger

  4. Institute of Physiology I, University of Münster, Robert-Koch-Straße 27a, 48149, Münster, Germany

    Thomas Budde

  5. Klinik für Neuropädiatrie, Charite, Berlin, Germany

    Christian E. Elger

Authors
  1. Lisa Langenbruch
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  2. Julia Krämer
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  3. Sati Güler
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  4. Gabriel Möddel
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  6. Nico Melzer
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  7. Christian E. Elger
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  8. Heinz Wiendl
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  9. Thomas Budde
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  10. Sven G. Meuth
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Contributions

SK, SGM and JK conceived the study and defined the concept, SK and LL statistically analyzed and interpreted the data and wrote the initial draft of the manuscript. JK revised the manuscript for intellectual content and together with LL prepared the figures for the manuscript. SG performed the database query. SGÜ, SK, LL and JK screened the clinic letters and collected the data. SGM, TB, CEE, GM, HW, NM advised on the study concept and interpreted some of the data. All authors contributed to the concept of the work and writing the manuscript, critically discussed the data and approved the version to be published.

Corresponding author

Correspondence to Stjepana Kovac.

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Conflicts of interest

Prof. S. G. Meuth has received honoraria for lecturing, travel expenses for attending meetings and financial research support from Almirall, Amicus Therapeutics GmbH Deutschland, Bayer Health Care, Biogen, Celgene, Diamed, Genzyme, MedDay Pharmaceuticals, Merck Serono, Novartis, Novo Nordisk, ONO Pharma, Roche, Sanofi-Aventis, Chugai Pharma, QuintilesIMS und Teva. Dr. J. Krämer received honoraria for lecturing from Biogen, Novartis, Mylan and Teva, and financial research support from Sanofi Genzyme. Prof. H. Wiendl has received honoraria for lecturing and travel expenses for attending meetings from Actelion, Alexion, Biogen, Cognomed, F. Hoffmann-La Roche Ltd., Gemeinnützige Hertie-Stiftung, Lundbeck, Merck Serono, Novartis, Roche Pharma AG, Sanofi-Genzyme, TEVA, WebMD Global, for scientific advisory boards/steering committees from Biogen, Evgen, MedDay Pharmaceuticals, Merck Serono, Novartis, Roche Pharma AG, Sanofi-Genzyme, and compensation for serving as a consultant for Abbvie, Actelion, Biogen, Immunic AG, Novartis, Roche, RxMx, Sanofi-Genzyme, and research support from German Ministry for Education and Research (BMBF), Deutsche Forschungsgesellschaft (DFG), Else Kröner Fresenius Foundation, European Union, Fresenius Foundation, Hertie Foundation, NRW Ministry of Education and Research, Interdisciplinary Center for Clinical Studies (IZKF) Muenster and RE Children’s Foundation, PML Consortium, Swiss MS Society, Biogen GmbH, GlaxoSmithKline GmbH, Roche Pharma AG, Sanofi-Genzyme. Dr. S. Kovac has received honoraria for lecturing and advising from Sanofi Genzyme and Esai. Dr. L. Langenbruch has received honoraria for lecturing Eisai. S. Güler and S. Geßner have no competing interests. Dr. N. Melzer has received honoraria for lecturing and travel expenses for attending meetings from Biogen Idec, GlaxoSmith Kline, Teva, Novartis Pharma, Bayer Healthcare, Genzyme, Alexion Pharmaceuticals, Fresenius Medical Care, and Diamed and has received financial research support from Euroimmun, Fresenius Medical Care, Diamed, Alexion Pharmaceuticals, and Novartis Pharma. Prof. C. E. Elger has received honoraria from UCB, Desitin, BIAL, and Eisai, and grants from the Deutsche Forschungsgemeinschaft (DFG) and the Bundesministerium für Bildung und Forschung (BMBF). Dr. G. Möddel has received honoraria for lecturing and travel expenses from UCB Pharma, Eisai, Desitin, and Electrical Geodesics Inc. (EGI). Prof. T. Budde has received grants from Deutsche Forschungsgemeinschaft (DFG), the Bundesministerium für Bildung und Forschung (BMBF), Biogen and Bayer Healthcare.

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Informed consent was not obtained because of the retrospective nature of the study.

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Langenbruch, L., Krämer, J., Güler, S. et al. Seizures and epilepsy in multiple sclerosis: epidemiology and prognosis in a large tertiary referral center. J Neurol 266, 1789–1795 (2019). https://doi.org/10.1007/s00415-019-09332-x

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  • DOI: https://doi.org/10.1007/s00415-019-09332-x

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