F.A. KHABIROV^1,2, T.I. KHAYBULLIN^1,2, E.V. GRANATOV², L.A. AVERIANOVA², N.N. BABICHEVA², S.R. SHAKIRZYANOVA²

¹Kazan State Medical Academy, 36 Butlerov St., Kazan, Russian Federation, 420012

²Republican Clinical Diagnostic Center for Demyelinating Diseases of the MH of RT, 13 Vatutin St., Kazan, Russian Federation, 420021

Khabirov F.A. — D. Med. Sc., Professor, Head of the Department of Neurology and Manual therapy, tel. (843) 278-88-29, e-mail: rkdcdz@rkbvl.ru

Khaybullin T.I. — Cand. Med. Sc., Associate Professor of the Department of Neurology and Manual therapy, tel. (843) 278-88-29, e-mail: timuur@gmail.com

Granatov E.V. — Cand. Med. Sc., neurologist, tel. (843) 278-88-29, e-mail: rkdcdz@rkbvl.ru

Averianova L.A. — neurologist, tel. (843) 278-88-29, e-mail: rkdcdz@rkbvl.ru

Babicheva N.N. — neurologist, tel. (843) 278-88-29, e-mail: rkdcdz@rkbvl.ru

Shakirzyanova S.R. — neurologist, tel. (843) 278-88-29, e-mail: rkdcdz@rkbvl.ru

The epilepsy in multiple sclerosis (MS) still remains poor investigated. Review about the main controversies in the field of epilepsy in MS, including epidemiology, clinical, EEG and MRI characteristics, and treatment, is provided. In addition preliminary results of own investigations is provided. Aim — to investigate clinical, neurophysiological and neurovisualizational characteristics of epilepsy among patients with MS in Tatarstan Republic (RT). Patients and methods. 42 patients with epilepsy and MS were evaluated. Neurological examination, EEG and MRI were performed. Main results. The prevalence of epilepsy among patients with MS in RT was 2,6% (42/1610). The most frequent were partial (33,3%) and secondary generalized (71,2%) seizures. Epilepsy was associated with more rapid MS progression. In 19% of cases seizures occurred before diagnosis MS, in 29% they were associated with MS relapses, in 52% such association was not observed. Regional and generalized epileptiform discharges on EEG were noted in 42,8 and 9,5% respectively. Correlation of seizure pattern, epileptiform discharges and localization of lesions on MRI was noted in 23,8% cases. Antiepileptic therapy was successful only in 81% of cases. Conclusion. Epilepsy in MS is associated with poor prognosis and unsatisfied treatment response. Further investigations in this field are needed.

Key words: multiple sclerosis, epilepsy, epileptic seizures, electroencephalography.

REFERENCES

1. Khabirov F.A., Boyko A.N., Devlikamova F.I. et al. Klinicheskaya kartina, diagnostika i lechenie rasseyannogo skleroza: rukovodstvo dlya vrachey [The clinical picture, diagnosis and treatment of multiple sclerosis: a guide for physicians]. Kazan: Meditsina, 2010. 88 p.
2. Murray T.L. Multiple sclerosis: the history of a disease. NY: Demos, 2005. 594 p.
3. Kelley B.J., Rodriguez M. Seizures in patients with multiple sclerosis: epidemiology, pathophysiology and management. CNS Drugs, 2009, vol. 23 (10), pp. 805–815.
4. Buttner T., Hornig C.R., Dorndorf W. Multiple sclerosis and epilepsy. An analysis of 14 case histories. Nervenarzt, 1989, vol. 60 (5), pp. 262–267.
5. Nyquist P.A., Cascino G.D., Rodriguez M. Seizures in patients with multiple sclerosis seen at Mayo Clinic, Rochester, Minn, 1990-1998. Mayo Clin. Proc, 2001, vol. 76 (10), pp. 983–986.
6. Nyquist P.A., Cascino G.D., McClelland R.L. et al. Incidence of seizures in patients with multiple sclerosis: a population-based study. Mayo Clin. Proc, 2002, vol. 77 (9), pp. 910-912.
7. Sokic D.V., Stojsavljevic N., Drulovic J. et al. Seizures in multiple sclerosis. Epilepsia, 2001, vol. 42 (1), pp. 72-79.
8. Cheng M.Y., Wai Y.Y., Ro L.S. et al. Seizures and multiple sclerosis in Chinese patients: a clinical and magnetic resonance imaging study. Epilepsy Res, 2012, vol. 101 (1-2), pp. 166-173.
9. Nicholas R., Magliozzi R., Campbell G. et al. Temporal lobe cortical pathology and inhibitory GABA interneuron cell loss are associated with seizures in multiple sclerosis. Mult. Scler, 2015.
10. Etemadifar M., Abtahi S.H., Roomizadeh P. Epileptic seizures in multiple sclerosis: a population-based survey in Iran. Acta Neurolyu Belg, 2013, vol. 113 (3), pp. 271-278.
11. Koch M., Uyttenboogaart M., Polman S. et al. Seizures in multiple sclerosis. Epilepsia, 2008, vol. 49 (6), pp. 948-953.
12. Marrie R.A., Cohen J., Stuve O. et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: Overview. Multiple Sclerosis Journal, 2015, vol. 21, no. 3, p. 263-281.
13. Beghi E., Carpio A., Forsgren L. et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia, 2010, vol. 51 (4), pp. 671–675.
14. Olafsson E., Benedikz J., Hauser W.A. Risk of epilepsy in patients with multiple sclerosis: a population-based study in Iceland. Epilepsia, 1999, vol. 40 (6), pp. 745–747.
15. Poser C.M., Brinar V.V. Epilepsy and multiple sclerosis. Epilepsy Behav, 2003, vol. 4 (1), pp. 6–12.
16. Spatt J., Chaix R., Mamoli B. Epileptic and non-epileptic seizures in multiple sclerosis. J Neurol., 2001, vol. 248 (1), pp. 2–9.
17. Lund C., Nakken K.O., Edland A. et al. Multiple sclerosis and seizures: incidence and prevalence over 40 years. Acta Neurol. Scand, 2014, vol. 130 (6), pp. 368-373.
18. Allen A.N., Seminog O.O., Goldacre M.J. Association between multiple sclerosis and epilepsy: large population-based record-linkage studies. BMC Neurol, 2013, vol. 13, pp. 189.
19. Sponsler J.L., Kendrick-Adey A.C. Seizures as a manifestation of multiple sclerosis. Epileptic Disord, 2011, vol. 13 (4), pp. 401-410.
20. Kinnunen E., Wikstrom J. Prevalence and prognosis of epilepsy in patients with multiple sclerosis. Epilepsia, 1986, vol. 27 (6), pp. 729-733.
21. Bolay H., Ay H., Saygi S. et al. Late onset absence seizures in multiple sclerosis: a case report. Clin. Electroencephalogr, 1995, vol. 26 (2), pp. 124-130.
22. Striano P., Striano S., Carrieri P.B. et al. Epilepsia partialis continua as a first symptom of multiple sclerosis: electrophysiological study of one case. Mult. Scler, 2003, vol. 9 (2), pp. 199-203.
23. Lebrun C. Epilepsy and multiple sclerosis. Epileptic disorders, 2006, vol. 8, no. 1, pp. 55-58.
24. Maingueneau F., Honnorat J., Isnard J. et al. Partial non-convulsive status epilepsy in multiple sclerosis. Neurophysiol. Clin, 1999, vol. 29 (6), pp. 463-472.
25. Gasparini E., Benuzzi F., Pugnaghi M. et al. Focal sensory-motor status epilepticus in multiple sclerosis due to a new cortical lesion. An EEG-fMRI co-registration study. Seizure, 2010, vol. 19 (8), pp. 525-528.
26. Striano P., Orefice G., Brescia Morra V. et al. Epileptic seizures in multiple sclerosis: clinical and EEG correlations. Neurol. Sci, 2003, vol. 24 (5), pp. 322–328.
27. Eriksson M., Ben-Menachem E., Andersen O. Epileptic seizures, cranial neuralgias and paroxysmal symptoms in remitting and progressive multiple sclerosis. Mult. Scler, 2002, vol. 8 (6), pp. 495–499.
28. Martinez-Juarez I.E., Lopez-Meza E., Gonzalez-Aragon Mdel C. et al. Epilepsy and multiple sclerosis: Increased risk among progressive forms. Epilepsy Res, 2009, vol. 84 (2–3), pp. 250–253.
29. Calabrese M., Grossi P., Favaretto A. et al. Cortical pathology in multiple sclerosis patients with epilepsy: a 3 year longitudinal study. J. Neurol. Neurosurg. Psychiatry, 2012, vol. 83 (1), pp. 49–54.
30. Catenoix H., Marignier R., Ritleng C. et al. Multiple sclerosis and epileptic seizures. Mult. Scler, 2011, vol. 17 (1), pp. 96–102.
31. Etemadifar M., Abtahi S.H., Tabrizi N. Epileptic seizures in early-onset multiple sclerosis. Arch. Iran Med, 2012, vol. 15 (6), pp. 381–383.
32. Etemadifar M., Abtahi S.H., Roomizadeh P. Epileptic seizures in multiple sclerosis: a population-based survey in Iran. Acta Neurologica Belgica, 2013, vol. 113, no. 3, pp. 271–278.
33. Durmus H., Kurtuncu M., Tuzun E. et al. Comparative clinical characteristics of early- and adult-onset multiple sclerosis patients with seizures. Acta Neurol. Belg, 2013, vol. 113 (4), pp. 421–426.
34. Ghezzi A., Montanini R., Basso P.F. et al. Epilepsy in multiple sclerosis. Eur. Neurol, 1990, vol. 30 (4), pp. 218–223.
35. Shaygannejad V., Ashtari F., Zare M. et al. Seizure characteristics in multiple sclerosis patients. J. Res. Med. Sci, 2013, vol. 18 (suppl 1), pp. S74-77.
36. Korwin-Piotrowska T., Nocon D. Is there any correlation between cerebral atrophy, EEG abnormalities and epileptic attacks in patients with multiple sclerosis? Neurol. Neurochir. Pol, 1999, vol. 33 (6), pp. 1305–1310.
37. Papathanasiou E.S., Pantzaris M., Myrianthopoulou P. et al. Brainstem lesions may be important in the development of epilepsy in multiple sclerosis patients: an evoked potential study. Clin. Neurophysiol, 2010, vol. 121 (12), pp. 2104–2110.
38. Martinez-Lapiscina E.H., Ayuso T., Lacruz F. et al. Cortico-juxtacortical involvement increases risk of epileptic seizures in multiple sclerosis. Acta Neurol. Scand, 2013, vol. 128 (1), pp. 24–31.
39. Calabrese M., De Stefano N., Atzori M. et al. Extensive cortical inflammation is associated with epilepsy in multiple sclerosis. J. Neurol, 2008, vol. 255 (4), pp. 581–586.
40. Kelley B.J., Rodriguez M. Seizures in patients with multiple sclerosis. CNS drugs, 2009, vol. 23, no. 10, pp. 805–815.
41. Schuele S.U., Kellinghaus C., Shook S.J. et al. Incidence of seizures in patients with multiple sclerosis treated with intrathecal baclofen. Neurology, 2005, vol. 64 (6), pp. 1086–1087.
42. Haupts M.R., Daum S., Ahle G. et al. Transcranial magnetic stimulation as a provocation for epileptic seizures in multiple sclerosis. Mult. Scler, 2004, vol. 10 (4), pp. 475–476.
43. Belova Yu.A., Yakushina T.I., Rudakova I.G., Kotov S.V. Epilepsy in patients with multiple sclerosis. The diagnosis and therapy. Nevrologiya, neyropsikhiatriya, psikhosomatika, 2014 (Special Issue 1), pp. 41–46 (in Russ.).