N.V. TOLSTYKH, N.Yu. KOROLEVA, I.D. STOLYAROV

N.P. Beсhtereva Institute of the Human Brain of the Russian Academy of Sciences, Saint Petersburg

Contact details:

Tolstykh N.V. — neurologist of the Neurology laboratory of the Out-patient and Consaltative Department

Address: 9 Akadenika Pavlova St., Saint Petersburg, Russian Federation, 197376, tel.: +7-981-741-84-18, e-mail: Zaratustra-e@yandex.ru

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, with a wide range of signs and symptoms. Although seizures are a rare manifestation of MS, a number of studies have shown that the risk of seizures and epilepsy in patients with multiple sclerosis is 3-6 times higher than in the general population. The role of gray matter in the development of the disease clinical manifestations was shown in the works of several authors. These findings made it possible to adequately explain epileptic seizures in multiple sclerosis.

The purpose of this work was to clarify the elements of the MS pathogenesis, which lead to the development of symptomatic epilepsy, and the features of the epileptic process in patients with MS.

Material and methods. 16 patients with MS and epileptic seizures were investigated. Demyelinization foci were determined with intravital neurovisualization techniques – contrasting MRT and targeted visualization of hippocampus, as well as positron-emission tomography with 18Fdesoxiglucose.

Results. An increase in neurological deficit after seizures was observed in one third of patients (31,25%). In 13 patients out of 16 (81,25%), epileptic-form patterns were observed in 2 or more areas, which is probably due to multi-focal lesion on MRI. Association was not found between the number of demyelination foci on MRI and the epilepsy severity.

Conclusion. In patients with MS combined with epilepsy, the brain structures (white and gray matter) showed clinical and radiological signs of inflammation. These manifestations can lead to activation of the latent focus of epileptic activity due to metabolic disorders accompanying the chronic inflammatory process and changes in the cerebral microenvironment (for example, neuronal irrigation and their increased excitability due to depolarization due to increased permeability of the cell membrane by antibodies, cytokines and other immune factors). We have shown that the clinical manifestations of epilepsy in MS patients are determined not by the number but by the activity of inflammatory foci.

Key words: multiple sclerosis, symptomatic epilepsy, pathogenesis, video-EEG monitoring.

(For citation: Tolstykh N.V., Koroleva N.Yu., Stolyarov I.D. Peculiarities of epileptic process in MS patients. Practical Medicine. 2019. Vol. 17, № 7, P. 67-73)

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