Service de neurologie, hôpital Pasteur, Nice, France
Epilepsy is three to six times more frequent in multiple sclerosis than in the general adult population. The probable anatomic basis for the seizures is areas of inflammation and demyelination in the cortex and juxtacortical white matter. Partial epilepsies with focal seizures often with atypical symptoms and with or without secondary generalisation are the usual pattern. Seizures can be observed as the first symptom of multiple sclerosis, or during relapses, with a direct correlation between paroxysmal phenomena and plaques demonstrated by brain MRI. Unfrequently, it can start during the progressive phase, without active inflammation, generally associated with brain atrophy and high lesion load. Generally, the prognosis of epilepsy in multiple sclerosis patients is estimated to be good, without special recommandations or consensus for the choice of anti-epileptic drug. Non-epileptic paroxysmal symptoms may be confused with epileptic seizures. It usually responds to many different anti-epileptic drugs.