The effect of epilepsy on lifespan

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Approximately 30% of the general population are expected to experience a fit at some stage of their life. The occurrence of repeated fits (or epilepsy) is less common, and is more likely if you have underlying brain injury or abnormalities in you brain waves (as demonstrated by the electroencephalogram or EEG).

The risk of epilepsy, however, trebles when you have MS – affecting 3% of individuals with MS.

It is therefore logical to assume that on the balance of probabilities epilepsy occurring after MS is MS induced. Pathologically, it is thought that MS plaques involving the cortex (the surface of the brain where the nerve centers sit) and the sub-cortical regions (the region below the cortex) contribute most to the onset of epilepsy in MS. Although, little is known beyond this.

In a study conducted via the Swedish MS register of cases of epilepsy diagnosis after MS, an unlikely finding was the effect of epilepsy on lifespan in MS. Shockingly, in their analysis the authors found (see below for the abstract) that PwMS were x4 likely to die following a diagnosis of MS than controls (see Table 2 below).

But is this simply confounding? Since the risk was greatest in those with SPMS, indicating that epilepsy is more of an indicator of MS severity rather than a cause of death.

Although, the contribution of epilepsy should not be entirely discounted, as nearly 1 in 5 of those who died in this study had epilepsy recorded as an underlying or contributing cause of death.

Mult Scler Relat Disord. 2019 Nov 5;38:101497. doi: 10.1016/j.msard.2019.101497. [Epub ahead of print]

Prognostic impact of epilepsy in multiple sclerosis.

Mahamud Z, Burman J, Zelano J.

Abstract

BACKGROUND:

The incidence of epilepsy, a disease generally associated with increased morbidity and mortality, is increased in multiple sclerosis (MS) but its impact on MS prognosis is largely unknown.

OBJECTIVES:

To investigate the association between acquired epilepsy and mortality in MS and to examine the occurrence of epilepsy as a stated cause of death in MS. To examine the association between acquired epilepsy and subsequent conversion to secondary progressive MS (SPMS).

METHODS:

Using the Swedish MS register, we conducted a nationwide register-based cohort study including 10,383 patients with MS onset between 31/12/1991 and 31/12/2014, and with no history of epilepsy before MS onset. Data on epilepsy diagnosis and cause of death (COD) were extracted from comprehensive national registers. Cox regression was used to estimate hazard ratios (HR) of death stratified by MS course, and SPMS conversion after epilepsy diagnosis. The HRs were adjusted for age at MS onset and sex.

RESULTS:

The adjusted HR of death after epilepsy diagnosis for unselected MS patients was 3.85 (95% CI: 2.53-5.85). Stratifying by disease course, the adjusted HR of death after epilepsy diagnosis in primary progressive MS was 2.28 (95% CI: 0.99-5.26) and in relapsing-onset MS (ROMS), 5.48 (95% CI: 3.33-9.04). Further subdivision of ROMS revealed the adjusted risk of death after epilepsy diagnosis in relapsing remitting MS to be 3.84 (95% CI: 1.57-9.42) and 6.66 (95% CI: 3.18-13.92) in SPMS. Epilepsy was the underlying COD in 4.55% of MS patients with epilepsy. The majority (50%) of MS patients with epilepsy had MS as their stated underlying COD. Adjusted HR of conversion to SPMS after epilepsy diagnosis was 0.83 (95% CI: 0.45-1.56).

CONCLUSION:

Epilepsy in MS is associated with increased mortality although death from epilepsy is rare. Most MS patients with epilepsy died of MS, and epilepsy was most lethal when developed in SPMS. We thus suggest that development of epilepsy is a marker of severe MS. Despite this, we found no association between epilepsy and conversion to SPMS.

About the author

Neuro Doc Gnanapavan

2 comments

  • It looks like sodium channel blockage + DMT is neuroprotective, should we be taking anti-convulsants and get a double whammy, epilepsy prophylaxis and neuroprotection?

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