First and foremost a very Happy New Year everyone!

And now to the topic that I’ve selected for today, Epilepsy in MS. This is something very rare in MS and mainly seen in established or severe MS.

Epilepsy can generally be divided into two forms – focal = there is focus of onset that is visible from the start or generalised = no focus per se, but the whole brain is affected and is associated with loss of consciousness.

In the focal epilepsies there is a sub-type of epilepsy called epilepsia partialis continua (EPC). Here the individual experiences recurrent and sometimes relentless focal onset seizure activity. They can be difficult to treat and be resistant to anti-epileptic medications in some instances leading to them lasting days, months or even years.

Their prognosis is largely dependent on the underlying cause, and it is therefore important to identifying the initial focus. I once had a gentleman with an unusual skull lesion overlying the brain just above the motor strip resulting in a limp arm and occasional jerking of this arm. The brain scan showed with associated swelling of the brain cortex in this area. This was biopsied and later proven to be Pott’s disease of the skull (Tuberculosis), but interestingly by removing the offending area of skull the biopsy in fact cured the seizure activity (a definite House moment for me!).

Interestingly, in the case of MS the treatment seems to be giving high dose corticosteroids. What this implies is that EPC in MS is either likely to be caused by MS lesions or activity within these lesions. The latter can be present even in the absence of a corresponding lesion on MRI brain scans, as cortical lesions are not picked up on standard MRI due to poor resolution. It is important that your treating doctors are aware of this as a treatment option should you present similarly and have MS.

Abstract

Clin Neurol Neurosurg. 2021 Dec 21;213:107099. doi: 10.1016/j.clineuro.2021.107099. Online ahead of print.

Epilepsia partialis continua in relapsing-remitting multiple sclerosis: A possible distinct relapse phenotype

Justin Jain , Maksim Son, Derek B Debicki, Mandar Jog , Courtney S Casserly , Jorge G Burneo , Adrian Budhram 

Epilepsia partialis continua (EPC) is a rare phenomenon in multiple sclerosis (MS). We describe a patient with relapsing-remitting MS and three episodes of EPC, with refractoriness to anti-seizure drugs but corticosteroid-responsiveness. No lesions likely attributable to her episodes of EPC were seen on 1.5 Tesla MRI, which we hypothesize was due to the small volume of presumed cortical/juxtacortical lesions involving the primary motor cortex. The association with relapsing-remitting disease, corticosteroid responsiveness, and dissemination of episodes of EPC in both space and time in our patient suggest that EPC may represent a distinct relapse phenotype in MS.