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Article
November 8, 2017

Epilepsy in multiple sclerosis
A nationwide population-based register study

December 12, 2017 issue
89 (24) 2462-2468

Abstract

Objective:

To determine the cumulative incidence of epilepsy in a population-based cohort of patients with multiple sclerosis (MS) and to investigate the association between epilepsy and clinical features of MS.

Methods:

All available patients in the Swedish MS register (n = 14,545) and 3 age- and sex-matched controls per patient randomly selected from the population register (n = 43,635) were included. Data on clinical features of MS were retrieved from the Swedish MS register, and data on epilepsy and death were retrieved from comprehensive patient registers.

Results:

The cumulative incidence of epilepsy was 3.5% (95% confidence interval [CI] 3.17–3.76) in patients with MS and 1.4% (95% CI 1.30–1.52) in controls (risk ratio 2.5, 95% CI 2.19–2.76). In a Cox proportional model, MS increased the risk of epilepsy (hazard ratio 3.2, 95% CI 2.64–3.94). Patients with relapsing-remitting MS had a cumulative incidence of epilepsy of 2.2% (95% CI 1.88–2.50), whereas patients with progressive disease had a cumulative incidence of 5.5% (95% CI 4.89–6.09). The cumulative incidence rose continuously with increasing disease duration to 5.9% (95% CI 4.90–7.20) in patients with disease duration ≥34 years. Patients with an Expanded Disability Status Scale (EDSS) score ≥7 had a cumulative incidence of epilepsy of 5.3% (95% CI 3.95–7.00). Disease duration and EDSS score were associated with epilepsy after multiple logistic regression (odds ratio [OR] 1.03, 95% CI 1.01–1.04 per year, p = 0.001; and OR 1.2, 95% CI 1.09–1.26 per EDSS step, p < 0.0001).

Conclusions:

Epilepsy is more common among patients with MS than in the general population, and a diagnosis of MS increases the risk of epilepsy. Our data suggest a direct link between severity of MS and epilepsy.

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Supplementary Material

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REFERENCES

1.
Ross J. Treatise on the Diseases of the Nervous System. New York: William Wood & Co; 1881.
2.
Koch M, Uyttenboogaart M, Polman S, De Keyser J. Seizures in multiple sclerosis. Epilepsia 2008;49:948–953.
3.
Marrie RA, Reider N, Cohen J, et al. A systematic review of the incidence and prevalence of sleep disorders and seizure disorders in multiple sclerosis. Mult Scler 2015;21:342–349.
4.
Fiest KM, Sauro KM, Wiebe S, et al. Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology 2017;88:296–303.
5.
Charcot J. Lectures on the Diseases of the Nervous System. London: New Sydenham Society; 1881.
6.
van Munster CE, Jonkman LE, Weinstein HC, Uitdehaag BM, Geurts JJ. Gray matter damage in multiple sclerosis: impact on clinical symptoms. Neuroscience 2015;303:446–461.
7.
Gasparini S, Ferlazzo E, Ascoli M, et al. Risk factors for unprovoked epileptic seizures in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci 2017;38:399–406.
8.
Annegers JF. Epilepsy: Neuroepidemiology From Principles to Practice. New York: Oxford University Press; 2004:303–318.
9.
Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940–1980. Epilepsia 1991;32:429–445.
10.
Christensen J, Vestergaard M, Pedersen MG, Pedersen CB, Olsen J, Sidenius P. Incidence and prevalence of epilepsy in Denmark. Epilepsy Res 2007;76:60–65.
11.
Marrie RA, Patten SB, Tremlett H, et al. Sex differences in comorbidity at diagnosis of multiple sclerosis: a population-based study. Neurology Epub 2016 9 Mar.
12.
Thurman DJ, Beghi E, Begley CE, et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia 2011;52(suppl 7):2–26.
13.
Spatt J, Chaix R, Mamoli B. Epileptic and non-epileptic seizures in multiple sclerosis. J Neurol 2001;248:2–9.
14.
Catenoix H, Marignier R, Ritleng C, et al. Multiple sclerosis and epileptic seizures. Mult Scler 2011;17:96–102.
15.
Zelano J, Redfors P, Åsberg S, Kumlien E. Association between poststroke epilepsy and death: a nationwide cohort study. Eur Stroke J 2016;1:272–278.
16.
Kutzelnigg A, Lucchinetti CF, Stadelmann C, et al. Cortical demyelination and diffuse white matter injury in multiple sclerosis. Brain 2005;128:2705–2712.
17.
Vezzani A, Aronica E, Mazarati A, Pittman QJ. Epilepsy and brain inflammation. Exp Neurol 2013;244:11–21.
18.
Thygesen LC, Ersboll AK. When the entire population is the sample: strengths and limitations in register-based epidemiology. Eur J Epidemiol 2014;29:551–558.
19.
Ludvigsson JF, Andersson E, Ekbom A, et al. External review and validation of the Swedish national inpatient register. BMC Public Health 2011;11:450.
20.
Sveinsson O, Andersson T, Carlsson S, Tomson T. The incidence of SUDEP: a nationwide population-based cohort study. Neurology 2017;89:170–177.

Information & Authors

Information

Published In

Neurology®
Volume 89Number 24December 12, 2017
Pages: 2462-2468
PubMed: 29117950

Publication History

Received: April 19, 2017
Accepted: September 20, 2017
Published online: November 8, 2017
Published in print: December 12, 2017

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

This study was funded by the Swedish Society for Medicine.

Authors

Affiliations & Disclosures

Joachim Burman, MD, PhD*
From the Department of Neuroscience (J.B.), Uppsala University; and Department of Clinical Neuroscience (J.Z.), Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Sweden.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Biogen
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
1. MS research fund 2. Swedish Society for Medical Research 3. Swedish Society of Medicine
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Johan Zelano, MD, PhD*
From the Department of Neuroscience (J.B.), Uppsala University; and Department of Clinical Neuroscience (J.Z.), Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Sweden.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
Sahlgrenska university hospital (public hospital) since 2015
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Sahlgrenska university hospital, combined research-clinical position, 2017-2018
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Swedish society of medicine, grant no SLS-585141, (2) Gothenburg society of medicine, 16/589241, (3) Jeanssons foundation, 2014-0032, (4) Magnus Bergwall foundation, (5) Felix Neubergh foundation, 2016-281, (7) Margaretahemmet foundation.
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Zelano: [email protected]
*
These authors contributed equally to this work.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Joachim Burman: study design, data analysis, manuscript. Johan Zelano: study design, statistical analyses, data analysis, manuscript.

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  8. Relationship Between Multiple Sclerosis and Spiritual Distress, Journal of Pediatric Epilepsy, 12, 03, (089-090), (2023).https://doi.org/10.1055/s-0043-1764149
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