Prognostic impact of epilepsy in multiple sclerosis

Area of Science:

• Neurology
• Epidemiology
• Clinical Research

Background:

• Multiple sclerosis (MS) is associated with a higher incidence of epilepsy.
• The impact of epilepsy on multiple sclerosis prognosis and mortality remains largely uncharacterized.

Purpose of the Study:

• To investigate the association between acquired epilepsy and mortality in patients with multiple sclerosis.
• To examine epilepsy as a cause of death in MS and its link to conversion to secondary progressive MS (SPMS).

Main Methods:

• Nationwide Swedish MS register-based cohort study of 10,383 MS patients (onset 1991-2014) without prior epilepsy.
• Utilized comprehensive national registers for epilepsy diagnosis and cause of death data.
• Employed Cox regression to estimate adjusted hazard ratios (HR) for mortality and SPMS conversion.

Main Results:

• Epilepsy diagnosis in MS patients was associated with a 3.85-fold increased adjusted hazard ratio for death.
• Mortality risk was significantly higher in relapsing-onset MS (ROMS) with epilepsy (HR 5.48), especially in SPMS (HR 6.66).
• Epilepsy was the underlying cause of death in 4.55% of MS patients with epilepsy; MS was the stated cause in 50%.

Conclusions:

• Epilepsy in MS is a significant marker of severe disease and is associated with substantially increased mortality.
• While epilepsy itself is rarely the stated cause of death, it is most lethal when developing in secondary progressive MS.
• No association was found between epilepsy diagnosis and subsequent conversion to secondary progressive MS.