Seizure as an Atypical Presentation of New-Onset Multiple Sclerosis: A Case Report

Multiple sclerosis (MS) can present with a wide range of symptoms in affected individuals. We report the case of a 56-year-old African-American woman with a history of hypertension who was admitted to the hospital due to persistent generalized weakness and intermittent seizures. According to her son, these symptoms began after starting antihypertensive therapy. She had experienced multiple hospital admissions for intermittent weakness and received treatment for a UTI and ruptured acute appendicitis. During one admission, she was prescribed Keppra at a dose of 500 mg twice daily. However, her symptoms persisted with no significant improvement, leading to an increased Keppra dosage of 750 mg twice daily. Imaging studies, including CT scans from all admissions, showed chronic ischemic changes but no acute abnormalities. An EEG was normal, but an MRI of the head and cervical spine revealed lesions characteristic of MS, including white matter inflammation, demyelination, and scarring. Her symptoms resolved following treatment with a 500 mg pulse dose of steroids for an MS exacerbation. This case highlights that effective seizure management often improves with appropriate treatment of the underlying disease. Once MS was identified and treated, her seizures resolved, and she continued on 750 mg of Keppra.