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Epilepsy in MS and its association with cognitive and psychological burden

Valeria Pozzilli1,2, Carla Tortorella3, Luca Prosperini3

  • 1Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Campus Bio-Medico University, Rome, Italy.

Multiple Sclerosis Journal - Experimental, Translational and Clinical
|August 4, 2025
PubMed
Abstract

Insights

Patients with multiple sclerosis and epilepsy (MS+E) experience more cognitive impairment, especially in processing speed and visuospatial memory. This highlights the need for specialized care for MS+E patients to improve their quality of life.

Area of Science:

  • Neurology
  • Neuroscience
  • Clinical Medicine

Background:

  • Epilepsy is 2-3 times more common in patients with multiple sclerosis (pwMS) than the general population.
  • Patients with MS and epilepsy (MS+E) exhibit greater cortical damage compared to those without epilepsy (MS-E).
  • Distinct cognitive and neuropsychological features in MS+E patients requiring specific management remain unclear.

Purpose of the Study:

  • To investigate the cognitive and neuropsychological profiles of MS+E patients.
  • To determine if MS+E patients exhibit distinct features necessitating tailored management strategies.
  • To compare cognitive impairment prevalence and specific deficits between MS+E and MS-E patients.

Main Methods:

  • A cohort of pwMS from three centers was analyzed, identifying MS+E patients.
  • A matched group of MS-E patients was included for comparison.
  • Cognitive and neuropsychiatric tests were administered, defining cognitive impairment (CI) as scoring ≥1.5 SD below normative values in ≥1 domain.

Main Results:

  • Cognitive impairment (CI) was more prevalent in MS+E patients (n=33) than in MS-E patients (n=33).
  • MS+E patients demonstrated significantly lower processing speed (p<0.01) and visuospatial memory (p=0.03).
  • MS+E was independently associated with CI (OR 3.6), with somatization, phobia, anxiety, and depression being the most affected neuropsychological domains.

Conclusions:

  • MS+E is linked to increased cognitive impairment, particularly affecting processing speed and visuospatial memory.
  • Psychological distress is prevalent in MS+E patients and negatively correlates with processing speed.
  • Targeted, multidisciplinary care is essential for MS+E patients to enhance outcomes and quality of life.
Keywords:
Multiple sclerosiscognitive impairmentdamageepilepsyneuropsychological dysfunctionseizure

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