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Multiple sclerosis (MS) is the most prevalent long-term inflammatory condition affecting the central nervous system in adults. However, seizures are rarely described as the first presentation of MS or as a sole manifestation of radiologically isolated syndrome (RIS) or clinically isolated syndrome (CIS). The diagnosis of MS typically requires clinical evidence of neurological deficits and supportive radiological findings; however, RIS is characterized by incidental magnetic resonance imaging (MRI) findings suggestive of MS in the absence of clinical symptoms. The management of RIS remains a subject of ongoing debate. Although the majority of individuals with RIS remain clinically asymptomatic, the presence of radiological lesions suggests a potential risk for progression to clinically definite MS. The decision to initiate disease-modifying therapies (DMTs) in RIS is influenced by factors such as lesion burden, lesion characteristics, and patient risk factors for conversion to MS. The association between RIS and epilepsy is not well established, and the timing of initiating long-term treatment in such cases remains uncertain. In cases where seizures occur in the context of RIS or CIS, it is important to balance the treatment of epilepsy with the careful monitoring of disease progression. While antiepileptic drugs (AEDs) may be necessary to control seizures, early initiation of DMTs may be considered to prevent further neurological damage and clinical exacerbations, particularly in patients with high-risk features on MRI. We report the case of a 29-year-old woman with no previous medical history who presented with an inaugural generalized tonic-clonic seizure with numerous MS-like demyelinating lesions in the supratentorial, brainstem and medullary areas and the presence of cerebrospinal fluid-specific oligoclonal bands. The AEDs were started after the second occurrence of seizures, raising the question of the mean time to start long-term treatment in MS/RIS/CIS disease., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hazim et al.)

We report the case of a 22-year-old mother with no medical history, admitted for gram-negative meningitis, identified as Pseudomonas aeruginosa , 15 days after spinal anaesthesia. She was initially treated with dual antibiotic therapy, consisting of ceftazidime (2g three times a day) and amikacin. The first lumbar puncture (LP) performed 10 days approximately after the beginning of the treatment found no bacterial growth on the CSF culture. However, after 21 days of well-conducted treatment, she relapsed, and the Pseudomonas aeruginosa was once again detected on the CSF culture. The therapeutic protocol was changed, and she began meropenem and ciprofloxacin, which was pursued for six weeks. She improved clinically and biologically and was discharged after nearly 90 days of hospitalisation., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hazim et al.)