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Purpose: The prevalence of epilepsy in patients with multiple sclerosis (MS) is three to six times the prevalence in the general population. Mechanisms resulting in increased seizure risk are not fully understood. Our objective is to characterize patients with MS and epilepsy regarding timing of diagnoses, MS and seizure (SZ) type, EEG findings suggesting cortical dysfunction, frequency of status epilepticus (SE), and seizure freedom., Methods: This was a single center retrospective study. Cases were obtained via DataDirect via the University of Michigan electronic medical record from January 1, 2006 through October, 12, 2016. The University of Michigan Health System is a large academic institute with a tertiary referral center and an Autoimmunity Center of Excellence. Patients were included if chart listed one or more of the top 62 epilepsy, and one or more of the top 2 MS, most frequently entered ICD9 and ICD10 codes. Patients with alternative epilepsy etiology were excluded. 74 of 361 patients were included. We collected information regarding demographics, MS and SZ type, age at diagnosis, imaging, EEG, seizure freedom, medications, and SE., Results: We found a high percentage of patients with SE. Most patients with imaging had multiple lesions at seizure onset. 27/54 of patients with EEG data showed electrographic evidence of cortical dysfunction. 6/8 of EEGs in PPMS showed features consistent with cortical dysfunction, followed by 9/17 in SPMS and 11/23 in RRMS. 7/8 of patients with PPMS showed EEG evidence of temporal lobe dysfunction., Conclusion: Time of seizure onset relative to MS diagnosis varied with MS type suggesting distinct pathophysiology. EEG results correspond with reports of increased cortical damage and temporal dysfunction in PPMS, but are unique as a functional modality (EEG) as indicator of gray matter dysfunction. EEG findings differed in RRMS and progressive MS suggesting possibility of supportive diagnostic marker. Our data suggests higher risk of SE in progressive MS and diminished rate of seizure freedom for MS patients with SE. We conclude that early treatment with antiseizure medication would be beneficial for MS patients with SE and with progressive MS forms and SZ, in agreement with previous studies., Competing Interests: Declaration of competing interest Y Mao-Draayer served as a consultant and/or received grant support from: Acorda, Bayer Pharmaceutical, Biogen Idec, EMD Serono, Sanofi-Genzyme, Genentech, Novartis, TG Therapeutics, Horizon, Janssen, Questor, and Teva Neuroscience. Y Mao-Draayer was supported by grants from NIH NIAID Autoimmune Center of Excellence: UM1-AI110557-05, UM1 AI144298-01, PCORI, Novartis, Sanofi-Genzyme, and Chugai. Others have nothing to disclose., (Copyright © 2023. Published by Elsevier Ltd.)

The article highlights the development of an epilepsy transition clinic, including identification of barriers and facilitators of developing specialty transition clinics between a children's and adult hospital. It focuses on development of the epilepsy transition clinic includes both a large urban pediatric hospital and separate university-affiliated adult hospital.

Introduction The prevalence of epilepsy (EP) in patients with multiple sclerosis (MS) is three to six times that of the prevalence in the general adult population. The mechanism resulting in an increased seizure risk is unclear. Seizures have been noted to occur prior to or during initial MS attack or relapses while others occur during progressive phases of MS, perhaps suggesting separate etiologies and treatment needs. Some preliminary evidence suggests a higher cortical-subcortical lesion load in MS/EP patients or increased cortical damage with more rapid accumulation of physical and cognitive disability. More recently, MRI studies have shown more severe damage of the temporal lobe in MS/EP patients compared to general MS patients. Demographically, MS/EP patients have been reported as having an earlier age of onset of MS and more rapid progression to disability. All types of seizures have been reported with studies reporting over 60% with partial component. Secondarily generalized seizures have been reported as the most common type. Generally, EP prognosis for MS/EP patients is thought to be good, although some research contradicts this with a high rate of status epilepticus that was often repeated and sometimes resulted in death. Specific treatment parameters and duration of antiepileptic treatment remains undefined. Due to a high rate of status epilepticus, initiation of antiepileptic medication after the first seizure has been proposed. Methods In this single center retrospective chart review we aimed to characterize patients with MS and seizures regarding timing of diagnoses, type of MS, type of seizure, subcortical versus cortical EEG findings, frequency of status epilepticus and seizure freedom. A secondary aim was to determine if there were predicting factors for eventual seizure freedom or status epilepticus. Cases were obtained via DataDirect from the University of Michigan electronic medical record from January 1, 2006 through October, 12, 2016 using EP and MS ICD9 and 10 codes. Results Thus far, 64 patients met inclusion criteria, 33% male. Average age of MS onset was 34 years of age and average age of seizure onset was 39 years of age. Focal seizures with or without secondary generalization were most common (12% with evidence of temporal etiology). Percent of status epilepticus was 28%. Of patients with EEG data, 52% showed evidence of cortical involvement. Conclusion In patients with MS and seizures, a high percentage of status epilepticus was noted. More than half of EEGs showed evidence of cortical involvement. [ABSTRACT FROM AUTHOR]