Multiple sclerosis (MS) can result in a wide range of symptoms, including seizures. In fact, up to 8 out of every 100 people with MS experience seizures — far more often than the average individual. Researchers have found that brain lesions that can occur in people with MS can lead to seizures. However, seizures can have other causes unrelated to MS.
“In the morning, early on, I had two seizures — then a [third] seizure [so] I went to the hospital,” wrote a MyMSTeam member. “I haven’t had a seizure in a year.”
Multiple sclerosis is a chronic disease of the brain and spinal cord, also referred to as the central nervous system, or CNS. Symptoms vary among people with MS, but cognitive and motor problems — including seizures — are among the most common.
Experiencing seizures can be frightening or stressful. Understanding their causes and effects, as well as potential treatments, can help.
The human brain is made up of neurons (brain cells) that allow people to think, speak, communicate, feel emotions, have personalities, and control the rest of our bodies. However, when a group of neurons suddenly becomes overactive and fires all at once, or when their connections are disturbed, different types of seizures can occur.
Seizures in general have many causes. For example, babies may get them if they have a high fever. Anyone can get seizures if their blood sugar or other electrolytes (like sodium) run especially low or high. These are called provoked seizures, meaning they are triggered by outside causes.
However, some people with seizures have unprovoked seizures, which occur suddenly without a direct, immediate external trigger. When people have many unprovoked seizures, they are said to have epilepsy, or a seizure disorder. Seizure symptoms can vary, depending on which part of the brain triggers them. Types of seizures include generalized, which involve the whole body, and partial, which involve a certain part of the body or function. MS seizures and epileptic seizures have the same symptoms.
MS causes brain lesions and plaques, which can lead to seizures. Chronic inflammation in areas of the brain can result in scarring of the underlying brain matter. This scarring can affect the normal connections between neurons, causing disarray that leads to an increased risk for recurrent seizures. For instance, MS flares that occur in a specific side and lobe of the brain may result in involuntary twitching of an arm or leg or strange sensations of taste or smell.
Researchers are still figuring out if MS-related seizures occur only during relapses. Some studies have indicated that a seizure may be the first symptom of MS, even before a diagnosis of MS is made (an MS diagnosis typically requires two episodes of some set of neurological symptoms).
Several risk factors have been identified for the development of seizures in people with MS. Most of these are the same risk factors for provoked, non-MS-related seizures as well. They include but are not limited to:
A diagnosis of MS is typically made during a medical exam, followed by an MRI brain scan. The diagnosis of epilepsy and seizures related to MS usually requires additional testing to monitor the brain’s activity across its different regions, such as an electroencephalogram, or EEG. Prior to this testing, your doctor may have you undergo an additional MRI after you’ve had a seizure to determine if you’re experiencing a flare or if your MS is progressing. Such findings could indicate the seizures are related to MS.
An EEG can be used to assess which part of the brain the seizures are coming from. The normal brain activity is displayed as spikes and waves on the EEG, but the part of the brain where seizures begin may have larger, more prominent spikes and waves. If the EEG and MRI findings both point to the same area of the brain, a doctor can more effectively make an MS-related epilepsy diagnosis.
Not all abnormal physical movements are seizures. Several conditions that are more common among people with MS may resemble the sudden jerking movements that can occur during a seizure episode. Some examples of these mimicking conditions include the following.
Trigeminal neuralgia is characterized by sudden attacks of intense, shooting nerve pains in one or both sides of the face, often triggered by otherwise mild facial stimulation such as brushing your teeth or putting on makeup. These jolting attacks of pain may feel like a seizure are not a sign of an actual seizure or epilepsy. Trigeminal neuralgia is more common among people living with MS. Fortunately, trigeminal neuralgia is usually treatable with medication.
This is a sign of spinal cord involvement from MS, and it’s characterized by a feeling of an electric shock running down the spine. The feeling can be stronger when you’re bending your neck forward. Like trigeminal neuralgia, these painful attacks can feel like a seizure, but they aren’t. The good news is, this symptom can often be treated without medications.
Choreoathetosis occurs when brain lesions in MS affect deeper brain structures that control fine movements. Therefore, this condition is defined by “dance-like” movements of the arms and legs that may seem seizure-like for many people. Choreoathetosis can now be treated with certain medications.
Treating seizures in people living with MS involves two main strategies: preventing seizures and controlling MS flares.
As with the treatment of other epilepsy conditions, treating MS-related epilepsy is often done with antiepileptic drugs (AEDs). Some of these drugs can also help with other symptoms of MS. For example, Tegretol (carbamazepine) and Neurontin (gabapentin) are AEDs that can also help with the management of MS-related nerve pain.
Currently, no single AED has been proven better than others in general, and the treatment choice will often depend on individual factors. The most common reason people stop using a particular AED is its side effects, so the specific drug that is best for you may depend on which one you can best tolerate.
Taking better control of your MS overall is generally thought to reduce your risk for developing seizures later on. Several medications that are commonly used to treat MS can also be utilized for those with MS-related seizures. However, some MS drugs may actually worsen seizures even while maintaining control of the other symptoms of your MS. These drugs include interferons and baclofen (e.g., Lioresal). Some newer and experimental drugs can worsen seizures as well.
“Were you put on any anti-seizure meds?” a MyMSTeam member asked a second member who’d experienced seizures. “The reason I ask is, as soon as I stopped those meds, the seizures slowly went away.”
You should talk with your doctor about which drugs, if any, may be right for you. They will weigh the benefits of using these medications to achieve control of your MS against the potential increased risks of seizures — which are often very small.
Beta interferons, including Rebif (interferon beta 1a) and Betaseron (interferon beta 1b), are widely used for preventing MS relapses. Major interferon medications include warning labels about an increased risk of seizures. However, whether this increase is significant is still the subject of debate within the medical and scientific community.
Baclofen has also been linked to seizures. A study of people with MS using baclofen reported a significantly increased rate of epilepsy — from 1 chance in 100 to 7 chances in 100.
Additionally, newer drugs undergoing testing, including Ampyra (dalfampridine), have warnings about seizure risk. Once again, your doctor can weigh the risks and benefits of starting or stopping these drugs.
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