Multipl Sklerozda Epileptik Nöbetler

Yıl 2020, Cilt: 6 Sayı: 2, 123 - 126, 05.06.2020

Rabia Gökçen Gözübatık Çelik , Mesrure Köseoğlu

https://doi.org/10.30934/kusbed.735739

Öz

Amaç: Epilepsi nöbeti Multipl Skleroz’un (MS) nadir bir prezentasyonudur. Bu çalışmada nöbetlerin MS’in seyri ile olan ilişkilerini, rekürren nöbetleri tetikleyebilecek faktörleri, status epileptikus prevelansını ve buna bağlı olarak epilepsi tedavisini başlama yada sürdürmedeki öngörümüzün oluşmasını amaçladık.
Yöntem: MS tanılı 995 hastadan epilepsi nöbeti geçiren 56’sı çalışmaya dahil edildi.Hastaların sosyodemografik verileri, hastalık süresi, MS atak sıklığı, nöbet sıklığı, elektroensefalografi bulguları, EDSS skorları Microsoft Office Excel'e kaydedildi.
Bulgular: Hastaların çoğu [%68’i (n:38)] kadındı. Ortalama yaş 28±10,5yıldı (min-max:18-61yıl). MS’in ilk atağı nöbet olan hasta 5 (%9) kişi idi. MS tipi ile nöbet varlığı açısından bir fark izlenmedi (p>0,05). Nöbet tipleri ile ortalama EDSS skoru ve MS atak sıklığı açısından karşılaştırıldığında anlamlı bir sonuca varılmadı (p>0,05). 56 hastanın %63’inde (n:35) rekürren nöbetler izlendi. 21 kişi ise 4 yıl boyunca tekrar nöbeti olmadı. Rekürren nöbet açısından CIS/RRMS olma ve ailede epilepsi öyküsü rekürren nöbetler için risk faktörleriydi (p<0,05). Rekürren nöbeti olanların 14 (%40)’ü interferon veya azatiopürin tedavileri; tek nöbeti olanların 8’i (%38) diğer oral MS-tedavilerini kullanmakta olup tedavi ve rekürren nöbet arasında anlamlı bir ilişki izlenmedi (p=0,301).
Sonuç: Rekürren nöbet için risk fakörlerini taşıyan MS hastalarının uygun antiepileptik tedaviye başlanarak takiplerinin yapılması önemlidir. 

Anahtar Kelimeler

Epilepsi, multipl skleroz, rekürren nöbet, risk faktörleri

Destekleyen Kurum

Bulunmamaktadır

Multiple Sclerosis and Epilepsy

Öz

Objective: Seizure is a rare presentation of Multiple Sclerosis (MS) patients. We aimed to establish the relationship between seizures and the course of MS, the factors that may trigger recurrent seizures, the prevalence of status epilepticus, and accordingly, our prediction to start or continue epilepsy treatment.
Methods: Fifty-six of 995 MS patients who had epileptic seizures were included. Sociodemographic data, disease duration, MS attack frequency, seizure frequency, electroencephalography, EDSS scores were recorded in Microsoft Office Excel.
Results: Most of the patients [68% (n:38)] were women. The mean age was 28 ± 10.5 years (min-max: 18-61 years). In 5 patients (9%), seizure had a first MS attack. There was no difference between MS type and seizure (p>0.05). No significant result was obtained when the types of seizures were compared in terms of mean EDSS score and MS attack frequency (p>0.05). Recurrent seizures were observed in 63% (n: 35) of 56 patients. 21 people did not have seizures again for 4 years. In terms of recurrent seizures, being CIS / RRMS and family history of epilepsy were risk factors for recurrent seizures (p<0.05). 14 (40%) using interferon or azathioprine in those with recurrent seizures; 8 of them (38%) were using other oral-MS-therapy only, and no significant relationship was observed between treatment and recurrent seizures (p=0.301).
Conclusion: It is important to follow-up with appropriate antiepileptic treatment of MS patients who carry risk factors for recurrent seizures. Epilepsy has no role in MS prognosis.

Anahtar Kelimeler

Epilepsy, multiple sclerosis, recurrent seizure, risk factors

Kaynakça

• Fisher RS, van Emde Boas W, Blume W, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4): 470-472.doi.org/10.1016/j.eplepsyres.2017.11.0 15.
• Calabrese M, Grossi P, Favaretto A, et al. Cortical pathology in multiple sclerosis patients with epilepsy: a 3year longitudinal study. J Neurol Neurosurg Psychiatry. 2012;83(1):49–54. doi:10.1136/jnnp-2011-300414.
• Compston A, Coles A. Multiple sclerosis. Lancet. 2008; 372:1502–1517.
• Geurts JJ, Bö L, Pouwels PJ, Castelijns JA, Polman CH, Barkhof F. Cortical lesions in multiple sclerosis: combined post-mortem MR imaging and histopathology. Am J Neuroradiol. 2005; 26:572–577.
• Aarli JA. Epilepsy and the immune system. Arch Neurol. 2000; 57(12):1689-1692.
• Amhaoul H, Staelens S, Dedeurwaerdere S. Imaging Brain Inflammation in Epilepsy. Neuroscience. 2014; 24:238-252. doi:10.1016/j.neuroscience.2014.08.044.
• Ransohoff RM, Perry VH. Microglial physiology: unique stimuli, specialized responses. Annu Rev Immunol. 2009; 27:119-145.
• Rocca MA, Amato MP, De Stefano N, et al. Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. The Lancet Neurology. 2015; 14: 302–317. doi:10.1016/S1474-4422(14)70250-9.
• Liu Z, Pardini M, Yaldizli Ö, et al. Magnetization transfer ratio measures in normal-appearing white matter show periventricular gradient abnormalities in multiple sclerosis. Brain. 2015; 138, 1239–1246. doi:10.1093/brain/awv065.
• Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018; 17:162–173. doi:10.1016/S1474-4422(17)30470-2.
• Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of epilepsies: position paper on the ILAE commission for classification and terminology. Epilepsia. 2017; 58:512–521. doi:10.1111/epi.13709.
• Fisher RS, Cross JH, French JA, et al. Operational classification of seizure types by the International league against epilepsy. Position Paper of the ILAE commission for classification and terminology. Epilepsia. 2017; 58:522–530. doi:10.1016/j.yebeh.2017.03.022.
• Lund C, Nakken KO, Edland A, Celius EG. Multiple sclerosis and seizures: Incidence and prevalence over 40 years. Acta Neurologica Scandinavica. 2014; 130: 368–373. doi:10.1111 /ane.12276.
• Burman J, Zelano J. Epilepsy in multiple sclerosis: a nationwide population-based register study. Neurology. 2017; 89:2462–2468. doi:10.1212/WNL.0000000000004740.
• Langenbruch L, Krämer J, Güler S, et al. Seizures and epilepsy in multiple sclerosis: epidemiology and prognosis in a large tertiary referral center. Journal of Neurology. 2019; 266:1789–1795. doi:10.1007/s00415-019-09332-x.
• Shekh-Ahmad T, Eckel R, Dayalan Naidu S, et al. KEAP1 inhibition is neuroprotective and suppresses the development of epilepsy. Brain 2018; 141:1390–1403. doi:10.1093/brain /awy071.
• Schorner A, Weissert R. Patients with Epileptic Seizures and Multiple Sclerosis in a Multiple Sclerosis Center in Southern Germany Between 2003–2015. Front. Neurol. 2019; 10:613. doi:10.3389/fneur.2019.00613.
• Zeqiraj K, Shatri N, Kruja J, et al. Epileptic Seizures in Multiple Sclerosis Patients. Turkish Journal of Neurology. 2013; 19:40-43.
• Catenoix H, Marignier R, Ritleng C, et al. Multiple sclerosis and epileptic seizures. Mult Scler. 2011; 17:96–102. doi:10. 1177/1352458510382246.
• Sponsler JL, Kendrick-Adey AC. Seizures as a manifestation of multiple sclerosis. Epileptic Disord. 2011; 13:401–410. doi:10.1684/epd.2011.0468.