Epilepsy associated with multiple sclerosis (сurrent state of the problem)

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Abstract
This article provides an overview of the current state of the problem regarding the comorbidity of multiple sclerosis (MS) and epileptic seizures (ES). Epilepsy occurs in patients with MS 3–6 times more often than in the general population; however, its prevalence and clinical manifestations are variable. The pathogenetic link between the two conditions is bidirectional: demyelination and gray matter atrophy in MS contribute to epileptogenesis, while epileptic activity itself can exacerbate neurodegeneration. The clinical manifestations of ES in MS are heterogeneous and can include both focal and generalized seizures, which often serve as the first manifestation of the demyelinating disease. Electroencephalography and cerebral magnetic-resonance imaging play a crucial role in diagnosis, revealing focal activity and structural changes in the cortex. Treatment requires a comprehensive approach, whereby some disease-modifying therapies for MS and antiepileptic drugs can have a mutually positive influence. Conclusion. The comorbidity of multiple sclerosis and epilepsy is a complex problem due to shared pathogenetic mechanisms and mutual aggravating influence. Diagnosing epileptic seizures in MS can be challenging due to the variable clinical picture and non-specific changes on electroencephalogram. Given the high risk of developing epilepsy in this patient category and its potential impact on the progression of disability, neurologists need to maintain a high index of diagnostic suspicion. Further research in this area should be devoted to optimal treatment strategies aimed at both conditions simultaneously.

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