Seizures, Epilepsy, and Multiple Sclerosis

How they are connected and how symptoms can overlap

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As a neurological condition affecting the central nervous system, including the brain, it may not surprise you that having multiple sclerosis (MS) puts you at a slightly higher risk of seizures and epilepsy. In fact, an estimated 2 percent to 5 percent of people living with MS have epilepsy, compared with 1.2 percent of the general population. Epilepsy is thought to be about three times more common in MS.

Signs and Symptoms of a Seizure
Verywell / Cindy Chung

Causes

A seizure is caused by inappropriate or excessive electrical activity in the brain, usually in the cerebral cortex. Epilepsy is defined as recurring seizures caused by this sort of abnormal brain activity.

While scientists don't understand exactly why there's a higher risk of epilepsy when you have MS, it may be due to a complex interplay between the role of inflammation in both conditions and brain damage from MS lesions, which could lead to electrical disruptions. More research needs to be done to understand this connection.

Research shows that seizures, if they occur, most often begin sometime after the onset of MS. Some studies have also found a link between the severity of MS and the risk of epilepsy, meaning that the more severe the case of MS, the more common seizures seem to be.

Seizure Types

There are two general types under which seizures are classified: generalized and focal. As in the general population, the latter are the most common type in MS; close to 70 percent of seizures that occur in MS are focal.

Generalized Seizures

A generalized seizure involves your whole brain. There are six types of generalized seizures, but tonic-clonic seizures are the most common type in MS.

Tonic-clonic seizures are characterized by the loss of consciousness and muscular rigidity (the tonic phase) accompanied by convulsions (the clonic phase). Referred to in the past as grand mal seizures, they generally last for one to three minutes.

While they're distressing to witness, most people who experience a tonic-clonic seizure don't actually feel them. Afterward, the person will typically feel exhausted, washed-out, and disoriented. Head and bodily injury can sometimes occur if the person collapses when the seizure begins.

Focal Seizures

Focal seizures, which used to be called partial or localized seizures, are those that arise from a localized region of the brain. Their appearance is less dramatic than tonic-clonic seizures and, in some cases, may be hardly noticed by the person experiencing one.

These seizures are broadly classified as the following:

  • Focal aware seizures: Previously known as simple partial seizures, this type doesn't cause the person to lose consciousness; rather, it makes everything seem temporarily "off." People often describe feeling strange emotions or experiencing changes in how things look, sound, feel, smell, or taste. In some cases, the person’s muscles may stiffen or start twitching, usually on one side of the face or body.
  • Focal impaired awareness seizures: This type of seizure, which used to be called a complex partial seizure, also does not cause loss of consciousness but instead results in a sudden lack of awareness. It's as if the person "blanked out" rather than passed out. During the seizure, the person may not be able to respond and will often stare into space or act in a repetitive way such as rubbing their hands together, smacking their lips, gulping, or making repetitive sounds. In most cases, the person will not remember what happened after the attack is over.

Symptoms

Television shows and movie depictions of seizures often paint an incomplete picture of how they can be experienced. Seizures can vary significantly in their symptoms and severity—some are transient and nearly imperceptible, while others can be far more severe and unnerving.

Seizure symptoms depend on the type of seizure you're having, but in general, could include:

  • Loss of consciousness or awareness
  • Confusion, behavior changes 
  • Falls with no recalls or warning
  • Strange sensations and emotions
  • Uncontrollable jerking movements of arms and legs
  • Staring
  • Aura

It's important to note that many of the paroxysmal (sudden and brief) symptoms of MS, including spasticity, sensory distortions, and unexplained slurring, can mimic a seizure.

Diagnosis

You'll need to see a neurologist who can tell you if your symptoms are paroxysmal symptoms or actual seizures.

A brain wave test called an electroencephalogram (EEG) shows a difference between the two, so your doctor may order one to make this distinction. You may also have some other lab and/or imaging tests to confirm or rule out a diagnosis of epilepsy.

Though you may have been living with your MS for some time and feel well-acquainted with its effect on you, it's important that your doctor determine what's causing how you are feeling. Delaying a proper diagnosis if you are indeed having a seizure can lead to consequences and keep you from being properly treated.

Treatment

Seizures in people with MS tend to be mild and cause no permanent damage. In most cases, anticonvulsant medications are needed to control or entirely eliminate the seizures.

There are a variety of medications available to treat epilepsy, each with varying potential benefits and risks. In fact, some of these anticonvulsants are also used to treat MS symptoms like pain and tremors.

Some examples of anticonvulsants include:

  • Tegretol, Carbatrol (carbamazepine)
  • Neurontin (gabapentin)
  • Depakote, Depakene (valproic acid)
  • Topamax (topiramate)

The goal with both MS and epilepsy is to find what works the best in decreasing your symptoms and controlling your seizures while also keeping side effects to a minimum. Your doctor will work with you to find the best medication for your needs and symptoms.

If you're having paroxysmal symptoms rather than seizures, your doctor may still treat you with an anticonvulsant if the symptoms are disrupting your quality of life. Thankfully, paroxysmal symptoms usually disappear within a few months.

A Word From Verywell

If you're experiencing any seizure-like symptoms, such as muscle spasms, twitches, weakness, or tremors, it's important to speak with your doctor, who can refer you to a neurologist for further investigation. Whether you're having seizures or paroxysmal symptoms, your medical team can come up with a treatment plan that helps you get control of your symptoms and improves your quality of life.

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