MS and Epilepsy....MS or Epilepsy????

[dawn868]

I am now 43 and was just dx with epilepsy with left temporal/frontal complex partial seizures with secondary generalization.  I have a clinical diagnose of MS; 5 years ago.  I have had intermittent neurological symptoms and what appeared to be exacerbations but they have never found any new or enhanced lesions. My neuro and I have when back and forth on the possibility of a misdiagnosis of MS and going off my Copaxone. In August I had several “seizures” that were a couple of minutes apart that only lasted 10-30 seconds when I was coming out of anesthesia. The EEG done the next day indicated seizure activity primarily in the left frontal/temporal area.  I was released and told I did not have epilepsy as what I had was considered provoked seizures from the anesthesia.  I had to be weaned off of the medication, Keppra, slowly.  I had a follow up EEG came back slightly abnormal but did not indicate epilepsy.  I was started on AED anyway; Keppra as it helped my migraines post-op…two birds one stone. At 500mg/day I woke up in the middle of the night having a very brief seizure followed very quickly by a second.  It was not a full classic tonic-clonic more of a tonic stiffening but I was incontinent for the second one. My neuro believed I had a seizure and sent me to an epileptic clinic for 2nd opinion. She also felt that my neurological symptoms could have always been due to seizures and was misdiagnosed with MS. After a brief exam I was referred back to my neuro who just informed me they dx me with epilepsy.  From what I read how could I have been dx with epilepsy and is epilepsy something that can be misdiagnosed as MS.  I am very confused and looking for some answers.

[dawn868]

Thank you for your response. When I was dx MS about 5 years ago.  It started with a severe bout of nystagmus that I went to the Dr. for.  I was sent for an MRI because of my history of migraines and it was a new doctor.  The MRI identified more than 30 non enhancing subcortical and deep periventricular white matter hyperintensities within each cerebral hemisphere.  There were greater than nine T2 hyperintense lesions located in both a juxtacortical and periventricular locations.  The second MRI stated that the lesions in the right frontal and anterior right parietal lobe appeared to be slightly larger than the previous study done 2 months before meeting three out of the four McDonald's diagnostic criteria for MS.  I had a negative LP, EP tests(the visiual was only slightly abnormal), and all other possible dx were ruled out except migraines but it was thought that at 38 it is not likely that migraines caused that many lesions so was given a clinical Dx of MS and started taking Copaxone.
Clinical dx of MS only. I am truely questioning both but understand the least about the Epilepsy dx. Can you help me with the diagnostic criteria. Also I live in NY where you must be seizure free for a year. Does that include seizures where there was no loss of conciousness or body control?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Multiple sclerosis is an inflammatory demyelinating disease that affects the central nervous system. To make the diagnosis there are specific criteria, in which objective neurologic findings are present affecting 2 or more locations in the nervous system in 2 or more episodes. In order to make this diagnosis, a detailed history and neurologic examination is required. MRI is very helpful and needed as it helps determining the presence of white matter lesions in 2 or more locations, however there are multiple conditions producing MRI changes that could be mistaken for MS, and the MRI should be reviewed properly and correlated to the symptoms. When the diagnosis is in doubt, LP to study the CSF is helpful, and if there is still some doubt, there are other tests such as evoked potentials that can help.

It is possible to have MS and epilepsy. You should continue to follow up with your neurologist regarding your diagnoses.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.