Treatment of seizures for patients with multiple sclerosis

Epileptic seizures occur in a relatively small number of patients with multiple sclerosis, but can have serious consequences. Because the cause of epileptic seizures in patients in MS may be different from that in other forms of epilepsy, it is uncertain whether patients with MS should be treated differently. We searched for studies on the treatment of epileptic seizures in patients with MS, but found none. Well designed studies that address this issue are needed.

Background: Epileptic seizures occur in only a minority of patients with multiple sclerosis (MS), but can have serious consequences. The available literature suggests an association of seizures in MS with cortical and subcortical demyelinating lesions, which suggest that seizures in MS are probably most often symptomatic rather that idiopathic. It is currently unknown whether patients with MS should be treated differently from other patients with epileptic seizures.

Objectives: To evaluate the efficacy and safety of antiepileptic treatments in patients with MS.

Search methods: We searched for double‐blind, single‐blind or unblinded randomised controlled trials on antiepileptic treatment in patients with MS through electronic searches of The Cochrane Multiple Sclerosis Group’s and Cochrane Epilepsy Group’s Trials Registers, Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE (From 1966 ‐ Jan 2008) and EMBASE (From 1974 ‐ Jan 2008).

Selection criteria: Double‐blind, single‐blind or unblinded randomised controlled trials on antiepileptic treatment in patients with MS.

Data collection and analysis: Searches yielded a total of 379 citations (CENTRAL: 20, MEDLINE: 264, EMBASE: 95). We perused titles and abstracts for relevance and independently excluded all 379 citations as clearly not meeting the inclusion criteria.

Main results: We found no studies meeting our inclusion criteria.

Authors’ conclusions: Well‐designed randomised controlled trials are needed to guide clinical practice. Such trials should preferably contain a head‐to‐head comparison of antiepileptic drugs in patients with MS.