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. 2025 Jul 31;11(3):20552173251359061.
doi: 10.1177/20552173251359061. eCollection 2025 Jul-Sep.

Epilepsy in MS and its association with cognitive and psychological burden

Valeria Pozzilli  1   2 , Carla Tortorella  3 , Luca Prosperini  3 , Maria D'Apolito  4 , Fioravante Capone  1   2 , Licia Maria Celani  1   2 , Maria Chiara Pantuliano  1   2 , Sara Cipollone  5 , Alessandro Cruciani  1   2 , Giovanna De Luca  5 , Giacomo Evangelista  5 , Erika Pietrolongo  5 , Shalom Haggiag  3 , Silvia La Cesa  3 , Serena Ruggieri  3 , Vincenzo Di Lazzaro  1   2 , Stefano L Sensi  4   5   6 , Claudio Gasperini  3 , Fedele Dono  5   6 , Valentina Tomassini  4   5   6
Affiliations

Epilepsy in MS and its association with cognitive and psychological burden

Valeria Pozzilli et al. Mult Scler J Exp Transl Clin. .

Abstract

Background: Epilepsy is two to three times more common in patients with multiple sclerosis (pwMS) compared to the general population. Patients with MS and epilepsy without other identifiable causes (MS + E) show greater cortical damage than those without epilepsy (MS-E). However, it's unclear whether MS + E patients exhibit distinct cognitive and neuropsychological features requiring specific management.

Methods: In a cohort of pwMS from three MS centers, MS + E patients were identified and data on MS clinical features, epilepsy history, and treatments were collected. A matched group of MS-E patients was included. Assessments included cognitive and neuropsychiatric tests. Cognitive impairment (CI) was defined as scoring ≥1.5 standard deviations below normative values in ≥1 cognitive domain.

Results: CI was more prevalent in MS + E (n = 33) patients than in MS-E (n = 33). MS + E patients had lower processing speed (p < 0.01) and visuospatial memory (p = 0.03). MS + E was independently associated with CI (odds ratio 3.6, 95% confidence interval 1.21-12). Somatization, phobia, anxiety, and depression were the most affected neuropsychological domains in MS + E, with global psychological distress negatively correlating with processing speed (rho -0.36, p = 0.048).

Conclusions: MS + E is associated with higher CI, particularly in processing speed and visuospatial memory, alongside psychological distress, highlighting the need for targeted multidisciplinary care to improve outcomes and quality of life.

Keywords: Multiple sclerosis; cognitive impairment; damage; epilepsy; neuropsychological dysfunction; seizure.

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Figures

Figure 1.
Figure 1.
Cognitive scores in MS-E versus MS + E. Mean and 95% confidence interval of SDMT (a) and BVMT-R (b) scores. BVMT-R: brief visuospatial memory test-revised; MS + E: multiple sclerosis and epilepsy; MS-E: multiple sclerosis without epilepsy; SDMT: symbol digit modalities test.
Figure 2.
Figure 2.
Prevalence of cognitively impaired patients (%) in MS-E versus MS + E. CI: cognitive impairment; MS-E: multiple sclerosis without epilepsy; MS + E: multiple sclerosis and epilepsy.
Figure 3.
Figure 3.
Prevalence of psychiatric comorbidities in the MS + E cohort. In darker colors are indicated subscales of the Symptom Checklist-90 test with higher scores compared to normative values. MS + E: multiple sclerosis and epilepsy.
See this image and copyright information in PMC

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