Multiple sclerosis (MS) attacks: causes and treatment

Multiple sclerosis (MS) attacks come from the same abnormal electrical discharges in the brain that cause epilepsy, which means it’s possible to have both MS and epilepsy.

According to the National MS Society, seizures occur in about 2-5% of MS cases. In comparison, the incidence of seizures is about 3% in the general population.

Researchers are not clear on the cause of attacks with MS. But there is a link between seizures and people with more severe MS.

Symptoms vary depending on the type of seizure, but they can include twitching, loss of consciousness, or involuntary twitching of the arms and legs. Treatment uses the same anti-epileptic drugs that are used to treat epilepsy in people without MS.

In this article, we discuss the causes, symptoms, and treatment of MS attacks. We also provide information on first aid and look at conditions that can resemble a seizure.

MS is an inflammatory disease that affected the brain and spinal cord. This happens when the immune system attacks the insulating sheath that covers the nerves, resulting in damage that causes various symptoms.

Seizures are not specifically associated with MS, but they do occur at a slightly higher rate in people with MS than in the general population.

A person with MS can have many types of seizures, but the most common are:

  • Focal conscious: Previously called simple partial seizures, conscious focal seizures start in an area of ​​the brain without causing the person to lose consciousness.
  • Deficient focal consciousness: An older term for these is complex partial seizures. They start in an area of ​​the brain and involve a shift in consciousness.
  • Focal to bilateral tonic-clonic: Formerly called secondarily generalized seizures, focal to bilateral tonic-clonic seizures start in one area of ​​the brain and spread to the other side of the brain as a tonic-clonic seizure.

The brain contains gray matter and white matter. Gray matter is found in the cortex (the area involved in thinking), and white matter is the part that provides connections for communication between areas of gray matter.

Abnormal electrical discharges from the cortex in the gray matter cause epileptic seizures. MS affects the white matter. But because some of the white matter extends into the gray matter, some believe that a lesion in MS can affect the overlapping gray matter.

Scientists believe that this could lead to an increase in the excitability of the cortex, which could cause a seizure. The higher incidence of seizures in MS suggests a possible relationship, but it is still the subject of debate, notes a 2019 study.

According to the study, research indicates that the risk of developing seizures with MS increases with the duration of MS. The likelihood may also increase with the number of lesions that MS produces in the brain.

The study adds that people who have seizures with MS may experience more severe disability. This is because seizures can increase damage to the brain, which can lead to more disability.

It is possible to have MS and epilepsy. The seizures that occur with MS are epileptic fits. Some data suggests that the risk of seizures and epilepsy is three to six times higher in people with MS than in the general population.

It should be noted that the studies included in the related research mostly involved a relatively small number of participants. This rate also differs from the incidence rates noted by the MS Society.

Symptoms depend on the type of seizure but can include:

  • thrill
  • a strange smell or taste
  • confusion and inability to respond to stimuli for a few minutes
  • involuntary twitching of the arms and legs
  • fall to the ground
  • loss of consciousness

Learn more about the signs and symptoms of a seizure here.

Most people associate seizures with a tonic-clonic seizure, which is the type where a person falls, jumps, and loses consciousness of what is going on around them.

For people having a tonic-clonic seizure, the Centers for Disease Control and Prevention (CDC) provide the following first aid recommendations:

  • Drag them to the ground.
  • Turn them to one side, which will help them breathe.
  • Place something soft under his head to avoid injury.
  • Loosen their tie or any restrictive clothing.
  • Take off their glasses.
  • Do not hold them down or restrict their movements.
  • Don’t do word of mouth.
  • Do not put anything in their mouth.
  • Do not offer food or drink until they are fully awake.

Someone should call 911 or the local emergency number if any of the following apply to the person who had the seizure:

  • They have difficulty waking up or breathing after the seizure.
  • They have a wound.
  • They have another seizure soon after the first one.
  • They have a health problem, such as heart disease or pregnancy.
  • The crisis occurs while they are in the water.
  • The seizure lasts more than 5 minutes.

Find out more about what to do if someone you know has a seizure.

The Multiple Sclerosis Foundation notes that the treatment of seizures in MS uses anti-epileptic drugs that control most seizures, such as:

  • phenytoin (Dilantin)
  • carbamazepine (Tegretol)
  • valproic acid (Depakote)
  • lamotrigine (Lamictal)
  • levetiracetam (Keppra)

Antiepileptic drugs can cause a number of side effects which are also typical symptoms of MS. Anyone exhibiting any of the following symptoms should notify their doctor. This so that the doctor can try to determine if the symptoms are due to the medication or to the worsening of MS:

  • misty thought
  • dizziness
  • tired
  • tingling
  • sleeping troubles

Stopping or reducing the use of anti-epileptic drugs should always be done under the supervision of a doctor. Stopping the use of this medicine suddenly may trigger a seizure.

Sometimes a person with MS can have an experience that looks like a seizure, but is actually a manifestation of their condition, known as a paroxysmal symptom. A paroxysmal symptom is a sudden symptom that lasts for a few seconds to a few minutes.

Paroxysmal symptoms can take many forms. For example, one form that can resemble a seizure is spasms, such as twitching or kicking in one leg. Other forms include:

  • an altered sensation that affects the skin, such as numbness or tingling
  • shooting pains in the arms or legs
  • difficulty swallowing
  • weakness, which can cause falling or unsteadiness
  • speech disorders
  • lack of coordination
  • brief freeze of movements

The cause of breakthrough symptoms is an abnormal electrical signal in a nerve in the brain or spinal cord that MS damages, which is different from the cause of a seizure. Although the cause is not epilepsy, doctors can treat it with anti-epileptic drugs, which often help reduce symptoms.

Aside from paroxysmal symptoms, several other conditions can resemble seizures, including:

  • fainting, which can cause a seizure in addition to loss of consciousness
  • hypoglycemia, which can cause episodes of confusion
  • sleep disorders, such as narcolepsy, falling asleep at inappropriate times
  • movement disorders, such as nervous tics or tremors
  • a migraine, which can cause confusion
  • non-epileptic seizures, which look like seizures but are associated with psychiatric disorders, such as post-traumatic stress disorder

Unlike breakthrough episodes, anti-epileptic drugs cannot help treat these conditions. Doctors will recommend appropriate treatment based on the cause.

MS attacks are not common. Research suggests that the risk of seizures may be higher in people who have had MS for a long time or who have more brain damage.

People with MS can sometimes have brief, sudden flare-ups or other problems called breakthrough symptoms. These are not seizures, although they may look like them.

Doctors treat MS seizures with standard anti-epileptic drugs such as phenytoin (Dilantin). If a seizure lasts longer than a few minutes, someone needs to call 911 for immediate medical attention.

About Antoine L. Cassell

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