Multiple Sclerosis (MS) is a neurological condition where the immune system attacks nerve fibers in the brain and spinal cord, disrupting communication. While not common, seizures affect an estimated 2% to 5% of individuals with MS, a rate slightly higher than the general population. Understanding MS-related seizures and how to respond is important for those affected and their caregivers.
Visual and Behavioral Indicators
MS seizures can present in diverse ways, from subtle changes to whole-body events, reflecting the varied locations of brain lesions. Their presentation varies greatly from person to person and even from one event to another.
Motor symptoms often involve involuntary movements like jerking or stiffening of limbs, or repetitive movements. These can be localized (focal seizure) or spread to affect both sides of the body (generalized movements). Temporary muscle weakness or paralysis may also occur during or after the event.
Sensory symptoms can be challenging to identify. Individuals may experience abnormal sensations like numbness, tingling, burning, or prickling (dysesthesia). Visual disturbances such as flashing lights, temporary blindness, or double vision can occur. Auditory changes like ringing or buzzing, or unusual smells or tastes, are also possible.
Cognitive and emotional changes often accompany MS seizures, including confusion, difficulty speaking, or problems understanding language. An individual might appear dazed, stare blankly, or have altered awareness. Repetitive, non-purposeful behaviors (automatisms) like lip smacking or chewing may be present. Some report sudden feelings of fear, anxiety, or déjà vu.
Autonomic symptoms can also be part of an MS seizure, involving involuntary bodily functions like changes in heart rate, breathing patterns, or sweating. These indicate temporary disruptions in the autonomic nervous system due to brain electrical activity.
After the active seizure, individuals enter the postictal state, a recovery period lasting minutes to hours, sometimes days. Common experiences include confusion, drowsiness, headaches, temporary limb weakness (Todd’s paresis), or general body soreness. The duration and intensity of this phase vary with seizure type and severity.
Distinguishing MS Seizures from Other Events
Distinguishing an MS seizure from other neurological events or common MS symptoms can be challenging due to similar manifestations. Some symptoms overlap, making precise identification difficult. Accurate identification is important for proper management.
Epileptic seizures and MS seizures both involve abnormal electrical activity in the brain. However, their underlying causes differ. MS seizures are linked to brain lesions, especially in the gray matter or cortex, while primary epilepsy typically arises from other neurological conditions.
MS pseudo-exacerbations or paroxysmal symptoms are often mistaken for seizures due to their sudden, transient nature. These events, such as tonic spasms, trigeminal neuralgia, or Lhermitte’s sign, are brief and repetitive. They may be triggered by specific movements or sensations. Unlike true seizures, pseudo-exacerbations do not involve abnormal brain electrical activity. Instead, they represent a temporary worsening of existing MS symptoms, often due to factors like infection, stress, or temperature changes.
Syncope, or fainting, can be confused with seizures as both involve temporary loss of consciousness and sometimes involuntary movements. Syncope results from a temporary reduction in blood flow to the brain, often preceded by lightheadedness or nausea. Recovery from syncope is usually rapid once the person is lying flat and blood flow is restored. Seizures, in contrast, involve disorganized brain electrical activity and often a prolonged postictal state with confusion or fatigue.
Careful observation of the event’s duration, symptom sequence, and post-event state helps distinguish these conditions. Noting triggers, the presence of a postictal phase, and overall symptom patterns provides clues. Consulting a neurologist is important for an accurate diagnosis.
Immediate Steps During a Seizure
When someone experiences a seizure, focus on ensuring their safety and providing support. These actions help prevent injury and offer comfort during a disorienting event.
Gently guide the person to the floor if standing or sitting. Remove any nearby objects that could cause injury during involuntary movements. Cushion their head with something soft, like a folded jacket or pillow, to protect it from impact.
Note the time the seizure begins and ends, as duration provides important information. Loosen any tight clothing around their neck to aid breathing. Remain with the person throughout the seizure and recovery, offering reassurance.
Avoid specific actions during a seizure. Do not attempt to restrain the person, as this can cause injury. Never place anything in their mouth, including fingers, as this can cause injury or airway obstruction. Do not give them food or drink until they are fully alert and can safely swallow.
Seek emergency medical attention under certain circumstances. Call emergency services if:
- The seizure lasts longer than five minutes.
- Multiple seizures occur without the person regaining consciousness between them.
- The individual is injured during the seizure.
- There are difficulties breathing or failure to regain consciousness.
- It is the person’s first seizure.