title: Extensive cortical inflammation is associated with epilepsy in multiple sclerosis.
abstract: BACKGROUND
  Epilepsy is three to six times more frequent in MS than in the general population. Previous studies based on conventional magnetic resonance (MR) imaging have suggested a possible correlation between cortical inflammatory pathology and epileptic seizures. However, pure intracortical lesions (ICLs) are unlikely to be demonstrated with conventional MR. We applied the double inversion recovery (DIR) sequence in relapsing remitting MS (RRMS) patients with or without epileptic seizures in order to clarify the relationship between ICLs and epilepsy in MS in vivo.
  
  
  METHODS
  Twenty RRMS patients who had epileptic seizures (RRMS/E) during the course of the disease were studied for the presence of ICLs. A group of 80 RRMS patients with no history of seizures and matched for gender, age, disease duration, Expanded Disability Status Scale (EDSS) grading, and T2 lesion volume (T2-WMLV) was selected as reference population. ICLs were detected by applying the DIR sequence.
  
  
  RESULTS
  ICLs were observed in 18/20 (90%) RRMS/E and in 39/80 (48%) RRMS (p = 0.001). RRMS/E showed five times more ICLs (7.2 +/- 8.4) than RRMS (1.5 +/- 2.4; p = 0.015). The total ICLs volume was 6 times larger in RRMS/E than in RRMS (1.2 +/- 1.7 cm3 versus 0.2 +/- 0.2 cm3, p = 0.016). No significant difference was observed between RRMS and RRMS/E with regard to the number and volume of juxtacortical lesions and T2-WMLV.
  
  
  CONCLUSIONS
  Our findings indicate that RRMS/E have more extensive cortical inflammation than RRMS patients with no history of epilepsy. Inflammatory ICLs may be responsible for epilepsy in MS.
authors.affiliation: The Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, Dept. of Neurosciences, University Hospital of Padova, Via Giustiniani 5, 35128 Padova, Italy. calabresem@hotmail.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Calabrese
authors.forename: Nicola
authors.initials: N
authors.lastname: De Stefano
authors.forename: Matteo
authors.initials: M
authors.lastname: Atzori
authors.forename: Valentina
authors.initials: V
authors.lastname: Bernardi
authors.forename: Irene
authors.initials: I
authors.lastname: Mattisi
authors.forename: Luigi
authors.initials: L
authors.lastname: Barachino
authors.forename: Luciano
authors.initials: L
authors.lastname: Rinaldi
authors.forename: Aldo
authors.initials: A
authors.lastname: Morra
authors.forename: Matthew M J
authors.initials: MM
authors.lastname: McAuliffe
authors.forename: Paola
authors.initials: P
authors.lastname: Perini
authors.forename: Leontino
authors.initials: L
authors.lastname: Battistin
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallo
mesh_terms: D000328:Adult; D001921:Brain / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D001931:Brain Mapping / Q000379:methods; D015984:Causality; D015897:Comorbidity; D018450:Disease Progression; D004569:Electroencephalography; D004660:Encephalitis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D004827:Epilepsy / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D012720:Severity of Illness Index