title: Risk factors for unprovoked epileptic seizures in multiple sclerosis: a systematic review and meta-analysis.
abstract: The role of different factors in influencing the risk of seizures during multiple sclerosis (MS) is not known. To perform a systematic review and meta-analysis of risk factors for epilepsy during MS. Pubmed, Google scholar, and Scopus databases were searched. Articles published in English (1986-2016) were included. Nine studies were included (3 retrospective cohort and 6 case-control) enrolling 2845 MS patients (217 with epilepsy; 7.6%). MS patients with epilepsy had a younger age at onset compared to MS patients without seizures (difference in means = -5.42 years, 95% CI -7.19 to -3.66, p < 0.001). Mean EDSS value at inclusion tended to be higher in patients with epilepsy, without reaching statistical significance (difference in means = 0.45, 95% CI -0.01 to 0.91, p = 0.054). No differences were observed in sex distribution (OR = 0.94, 95% CI 0.51-1.72, p = 0.83) and clinical form (OR = 1.03, 95% CI 0.33-3.21, p = 0.96). Two studies evaluated presence and number of cortical lesions as a risk factor for epilepsy in MS using different MRI techniques: in one study, cortical lesions were more frequently observed in patients with epilepsy (OR = 7.06, 95% CI 2.39-20.8; p < 0.001). In the other, cortico-juxtacortical lesions were more frequently observed in patients with epilepsy (OR = 2.6, 95% CI 1.0-6.5; p = 0.047). Studies about risk factors for epilepsy during MS are heterogeneous. Compared to MS patients without seizures, patients with epilepsy have an earlier MS onset and a higher EDSS score after similar disease duration. Clinical form of MS and sex do not predict the appearance of seizures.
authors.affiliation: Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, Italy.|Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Gasparini
authors.affiliation: Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, Italy.|Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Ferlazzo
authors.affiliation: Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, Italy.|Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Ascoli
authors.affiliation: Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Sueri
authors.affiliation: Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Cianci
authors.affiliation: Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, Reggio Calabria, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Russo
authors.affiliation: IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy.
authors.forename: Laura Rosa
authors.initials: LR
authors.lastname: Pisani
authors.affiliation: Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, G. Gaslini Institute, University of Genova, Via Gaslini 5, Genoa, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Striano
authors.affiliation: Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Via Conte Ruggero 73, Troina, EN, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Elia
authors.affiliation: Laboratory of Neurological Disorders, IRCCS-Istituto di Ricerche Farmacologiche ''Mario Negri'', Via La Masa 19, Milan, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Beghi
authors.affiliation: Institute of Bioimaging and Molecular Physiology, National Research Council, Viale Europa, Catanzaro, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Colica
authors.affiliation: Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, Italy. u.aguglia@unicz.it.|Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital, Via Melacrino, Reggio Calabria, Italy. u.aguglia@unicz.it.
authors.forename: Umberto
authors.initials: U
authors.lastname: Aguglia
mesh_terms: D017668:Age of Onset; D004827:Epilepsy / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications*; D012307:Risk Factors
keywords: Age; Cortical lesion; Epilepsy; Meta-analysis; Multiple sclerosis