PT  - JOURNAL ARTICLE
AU  - Villamar, Mauricio F.
AU  - Sarkis, Rani A.
AU  - Pennell, Page
AU  - Kohane, Isaac
AU  - Beaulieu-Jones, Brett K
TI  - Severity of Epilepsy and Response to Antiseizure Medications in Individuals with Multiple Sclerosis: Analysis of a Real-World Dataset
AID  - 10.1212/CPJ.0000000000001178
DP  - 2022 May 18
TA  - Neurology: Clinical Practice
PG  - 10.1212/CPJ.0000000000001178
4099  - http://cp.neurology.org/content/early/2022/05/18/CPJ.0000000000001178.short
4100  - http://cp.neurology.org/content/early/2022/05/18/CPJ.0000000000001178.full
AB  - Background and objectives: Epilepsy is an important comorbidity that affects outcomes for people with multiple sclerosis (MS). However, it is unclear if seizure severity among individuals with coexistence of multiple sclerosis and epilepsy (MS+E) is higher than in those with other focal epilepsies. Our goal was to compare the overall severity of epilepsy in individuals with MS+E versus those with focal epilepsy without MS (E-MS) as defined by seizure-related healthcare utilization, frequency and duration of status epilepticus, and frequency of antiseizure medication (ASM) regimen changes.Methods: In this hypothesis-generating study, we analyzed a U.S. commercial nationwide de-identified claims dataset with > 86 million individuals between 1/1/2008 and 8/31/2019. Using validated algorithms, we identified adults with E-MS and those with MS+E. We compared the number and length of seizure-related hospital admissions, the number of claims and unique days with claims for status epilepticus, and the rates of ASM regimen changes between the MS+E and the E-MS groups.Results: During the study period, 66,708 individuals with E-MS and 537 with MS+E had ≥ 2 years of coverage after their initial diagnosis of epilepsy. There was no difference between the MS+E and E-MS groups in the percentage of individuals admitted for seizures and/or status epilepticus. However, MS+E with seizure-related admissions had more admissions and longer hospital stays than those with E-MS. MS+E who experienced status epilepticus had more unique days with status epilepticus claims compared to E-MS. MS+E were more likely to have ASM regimen changes in Year 2 after the initial diagnosis of epilepsy and had more ASM changes during Year 2 compared to E-MS. Among individuals with MS+E, there were no differences in our measures of seizure severity for those treated with sodium channel blockers/modulators versus other ASM classes.Discussion: This study supports the notion that individuals with MS+E can have more severe epilepsy than those with E-MS. Seizure severity among individuals with MS+E treated with sodium-channel blockers/modulators versus other ASM classes shows no significant differences.Classification of evidence: This study provides Class III evidence that individuals with MS+E can have more severe epilepsy than those with E-MS.