medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-32-30-34medalphabet-4777Research ArticleСтатьиЭпилепсия, ассоциированная с рассеянным склерозом (cовременное состояние проблемы)Epilepsy associated with multiple sclerosis (сurrent state of the problem)https://orcid.org/0000-0003-0190-3335ВасиленкоА. В.VasilenkoA. V.

Василенко Анна Владимировна, к. м. н., зав. учебной частью, доцент кафедры нейрохирургии с клиникой Института медицинского образования; доцент кафедры неврологии им. акад. С. Н. Давиденкова

Санкт-Петербург

Vasilenko Anna V., PhD Med, head of teaching unit, associate professor at Neurosurgery Dept; associate professor at Neurology Dept named after academician S. V. Davidenkov

Saint Petersburg

vasilenko_anna@list.ruhttps://orcid.org/0009-0005-1600-9389ДружининаВ. Е.DruzhininaV. E.

Дружинина Валерия Евгеньевна, аспирант кафедры нейрохирургии с клиникой Института медицинского образования; ординатор кафедры неврологии им. акад. С. Н. Давиденкова

Санкт-Петербург

Druzhinina Valeriya E., postgraduate student at Neurosurgery Dept; resident at Neurology Dept named after academician S. V. Davidenkov

Saint Petersburg

https://orcid.org/0000-0001-9245-8067ГолдобинВ. В.GoldobinV. V.

Голдобин Виталий Витальевич, д. м. н., проф., зав. кафедрой неврологии им. акад. С. Н. Давиденкова, член Ассоциации неврологов Санкт-Петербурга и Ленинградской области, Европейской академии неврологии

Санкт-Петербург

Goldobin Vitaly V., Dr Med Sci (habil.), professor, head of Dept of Neurology named after academician S. N. Davidenkov2, member of the Association of Neurologists of St. Petersburg and the Leningrad Region, European Academy of Neurology

Saint Petersburg

ФГБУ «Национальный медицинский исследовательский центр имени В. А. Алмазова» Минздрава РоссииРоссияAlmazov National Medical Research Centre, Saint Petersburg; North-Western State Medical University named after I. I. MechnikovRussian FederationФГБУ «Национальный медицинский исследовательский центр имени В. А. Алмазова» Минздрава России; ФГБОУ ВО «Северо-Западный государственный медицинский университет имени И. И. Мечникова» Минздрава РоссииРоссияAlmazov National Medical Research Centre; North-Western State Medical University named after I. I. MechnikovRussian FederationФГБОУ ВО «Северо-Западный государственный медицинский университет имени И. И. Мечникова» Минздрава РоссииРоссияNorth-Western State Medical University named after I. I. MechnikovRussian Federation202526122025032Неврология и психиатрия (4)30‑34Copyright © Василенко А.В., Дружинина В.Е., Голдобин В.В., 20252025Василенко А.В., Дружинина В.Е., Голдобин В.В.Vasilenko A.V., Druzhinina V.E., Goldobin V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4777

Представлен обзор современного состояния проблемы коморбидности рассеянного склероза (РС) и эпилептических приступов (ЭП). Эпилепсия встречается у пациентов с РС в 3–6 раз чаще, чем в популяции. Патогенетическая связь заболеваний является двунаправленной: демиелинизация и атрофия серого вещества при РС способствуют эпилептогенезу, в то время как эпилептическая активность может усугублять нейродегенерацию. Клиническая картина ЭП и РС гетерогенна и может включать как фокальные, так и генерализованные приступы, которые нередко служат первым проявлением демиелинизирующего заболевания. В диагностике важную роль играют электроэнцефалографическое исследование и магнитно-резонансная томография головного мозга, выявляющие очаговую активность и структурные изменения коры. Лечение требует комплексного подхода, при этом ряд препаратов, модифицирующих течение РС, и противоэпилептических средств могут оказывать взаимное положительное влияние.

Заключение. Коморбидность рассеянного склероза и эпилепсии представляет собой сложную проблему ввиду общности патогенетических механизмов и взаимного влияния. Диагностика эпилептических приступов при РС может быть затруднена из-за вариабельной клинической картины и неспецифических изменений на электроэнцефалограмме. Учитывая высокий риск развития эпилепсии у данной категории пациентов и ее потенциальное влияние на прогрессирование инвалидизации, неврологам необходимо проявлять активную диагностическую настороженность. Дальнейшие исследования в этой области могут быть направлены на разработку оптимальной стратегии терапии данных заболеваний одновременно.

This article provides an overview of the current state of the problem regarding the comorbidity of multiple sclerosis (MS) and epileptic seizures (ES). Epilepsy occurs in patients with MS 3–6 times more often than in the general population; however, its prevalence and clinical manifestations are variable. The pathogenetic link between the two conditions is bidirectional: demyelination and gray matter atrophy in MS contribute to epileptogenesis, while epileptic activity itself can exacerbate neurodegeneration. The clinical manifestations of ES in MS are heterogeneous and can include both focal and generalized seizures, which often serve as the first manifestation of the demyelinating disease. Electroencephalography and cerebral magnetic-resonance imaging play a crucial role in diagnosis, revealing focal activity and structural changes in the cortex. Treatment requires a comprehensive approach, whereby some disease-modifying therapies for MS and antiepileptic drugs can have a mutually positive influence. Conclusion. The comorbidity of multiple sclerosis and epilepsy is a complex problem due to shared pathogenetic mechanisms and mutual aggravating influence. Diagnosing epileptic seizures in MS can be challenging due to the variable clinical picture and non-specific changes on electroencephalogram. Given the high risk of developing epilepsy in this patient category and its potential impact on the progression of disability, neurologists need to maintain a high index of diagnostic suspicion. Further research in this area should be devoted to optimal treatment strategies aimed at both conditions simultaneously.

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The authors declare that there are no conflicts of interest present.