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Summary:Purpose: In patients with multiple sclerosis (MS), epileptic seizures occur more frequently than in the general population. The aim of this study was to analyze clinical characteristics of epilepsy in patients with MS, potential correlation between the semiology of seizures, EEG and magnetic resonance imaging (MRI) findings in these patients, as well as to examine the response to anticonvulsant therapy.Methods: In a series of 268 consecutive patients with definite MS hospitalized at the Institute of Neurology, Belgrade, we identified 20 (7.5%) patients with seizures or epilepsy. All patients with seizures or epilepsy were submitted to standard EEG and brain MRI with gadopentetate dimeglumine.Results: In four patients, epilepsy occurred 1-5 years before other clinical manifestations of MS. Eight patients had seizures only during MS relapses (provoked seizures). In two of them, seizures were the only manifestations of relapse. In 12 patients, seizures occurred regardless of the phase of MS (chronic epilepsy). In the majority of patients, seizures were partial with secondary generalization. Five patients experienced episodes of status epilepticus, and they all had dementia. Abnormal EEG pattern was found in 11 patients. Brain MRI disclosed corticalsubcortical lesions in nine patients and focal cortical atrophy in one, whereas in the remaining patients, findings were inconclusive. Probable EEG-MRI-seizure type correlation existed in 10 patients.Conclusions: Our data suggest that epilepsy may represent an initial symptom of MS and a single clinical manifestation of a relapse, and further support the assumption of the existing correlation between the presence of cortical-subcortical lesions and epileptic seizures or epilepsy in patients with MS.

Summary: Purpose:We report the frequency of parkinsonism and cognitive decline (P/CD) in patients treated with valproate (VPA) after 1 year of treatment and at least 1 year of follow-up.Methods: Three hundred sixty-four patients with various epileptic syndromes and seizure types were treated with VPA mono-or polytherapy for more than 1 year.Results: We found five cases of P/CD (1.37%; 95% CI, 0.18-2.56%). Among 140 patients with different adverse effects (AEs) of VPA, P/CD were among the rarest in frequency but significant in terms of drug discontinuation (five of 17).Conclusions: Early identification of this type of AE and discontinuation of the drug led to complete recovery in affected patients. Key Words: Parkinsonism-Cognitive declineValproate-Epilepsy.Valproate (VPA) is considered to have a good safety profile. Sporadic reports and a few case series or clinical studies of reversible syndrome of parkinsonism and cognitive decline (P/CD) have been made in patients treated with VPA (Zaret and Cohen, 1986;Armon et al., 1996;Easterford et al., 2004;Masmoudi et al, 2006). The prevalence of this type of treatment complication has been estimated at 6% in a smaller group of consecutively recruited patients (Easterford et al., 2004). We report the frequency of P/CD in patients treated with VPA after 1 year of treatment and with ≥1 year of follow-up. MATERIALS AND METHODS PatientsIn total, 364 patients (55.2% women) aged between 17 and 73 years were treated with VPA mono-(37.6%) or polytherapy (VPA as comedication with enzyme-inducing anticonvulsants, 26.3%; VPA with lamotrigine, 22.5%; and VPA with other anticonvulsants, 13.4%) for >1 year were prospectively included in this study (Table 1). Of these, 110 patients had generalized and 254 had partial epileptic syndromes. Patients were recruited from the Epilepsy

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