WHEN EPILEPSY REVEALS MULTIPLE SCLEROSIS: A CASE REPORT OF AN ATYPICAL PRESENTATION

Temporal lobe epilepsy is an uncommon manifestation of multiple sclerosis (MS), particularly in patients with cortical involvement. We report the case of a 24-year-old woman presenting with focal epileptic seizures evolving for one year, characterized by behavioral arrest, head and eye deviation, and automatisms, with suspected nocturnal generalized seizures. Interictal neurological examination was normal.Electroencephalography revealed a left temporal epileptogenic focus. Brain MRI demonstrated white matter lesions fulfilling the McDonald criteria, along with left temporal cortical and juxtacortical lesions.Cerebrospinal fluid analysis showed a type 2 oligoclonal band pattern with intrathecalIgG synthesis, while extensive etiological investigations were unremarkable.Despite treatment with carbamazepine, seizure control remained incomplete. Fingolimod therapy was initiated, leading to a marked reduction in seizure frequency after three months. This case highlights the importance of considering demyelinating disease in young patients with focal epilepsy, particularly in the presence of cortical lesions, and suggests a potential role of inflammation in epileptogenesis.