The review of Russian and foreign literature analyzes the factors and features of the development of epilepsy in patients with multiple sclerosis (MS). The following are considered as causes of epileptic seizures: acute focal lesions of brain tissue with edema and irritation of the cerebral cortex; the systemic effect of neuroinflammation with impaired ion, electrolyte, and neurotransmitter metabolism; the effect of cytokines; secondary neurodegenerative changes with impaired metabolism of neurotransmitters in long-term MS; comorbidities; the effect of disease-modifying drugs on the occurrence of epileptic seizures, an independent combination of epilepsy and MS. MRI is the gold standard for diagnosing MS; however, it does not detect axon and dendritic damage, so new imaging techniques need to be studied. Neuroplastic changes in epilepsy and MS can be both adaptive and maladaptive, which requires the search for therapeutic interventions that enhance the former and hinder the latter, considering the mechanisms of neuroplasticity in both epilepsy and MS.