Epilepsy is a notable comorbidity in multiple sclerosis (MS), with a prevalence significantly higher than in the general population. This co-occurrence suggests shared pathophysiological mechanisms, including cortical demyelination, chronic inflammation and neurodegeneration, which predispose MS patients to seizures. Advanced imaging studies highlight the role of cortical lesions and atrophy in epileptogenesis, while inflammatory processes further lower the seizure threshold. Additionally, MS-associated network dysfunction disrupts normal neural activity, contributing to seizure susceptibility. This review synthesizes epidemiological, neuroimaging, and clinical evidence to elucidate the complex relationship between epilepsy and MS. It emphasizes the importance of personalized care and the need for further research to refine treatment protocols, improve outcomes, and enhance the quality of life for this unique patient population.