Epilepsy among Systemic Lupus Erythematosus Patients: Insights from a Large Database Analysis

Abstract

Objective: Epilepsy is characterized by a relevant epidemiological and clinical burden. In the extant literature, an increased risk of seizures has been described in several inflammatory/autoimmune disorders, including systemic lupus erythematosus (SLE). However, so far, relatively few and small size-based studies have been conducted. We aimed to investigate the link between seizure and SLE utilizing a large sample of subjects and extensive data analysis. Methods: Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of epilepsy in a cross-sectional study. Chi-square and t tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services. Results: The study included 5,018 patients with SLE and 25,090 age- and gender-frequency-matched controls. The proportion of epilepsy was found significantly higher among SLE patients (4.03 vs. 0.87%, p < 0.001). Using logistic regression, adjusting for multiple confounding factors, older age (≥70 years) resulted as negative predictor (OR 0.42 [95% CI 0.27–0.62], p <0.001), whereas the presence of SLE was a positive predictor of epilepsy (OR 4.70 [95% CI 3.94–5.82], p < 0.001). Interaction between SLE and elderly age resulted in high OR of 5.47 for epilepsy (95% CI 2.53–11.9). Conclusion: Our study confirms the higher prevalence of epilepsy in SLE patients. Physicians should be aware of such findings and have a lower threshold for suspecting epileptic seizures in these patients. Further studies are needed to better elucidate the mechanisms by which SLE favors the insurgence of seizures.

Seizures as a clinical manifestation in somatic autoimmune disorders

“…Various reports indicated a high prevalence of seizures among people with SLE (prevalence:1.6%-16%) [3,8,[36][37][38][39][40][41]; and from studies including controls they seem higher than in the general population [8,[38][39][40][41]. A recent cross sectional study with over 5000 people with SLE and over 25,000 controls found epilepsy 4.7 times more likely in the SLE cohort (95% CI: 3.9-5.8%) [39]. One retrospective cohort study also reported that SLE was associated with 5.6-fold increased risk of epilepsy [41].…”

Familial Mediterranean fever is associated with increased risk for ischaemic heart disease and mortality–Perspective derived from a large database

“…Data available from CHS database included age, sex, smoking status, SES (based on the subject's residence area poverty index, divided into 3 categories – low, medium and high) and diagnosis of chronic diseases, including input date into CHS database. The validity of the diagnosis in the registry was found to be high in previous studies . A control patient matched by age and sex was randomly selected for each FMF case.…”

“…The validity of the diagnosis in the registry was found to be high in previous studies. 19,20 A control patient matched by age and sex was randomly selected for each FMF case. The control group was selected from the list of CHS members, excluding patients with FMF.…”

Management of Patients with Systemic Lupus Erythematosus at the Stage of Primary Care: Answers to Frequently Asked Questions

“…Волчаночный нефрит представляет собой одно из самых серьезных осложнений СКВ с учетом повышенной заболеваемости, развития терминальной почечной недостаточности и высокого уровня смертности [2], поэтому раннее подозрение и выявление заболевания на уровне первичной медицинской помощи имеет первостепенное значение. Нейропсихиатрическая волчанка также является тяжелым и жизнеугрожающим фенотипом СКВ [21] и охватывает широкий спектр неврологических и психиатрических проявления различной степени тяжести, такие, как судороги, когнитивная дисфункция, психоз и депрессия [69]. Таким образом, семейные врачи должны вовремя оценить такие случаи и заподозрить СКВ для раннего назначения специфического лечения [69].…”

“…Нейропсихиатрическая волчанка также является тяжелым и жизнеугрожающим фенотипом СКВ [21] и охватывает широкий спектр неврологических и психиатрических проявления различной степени тяжести, такие, как судороги, когнитивная дисфункция, психоз и депрессия [69]. Таким образом, семейные врачи должны вовремя оценить такие случаи и заподозрить СКВ для раннего назначения специфического лечения [69].…”