Epilepsy in systemic lupus erythematosus: prevalence and risk factors

Abstract

Background and purposeThe aim was to study the prevalence of epilepsy in a hospital‐based systemic lupus erythematosus (SLE) cohort and to investigate the relationship between epilepsy and other manifestations of neuropsychiatric SLE (NPSLE).MethodsThe study population consisted of 440 SLE patients recruited from 1998 to 2012. An epilepsy‐screening questionnaire was sent to all patients, where those screening positive were invited to a neurological examination with documentation of NPSLE symptoms according to the American College of Rheumatology nomenclature. Occurrences of autoantibodies (double stranded DNAantibody, antinuclear antibody, lupus anticoagulant, Sjögren's syndrome A, Sjögren's syndrome B) and the antiphospholipid syndrome (APS) were tabulated.ResultsOut of 440 patients, 14% were dead and 2.7% were lost to follow‐up. The questionnaire was sent to 368 patients; 312 (85%) responded. Of these, 131 (42%) screened positive. Epilepsy was confirmed in 36 (11.5%), of whom 30 (83%) had focal onset. Ten (3.2%) patients had isolated or provoked seizures. Manifestations of NPSLE occurred in 50%. The rates of cerebrovascular disease and psychosis were elevated two‐ and three‐fold in NPSLE patients with epilepsy versus NPSLE patients without epilepsy, respectively (P = 0.001 and P = 0.0006). APS was more common in patients with epilepsy compared to epilepsy‐free SLE patients with or without NPSLE (P = 0.02). In 50% of patients with epilepsy, no other etiology than SLE was detected.ConclusionsA high prevalence of epilepsy in SLE patients is reported, with association to concurrent cerebrovascular disease, APS and psychosis. Our findings support the notion of a multifactorial background for epilepsy in SLE including both vascular disease and features consistent with autoimmunity.

Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: Data from the UK Juvenile-onset systemic lupus erythematosus cohort study

“…In adult-onset SLE cohorts, epilepsy, and/or seizures occur in up to 11.5% of patients. 42 Younger patient age and high disease activity may be independent predictors of seizures. 43 In a Chinese cohort of juvenile NP-SLE patients, seizures were one of the most frequent NP-JSLE–related symptoms, observed in 84% of NP-JSLE patients.…”

The antiphospholipid syndrome – often overlooked cause of vascular occlusions?

“…Seizures occur in approximately 5–12% of patients with SLE, and they are consistently included as part of the immunologic criteria in SLE . aPL and APS are overrepresented among SLE patients with seizures according to several studies are . Positive aCL IgG titres were also recently reported in patients from the general population with severe refractory focal epilepsy .…”

“…Autoimmune mechanisms have recently been more tightly associated with epilepsy/seizures and both APS and SLE were associated with epilepsy in a large epidemiological registry study . Seizures occur in approximately 5–12% of patients with SLE, and they are consistently included as part of the immunologic criteria in SLE . aPL and APS are overrepresented among SLE patients with seizures according to several studies are .…”

Acute Neurologic Manifestations of Systemic Immune-Mediated Diseases

“…72 They can be focal or generalized, though older literature suggests that they are more commonly generalized. 73 Seizures may occur due to lupus itself or to secondary causes including stroke or metabolic disturbances. 73 The use of steroids and cyclophosphamide has also been associated with an increased risk of seizure.…”

“…73 Seizures may occur due to lupus itself or to secondary causes including stroke or metabolic disturbances. 73 The use of steroids and cyclophosphamide has also been associated with an increased risk of seizure. 70 Among patients with autoimmune disease, patients with lupus and those with APS have higher rates of seizure than those with other diagnoses.…”