Features associated with epilepsy in the antiphospholipid syndrome.
OBJECTIVE
To assess the frequency of epilepsy in primary and secondary antiphospholipid syndrome (APS); to analyze the clinical and laboratory features characterizing those with epilepsy in a cohort of 538 patients with APS; and to find associated features that would suggest risk factors for epilepsy in APS.


METHODS
We analyzed the clinical features of patients with APS who had epilepsy and compared them to the clinical features of non-epileptic APS patients.


RESULTS
Of 538 APS patients, 46 (8.6%) had epilepsy. Epilepsy was more prevalent among APS secondary to systemic lupus erythematosus (SLE) compared to primary APS (13.7% vs 6%; p < 0.05). The patients with epilepsy had a higher prevalence of central nervous system (CNS) manifestations including focal ischemic events (strokes or transient ischemic events, 54.3% vs 24.6%; p < 0.0001) and amaurosis fugax (15.2% vs 4.9%; p < 0.05). APS patients with epilepsy had a higher frequency of valvular pathology (30.4% vs 14.6%; p < 0.01), thrombocytopenia (43.5% vs 25%; p < 0.05), and livedo reticularis (26.1% vs 11.5%; p < 0.01). The multivariate logistic regression analysis found CNS thromboembolic events as the most significant factor associated with epilepsy, with an odds ratio (OR) of 4.05 (95% confidence interval, CI: 2.05-8), followed by SLE (OR 1.4, 95% CI 1.2-4.7), and valvular vegetations (OR 2.87, 95% CI 1-8.27).


CONCLUSIONS
Epilepsy is common in APS and most of the risk seems to be linked to vascular disease as manifested by extensive CNS involvement, valvulopathy, and livedo reticularis and to the presence of SLE. These factors, however, explain only part of the increased occurrence of epilepsy in APS and other causes such as direct immune interaction in the brain should be investigated.
Shoenfeld
Yehuda
Y
Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel.
Lev
Shaul
S
Blatt
Ilan
I
Blank
Miri
M
Font
Joseph
J
von Landenberg
Philipp
P
Lev
Nirit
N
Zaech
Joseph
J
Cervera
Ricard
R
Piette
Jean-Charles
JC
Khamashta
Munther A
MA
Bertolaccini
Maria L
ML
Hughes
Graham R V
GR
Youinou
Pierre
P
Meroni
Pierre Luigi
PL
Pengo
Vittorio
V
Alves
J Delgado
JD
Tincani
Angela
A
Szegedi
Gyula
G
Lakos
Gabriella
G
Sturfelt
Gunnar
G
Jönsen
Andreas
A
Koike
Takao
T
Sanmarco
Marielle
M
Ruffatti
Amelia
A
Ulcova-Gallova
Zdenka
Z
Praprotnik
Sonja
S
Rozman
Blaz
B
Lorber
Margalit
M
Chapman
Joab
J
van-Breda-Vriezman
Peter J C
PJ
Damoiseaux
Jan
J
D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications*; D015331:Cohort Studies; D004827:Epilepsy / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors