Factors at diagnosis predict subsequent occurrence of seizures in systemic lupus erythematosus.
OBJECTIVE
To determine the factors associated with seizures in systemic lupus erythematosus (SLE).


METHODS
One hundred ninety-five patients with SLE were followed at the University of Maryland Lupus Clinics from January 1992 until June 2004. Neuropsychiatric (NP) manifestations were defined according to the American College of Rheumatology nomenclature and case definitions for NP-SLE syndromes, and seizures were defined using the International Classification of Epileptic Seizures. At the end of the study period, 28 of the 195 (14%) patients with SLE had seizures (21 generalized convulsive, 7 partial) during their course of disease. Recurrent seizures or epilepsy occurred in 12 of 28 patients (43%). The baseline features of those patients with seizures and those without them were compared to determine their contribution to the occurrence of isolated seizures and epilepsy.


RESULTS
Isolated seizures in SLE are common; epilepsy is less frequent but nonetheless important. Certain clinical features at baseline were independent predictors of seizures including disease activity, in particular psychosis, moderate- to high-titer serum anti-cardiolipin and anti-Smith antibodies, and damage accrual. Higher disease activity at baseline, concurrent multiple NP-SLE manifestations, prior strokes, and male gender were predictive of epilepsy.


CONCLUSIONS
The risk of seizure and epilepsy in systemic lupus erythematosus (SLE) is increased in those patients with higher disease activity at baseline, prior neuropsychiatric SLE disease, and anti-cardiolipin and anti-Smith antibodies.
Department of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, 10 S. Pine St., Suite 834, Baltimore, MD 21201, USA. jmikdash@umaryland.edu
Jamal
J
Mikdashi
Allan
A
Krumholz
Barry
B
Handwerger
D000328:Adult; D001323:Autoantibodies / Q000097:blood; D001324:Autoantigens; D001921:Brain / Q000503:physiopathology*; D002308:Cardiolipins / Q000276:immunology; D015331:Cohort Studies; D018450:Disease Progression; D004827:Epilepsy / Q000175:diagnosis* / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D020945:Lupus Vasculitis, Central Nervous System / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011618:Psychotic Disorders / Q000150:complications; D012044:Regression Analysis; D017411:Ribonucleoproteins, Small Nuclear / Q000276:immunology; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000150:complications; D055517:snRNP Core Proteins
D001323:Autoantibodies; D001324:Autoantigens; D002308:Cardiolipins; D017411:Ribonucleoproteins, Small Nuclear; D055517:snRNP Core Proteins