title: Epileptic syndrome in systemic lupus erythematosus and neuronal autoantibody associations.
abstract: We investigated systemic lupus erythematosus (SLE) patients with epilepsy, a major and organic neurological symptom. Our aim was to test patients for the autoimmune epilepsy-associated antibodies anti-GAD, anti-NMDAR, anti-AMPAR1/2, anti-GABABR and anti-VGKC. We tested sera from ten SLE patients with current or previous episodes of epileptic seizures. In addition, sera were tested for staining on primary hippocampal neurons. The patients' clinical and neuroimaging profile, disease activity and accumulated damage scores and therapeutic regimens administered were recorded, and correlations were evaluated. Patients were negative for all anti-neuronal autoantibodies tested, and showed no staining on primary hippocampal cells, which suggests the absence of autoantibodies against neuronal cell surface antigens. Epileptic seizures were all tonic-clonic, and all patients had high disease activity (mean SLE Damage Acticity Index score 19.3 ± 7.3). Six patients had minor or no brain magnetic resonance imaging findings, and three had major findings. 9/10 patients received immunosuppression for 5 ± 4 months, while anti-convulsive treatment was administered to all patients (4.2 ± 3 years). Our results suggest that the majority of SLE-related epileptic seizures cannot be attributed to the action of a single antibody against neuronal antigens. Studies with larger neuropsychiatric SLE populations and stricter inclusion criteria are necessary to verify these findings.
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: E I
authors.initials: EI
authors.lastname: Kampylafka
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: H
authors.initials: H
authors.lastname: Alexopoulos
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Fouka
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: H M
authors.initials: HM
authors.lastname: Moutsopoulos
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece Department of Neurology, Thomas Jefferson University, Philadelphia, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Dalakas
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece agtzi@med.uoa.gr.
authors.forename: A G
authors.initials: AG
authors.lastname: Tzioufas
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D000927:Anticonvulsants / Q000627:therapeutic use; D000954:Antigens, Surface / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D004827:Epilepsy / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D006624:Hippocampus / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000276:immunology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D000927:Anticonvulsants; D000954:Antigens, Surface; D001323:Autoantibodies; D015415:Biomarkers; D007166:Immunosuppressive Agents
keywords: NMDA receptors; Systemic lupus erythematosus; autoantibodies; epilepsy; neurological manifestations