Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study

John G. Hanly*, Murray B. Urowitz, Li Su, Caroline Gordon, Sang Cheol Bae, Jorge Sanchez-Guerrero, Juanita Romero-Diaz, Daniel J. Wallace, Ann E. Clarke, E. M. Ginzler, Joan T. Merrill, David A. Isenberg, Anisur Rahman, M. Petri, Paul R. Fortin, D. D. Gladman, Ian N. Bruce, Kristjan Steinsson, M. A. Dooley, Munther A. KhamashtaGraciela S. Alarcón, Barri J. Fessler, Rosalind Ramsey-Goldman, Susan Manzi, Asad A. Zoma, Gunnar K. Sturfelt, Ola Nived, Cynthia Aranow, Meggan Mackay, Manuel Ramos-Casals, R. F. Van Vollenhoven, Kenneth C. Kalunian, Guillermo Ruiz-Irastorza, Sam Lim, Diane L. Kamen, Christine A. Peschken, Murat Inanc, Chris Theriault, Kara Thompson, Vernon Farewell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

Objective: The aim of this study was to describe the frequency, attribution, outcome and predictors of seizures in systemic lupus erythematosus (SLE). Methods: The Systemic Lupus International Collaborating Clinics, or SLICC, performed a prospective inception cohort study. Demographic variables, global SLE disease activity (SLE Disease Activity Index 2000), cumulative organ damage (SLICC/American College of Rheumatology Damage Index (SDI)) and neuropsychiatric events were recorded at enrolment and annually. Lupus anticoagulant, anticardiolipin, anti-β 2glycoprotein-I, antiribosomal P and anti-NR2 glutamate receptor antibodies were measured at enrolment. Physician outcomes of seizures were recorded. Patient outcomes were derived from the SF-36 (36-Item Short Form Health Survey) mental component summary and physical component summary scores. Statistical analyses included Cox and linear regressions. Results: The cohort was 89.4% female with a mean follow-up of 3.5±2.9 years. Of 1631 patients, 75 (4.6%) had ≥1 seizure, the majority around the time of SLE diagnosis. Multivariate analysis indicated a higher risk of seizures with African race/ethnicity (HR (CI): 1.97 (1.07 to 3.63); p=0.03) and lower education status (1.97 (1.21 to 3.19); p<0.01). Higher damage scores (without neuropsychiatric variables) were associated with an increased risk of subsequent seizures (SDI=1:3.93 (1.46 to 10.55); SDI=2 or 3:1.57 (0.32 to 7.65); SDI≥4:7.86 (0.89 to 69.06); p=0.03). There was an association with disease activity but not with autoantibodies. Seizures attributed to SLE frequently resolved (59/78 (76%)) in the absence of antiseizure drugs. There was no significant impact on the mental component summary or physical component summary scores. Antimalarial drugs in the absence of immunosuppressive agents were associated with reduced seizure risk (0.07 (0.01 to 0.66); p=0.03). Conclusion: Seizures occurred close to SLE diagnosis, in patients with African race/ethnicity, lower educational status and cumulative organ damage. Most seizures resolved without a negative impact on health-related quality of life. Antimalarial drugs were associated with a protective effect.

Original languageEnglish (US)
Pages (from-to)1502-1509
Number of pages8
JournalAnnals of the Rheumatic Diseases
Volume71
Issue number9
DOIs
StatePublished - Sep 2012

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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