Factors and comorbidities associated with first neuropsychiatric event in systemic lupus erythematosus: does a risk profile exist? A large multicentre retrospective cross-sectional study on 959 Italian patients

Govoni, Marcello; Bombardieri, Stefano; Bortoluzzi, Alessandra; Caniatti, Luisa; Casu, Cinzia; Conti, Fabrizio; Vita, Salvatore De; Doria, Andrea; Farina, Ilaria; Ferraccioli, Gianfranco; Gremese, Elisa; Mansutti, Elisa; Mosca, Marta; Padovan, Melissa; Piga, Matteo; Tincani, Anǵela; Tola, Maria Rosaria; Tomietto, Paola; Taglietti, Marco; Trotta, Francesco; Valesini, Guido; Zen, Margherita; Mathieu, Alessandro

doi:10.1093/rheumatology/ker310

Cited by 94 publications

(62 citation statements)

References 40 publications

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“…In a 7.8-year follow-up study, Appenzeller et al8 identified 60 (11.6%) epileptic seizures in 519 SLE patients, with 19 episodes appearing at the onset of SLE symptoms. In an Italian 10-year multicenter study, Govoni et al13 followed a cohort of 959 SLE patients and found 14.4% with epileptic seizures. These studies show that epilepsy is the unfortunate consequence of SLE, occurring before or at the onset of SLE, or after diagnosis of the disease.…”

Section: Introductionmentioning

confidence: 99%

Risk of epilepsy in patients with systemic lupus erythematosus – a retrospective cohort study

Tsai¹,

Lin²,

Lin³

et al. 2014

NDT

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BackgroundSystemic lupus erythematosus (SLE) affects central and peripheral nervous systems, manifesting neuropsychiatric disorders that vary from subtle signs to life-threatening complications. This study compared the risk of epilepsy between a general population and patients with SLE.MethodsFrom the national insurance claims data of the Taiwan National Health Research Institutes, we identified 32,301 patients with newly diagnosed SLE from 1997–2010 and, for comparison, 129,204 randomly selected people without SLE; the frequencies of both groups were matched by sex, age, and diagnosis date. The incidence of epilepsy was estimated for both cohorts by the end of 2010.ResultsThe incidence of epilepsy was 2.86-fold higher in the SLE cohort than in the non-SLE cohort (9.10 per 10,000 person-years versus 3.18 per 10,000 person-years), with a Cox method estimated adjusted hazard ratio (aHR) of 2.33 (95% confidence interval [CI] =1.89–2.88) for the SLE cohort. The incidence increased with age in the non-SLE cohort, while it decreased with the increase of age in the SLE cohort. Compared with the non-SLE cohort, the age-specific aHR of epilepsy for the SLE cohort decreased from 8.05 (95% CI =4.30–15.0) for those aged ≤20 years to 0.90 (95% CI =0.57–1.42) for those aged 60 years and above (P=0.01). Comorbidities that had a significant association with epilepsy included infarction (aHR =7.62), intracerebral hemorrhage (aHR =5.75), aseptic meningoencephalitis (aHR =5.35), and psychiatric disorder (aHR =3.31).ConclusionPatients with SLE are at higher risk of epilepsy than the general population, especially younger SLE patients. Neurologic comorbidities and psychiatric disorders increase the epilepsy risk further.

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Section: Introductionmentioning

confidence: 99%

Risk of epilepsy in patients with systemic lupus erythematosus – a retrospective cohort study

Tsai¹,

Lin²,

Lin³

et al. 2014

NDT

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“…Such antibodies were found to be associated with the hypercoagulable state, vasculopathy and thrombokinesis [3]. In addition it has been reported that variable risk factors, such as hypertension, carotid vasculopathy, and dyslipidemia, are associated with cerebrovascular accidents and the decline in cognitive function [8]. The current patient had a risk factor of hypertension.…”

Section: Discussionmentioning

confidence: 90%

“…A previous study reported a case where the brain lesion gradually progressed subsequent to the onset of myelitis. At first a brain lesion was accidentally detected on brain single-photon emission computed tomography (SPECT) but was not observed on brain MRI, and there was no symptom that manifested cerebral disorders [8]. This patient showed neurological abnormalities and symptoms, such as motor weakness, hypoesthesia and dysuresia, which were proved by brain and spinal MRI scans and electromyogram.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Occurrence of Cervical Myelopathy, Cerebral Infarction, and Peripheral Neuropathy in Systemic Lupus Erythematosus: A Case Report

2014

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Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease characterized by multiorgan involvement with diverse clinical presentations. Central nervous system involvement in neuropsychiatric syndromes of SLE (NPSLE), such as cerebrovascular disease and myelopathy, is a major cause of morbidity and mortality in SLE patients. The concomitant occurrence of myelopathy, cerebrovascular disease, and peripheral neuropathy in a patient with SLE has not yet been reported. We report on a 41-year-old woman with SLE who showed motor and sensory impairment with urinary retention and was diagnosed with cervical myelopathy and acute cerebral infarction by spine and brain magnetic resonance imaging and peripheral neuropathy by electrodiagnostic examination. Even though pathogenesis of NPSLE is not well elucidated, we assume that increased antibodies of anti-double stranded DNA (anti-dsDNA), presence of lupus anticoagulant and hypertension are risk factors that have caused neuropsychiatric lupus in this patient.

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“…Her clinical state could be the cerebrovascular disease due to vasculitis or autoantibody associated with NPSLE, because of the upregulated spinal level of IL-6 and absence of antiphospholipid antibody, atrial fibrillation, valvular diseases and atrial sclerosis. Hypertension and a high cumulative dose of glucocorticoids were risk factors for NPSLE (6,8).…”

Section: Discussionmentioning

confidence: 97%

Successful Treatment of Lupus Cerebrovascular Disease with Mycophenolate Mofetil

et al. 2015

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We report a case of neuropsychiatric systemic lupus erythematosus successfully treated with mycophenolate mofetil (MMF). The patient was a 40-year-old female who maintained with 7 mg of prednisolone plus 100 mg of azathioprine (AZ) per day. According to transient ischemic attack that occurred repeatedly and an elevated level of interleukin-6 (IL-6) in spinal fluid, she was diagnosed as having neuropsychiatric systemic lupus erythematosus (NPSLE). Initial increase in doses of prednisolone and AZ to 20 mg and 150 mg per day, respectively, was ineffective. After switching from AZ to MMF, her symptoms of NPSLE completely resolved with marked improvement of the IL-6 level in her spinal fluid, suggesting that MMF was effective.

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Factors and comorbidities associated with first neuropsychiatric event in systemic lupus erythematosus: does a risk profile exist? A large multicentre retrospective cross-sectional study on 959 Italian patients

Cited by 94 publications

References 40 publications

Risk of epilepsy in patients with systemic lupus erythematosus – a retrospective cohort study

Risk of epilepsy in patients with systemic lupus erythematosus – a retrospective cohort study

Concomitant Occurrence of Cervical Myelopathy, Cerebral Infarction, and Peripheral Neuropathy in Systemic Lupus Erythematosus: A Case Report

Successful Treatment of Lupus Cerebrovascular Disease with Mycophenolate Mofetil

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Factors and comorbidities associated with first neuropsychiatric event in systemic lupus erythematosus: does a risk profile exist? A large multicentre retrospective cross-sectional study on 959 Italian patients

Cited by 94 publications

References 40 publications

Risk of epilepsy in patients with systemic lupus erythematosus &ndash; a retrospective cohort study

Risk of epilepsy in patients with systemic lupus erythematosus &ndash; a retrospective cohort study

Concomitant Occurrence of Cervical Myelopathy, Cerebral Infarction, and Peripheral Neuropathy in Systemic Lupus Erythematosus: A Case Report

Successful Treatment of Lupus Cerebrovascular Disease with Mycophenolate Mofetil

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Risk of epilepsy in patients with systemic lupus erythematosus – a retrospective cohort study

Risk of epilepsy in patients with systemic lupus erythematosus – a retrospective cohort study