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

Abstract

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.

Seizures as a clinical manifestation in somatic autoimmune disorders

“…Various reports indicated a high prevalence of seizures among people with SLE (prevalence:1.6%-16%) [3,8,[36][37][38][39][40][41]; and from studies including controls they seem higher than in the general population [8,[38][39][40][41]. A recent cross sectional study with over 5000 people with SLE and over 25,000 controls found epilepsy 4.7 times more likely in the SLE cohort (95% CI: 3.9-5.8%) [39].…”

“…Younger age, history of stroke, African descent, history of psychosis, history of malar rash, proteinuria, neuropathy and low levels of complement 3 (C3) seem associated with increased seizure risk [38,40,[42][43][44]. Seizures are more likely to happen in the year after the diagnosis of SLE [3,42] and are not explained by infection or antiphospholipid syndrome [3].…”

Neuropsychiatric systemic lupus erythematosus: a diagnostic challenge

“…Neuropsychiatric symptoms of SLE are associated with generalised SLE activity and often recur 11. The incidence of epilepsy in people with SLE is three times that of the general population and people with SLE and epilepsy are more likely to experience psychiatric disorders 12. However, as in this case, seizures often predate other symptoms by many years and so diagnosis of isolated epilepsy syndromes is common 13.…”

Epilepsy among Systemic Lupus Erythematosus Patients: Insights from a Large Database Analysis

“…A study from Taiwan, retrospective in its design, contained 32,301 SLE patients matched with 129,204 controls, based on the national insurance claims data of the Taiwan National Health Research Institutes (1997–2010 as the study period) [35]. Authors found that the 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).…”