Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study.
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Author
Hanly, John GUrowitz, Murray B
Su, Li
Gordon, Caroline
Bae, Sang-Cheol
Sanchez-Guerrero, Jorge
Romero-Diaz, Juanita
Wallace, Daniel J
Clarke, Ann E
Ginzler, Em
Merrill, Joan T
Isenberg, David A
Rahman, Anisur
Petri, M
Fortin, Paul R
Gladman, Dd
Bruce, Ian N
Steinsson, Kristjan
Dooley, Ma
Khamashta, Munther A
Alarcón, Graciela S
Fessler, Barri J
Ramsey-Goldman, Rosalind
Manzi, Susan
Zoma, Asad A
Sturfelt, Gunnar K
Nived, Ola
Aranow, Cynthia
Mackay, Meggan
Ramos-Casals, Manuel
van Vollenhoven, Rf
Kalunian, Kenneth C
Ruiz-Irastorza, Guillermo
Lim, Sam
Kamen, Diane L
Peschken, Christine A
Inanc, Murat
Theriault, Chris
Thompson, Kara
Farewell, Vernon
Journal title
Annals of the rheumatic diseasesDate Published
2012-04-04Publication Volume
71Publication Issue
9Publication Begin page
1502Publication End page
9
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Show full item recordAbstract
The aim of this study was to describe the frequency, attribution, outcome and predictors of seizures in systemic lupus erythematosus (SLE).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(2) glycoprotein-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.
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).
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.
Citation
Hanly JG, Urowitz MB, Su L, Gordon C, Bae SC, Sanchez-Guerrero J, Romero-Diaz J, Wallace DJ, Clarke AE, Ginzler E, Merrill JT, Isenberg DA, Rahman A, Petri M, Fortin PR, Gladman D, Bruce IN, Steinsson K, Dooley M, Khamashta MA, Alarcón GS, Fessler BJ, Ramsey-Goldman R, Manzi S, Zoma AA, Sturfelt GK, Nived O, Aranow C, Mackay M, Ramos-Casals M, van Vollenhoven R, Kalunian KC, Ruiz-Irastorza G, Lim S, Kamen DL, Peschken CA, Inanc M, Theriault C, Thompson K, Farewell V. Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study. Ann Rheum Dis. 2012 Sep;71(9):1502-9. doi: 10.1136/annrheumdis-2011-201089. Epub 2012 Apr 4. PMID: 22492779; PMCID: PMC4656036.DOI
10.1136/annrheumdis-2011-201089ae974a485f413a2113503eed53cd6c53
10.1136/annrheumdis-2011-201089
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