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Journal article
Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study
Annals of the rheumatic diseases, v 71(9), pp 1502-1509
01 Sep 2012
PMID: 22492779
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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-beta(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.
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.
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Details
- Title
- Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study
- Creators
- John G. Hanly - Queen Elizabeth II Health Sciences CentreMurray B. Urowitz - Toronto Western HospitalLi Su - MRC Biostatistics UnitCaroline Gordon - University of BirminghamSang-Cheol Bae - Hanyang UniversityJorge Sanchez-Guerrero - Toronto Western HospitalJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránDaniel J. Wallace - College Station Medical CenterAnn E. Clarke - McGill University Health CentreE. M. Ginzler - SUNY Downstate Health Sciences UniversityJoan T. Merrill - Oklahoma Medical Research FoundationDavid A. Isenberg - University College LondonAnisur Rahman - University College LondonM. Petri - Johns Hopkins UniversityPaul R. Fortin - Centre hospitalier universitaire de QuébecD. D. Gladman - Toronto Western HospitalIan N. Bruce - University of ManchesterKristjan Steinsson - Reykjavík UniversityM. A. Dooley - University of North Carolina at Chapel HillMunther A. Khamashta - St Thomas' HospitalGraciela S. Alarcon - University of Alabama at BirminghamBarri J. Fessler - University of Alabama at BirminghamRosalind Ramsey-Goldman - Northwestern UniversitySusan Manzi - University of PittsburghAsad A. Zoma - Hairmyres HospitalGunnar K. Sturfelt - Lund UniversityOla Nived - Lund UniversityCynthia Aranow - Feinstein Institute for Medical ResearchMeggan Mackay - Feinstein Institute for Medical ResearchManuel Ramos-Casals - Hospital Clínic de BarcelonaR. F. van Vollenhoven - Karolinska InstitutetKenneth C. Kalunian - University of California, San DiegoGuillermo Ruiz-Irastorza - Hospital de CrucesSam Lim - Emory UniversityDiane L. Kamen - Medical University of South CarolinaChristine A. Peschken - University of ManitobaMurat Inanc - Istanbul UniversityChris Theriault - Queen Elizabeth II Health Sciences CentreKara Thompson - Queen Elizabeth II Health Sciences CentreVernon Farewell - MRC Biostatistics Unit
- Publication Details
- Annals of the rheumatic diseases, v 71(9), pp 1502-1509
- Publisher
- BMJ Publishing Group
- Number of pages
- 8
- Grant note
- U105261167 / MRC (UK); UK Research & Innovation (UKRI); Medical Research Council UK (MRC) A080588 / Korea Healthcare Technology R&D Project, Ministry for Health and Welfare, Republic of Korea Singer Family Fund for Lupus Research MC_U105261167 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC); European Commission MC_U105261167 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) UL-1RR-025741; K24-AR-02318; P60-AR-48098 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Department of Education, Universities and Research of the Basque Government P60AR048098 / NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) MOP-57752 / Canadian Institutes of Health Research grant; Canadian Institutes of Health Research (CIHR) UL1RR025741 / NATIONAL CENTER FOR RESEARCH RESOURCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:000307646500013
- Scopus ID
- 2-s2.0-84864868783
- Other Identifier
- 991021934014404721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology