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

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Watad A1,2,3, Tiosano S1,3, Bragazzi NL4, Brigo F5, Comaneshter D6, Cohen AD6,7, Amital H1,2,3. Neuroepidemiology. 2017 Dec 1;50(1-2):1-6. doi: 10.1159/000485136. [Epub ahead of print]


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1 Department of Medicine "B", Tel-Hashomer, Israel.

2 The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.

3 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

4 School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

5 Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy, Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.

6 Chief Physician's Office, Clalit Health Services Tel Aviv, Faculty of Health Sciences, Tel Aviv, Israel.

7 Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.


OBJECTIVE: Epilepsy is characterized by a relevant epidemiological and clinical burden. In the extant literature, an increased risk of seizures has been described in several inflammatory/autoimmune disorders, including systemic lupus erythematosus (SLE). However, so far, relatively few and small size-based studies have been conducted. We aimed to investigate the link between seizure and SLE utilizing a large sample of subjects and extensive data analysis.

METHODS: Patients with SLE were compared with age- and sex-matched controls regarding the prevalence of epilepsy in a cross-sectional study. Chi-square and t tests were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was performed utilizing the medical database of Clalit Health Services.

RESULTS: The study included 5,018 patients with SLE and 25,090 age- and gender-frequency-matched controls. The proportion of epilepsy was found significantly higher among SLE patients (4.03 vs. 0.87%, p < 0.001). Using logistic regression, adjusting for multiple confounding factors, older age (≥70 years) resulted as negative predictor (OR 0.42 [95% CI 0.27-0.62], p <0.001), whereas the presence of SLE was a positive predictor of epilepsy (OR 4.70 [95% CI 3.94-5.82], p < 0.001). Interaction between SLE and elderly age resulted in high OR of 5.47 for epilepsy (95% CI 2.53-11.9).

CONCLUSION: Our study confirms the higher prevalence of epilepsy in SLE patients. Physicians should be aware of such findings and have a lower threshold for suspecting epileptic seizures in these patients. Further studies are needed to better elucidate the mechanisms by which SLE favors the insurgence of seizures.