Factors at diagnosis predict subsequent occurrence of seizures in systemic lupus erythematosus.

OBJECTIVE: To determine the factors associated with seizures in systemic lupus erythematosus (SLE).

METHODS: One hundred ninety-five patients with SLE were followed at the University of Maryland Lupus Clinics from January 1992 until June 2004. Neuropsychiatric (NP) manifestations were defined according to the American College of Rheumatology nomenclature and case definitions for NP-SLE syndromes, and seizures were defined using the International Classification of Epileptic Seizures. At the end of the study period, 28 of the 195 (14%) patients with SLE had seizures (21 generalized convulsive, 7 partial) during their course of disease. Recurrent seizures or epilepsy occurred in 12 of 28 patients (43%). The baseline features of those patients with seizures and those without them were compared to determine their contribution to the occurrence of isolated seizures and epilepsy.

RESULTS: Isolated seizures in SLE are common; epilepsy is less frequent but nonetheless important. Certain clinical features at baseline were independent predictors of seizures including disease activity, in particular psychosis, moderate- to high-titer serum anti-cardiolipin and anti-Smith antibodies, and damage accrual. Higher disease activity at baseline, concurrent multiple NP-SLE manifestations, prior strokes, and male gender were predictive of epilepsy.

CONCLUSION: The risk of seizure and epilepsy in systemic lupus erythematosus (SLE) is increased in those patients with higher disease activity at baseline, prior neuropsychiatric SLE disease, and anti-cardiolipin and anti-Smith antibodies.