Department of Clinical Neuroscience, Unit of Neurology, Karolinska Institutet och Karolinska Universitetssjukhuset, Solna, Stockholm, Sweden.
Department of Medicine, Unit of Rheumatology, Karolinska Institutet and Karolinska University Hospital, Solna, Stockholm, Sweden.
Eur J Neurol. 2020 Feb;27(2):297-307. doi: 10.1111/ene.14077. Epub 2019 Oct 8.
The aim was to study the prevalence of epilepsy in a hospital-based systemic lupus erythematosus (SLE) cohort and to investigate the relationship between epilepsy and other manifestations of neuropsychiatric SLE (NPSLE).
The study population consisted of 440 SLE patients recruited from 1998 to 2012. An epilepsy-screening questionnaire was sent to all patients, where those screening positive were invited to a neurological examination with documentation of NPSLE symptoms according to the American College of Rheumatology nomenclature. Occurrences of autoantibodies (double stranded DNAantibody, antinuclear antibody, lupus anticoagulant, Sjögren's syndrome A, Sjögren's syndrome B) and the antiphospholipid syndrome (APS) were tabulated.
Out of 440 patients, 14% were dead and 2.7% were lost to follow-up. The questionnaire was sent to 368 patients; 312 (85%) responded. Of these, 131 (42%) screened positive. Epilepsy was confirmed in 36 (11.5%), of whom 30 (83%) had focal onset. Ten (3.2%) patients had isolated or provoked seizures. Manifestations of NPSLE occurred in 50%. The rates of cerebrovascular disease and psychosis were elevated two- and three-fold in NPSLE patients with epilepsy versus NPSLE patients without epilepsy, respectively (P = 0.001 and P = 0.0006). APS was more common in patients with epilepsy compared to epilepsy-free SLE patients with or without NPSLE (P = 0.02). In 50% of patients with epilepsy, no other etiology than SLE was detected.
A high prevalence of epilepsy in SLE patients is reported, with association to concurrent cerebrovascular disease, APS and psychosis. Our findings support the notion of a multifactorial background for epilepsy in SLE including both vascular disease and features consistent with autoimmunity.
本研究旨在调查红斑狼疮（SLE）患者中癫痫的发病率，并探讨癫痫与神经精神性 SLE（NPSLE）其他表现之间的关系。
研究人群由 1998 年至 2012 年间招募的 440 例 SLE 患者组成。向所有患者发送癫痫筛查问卷，对筛查阳性的患者进行神经科检查，并根据美国风湿病学会的命名法记录 NPSLE 症状。记录自身抗体（双链 DNA 抗体、抗核抗体、狼疮抗凝物、干燥综合征 A、干燥综合征 B）和抗磷脂综合征（APS）的发生情况。
440 例患者中，14%死亡，2.7%失访。共向 368 例患者发送问卷，312 例（85%）做出回应。其中 131 例（42%）筛查阳性。确诊癫痫 36 例（11.5%），其中 30 例（83%）为局灶性发作。10 例（3.2%）为孤立或诱发性发作。NPSLE 患者癫痫发生率为 50%。与无癫痫的 NPSLE 患者相比，NPSLE 合并癫痫患者的脑血管疾病和精神病发病率分别升高 2 倍和 3 倍（P=0.001 和 P=0.0006）。与无癫痫的 SLE 患者相比，癫痫患者中 APS 更为常见（P=0.02）。50%的癫痫患者除 SLE 外，未发现其他病因。
SLE 患者癫痫发病率较高，与并发脑血管疾病、APS 和精神病有关。我们的研究结果支持 SLE 患者癫痫发病具有多因素背景，包括血管疾病和自身免疫特征。
