Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
A Prospective Study of Seizures in Systemic Lupus Erythematosus.
Hanly1, John G., Urowitz2, Murray B., Su3, Li, Gordon4, Caroline, Bae5, Sang-Cheol, Sanchez-Guerrero6, Jorge, Romero-Diaz7, Juanita
Dalhousie University, Halifax, NS
McGill UHC/RVH, Montreal, QC
SUNY-Downstate Medical Center, Brooklyn, NY
Oklahoma Medical Research Foundation, Oklahoma City, OK
University College London, London, United Kingdom
Johns Hopkins University School of Medicine, Baltimore, MD
Toronto Western Hospital, Toronto, ON
Toronto Western Hospital, University of Toronto, Toronto, ON
A, Manchester, United Kingdom
Landspital Univ Hospital, Reykjavik, Iceland
University of North Carolina at Chapel Hill, Chapel Hill, NC
Toronto Western Hospital and University of Toronto, Toronto, ON
Lupus Research Unit, The Rayne Institute, Kings College London School of Medicine, London, United Kingdom
University of Alabama at Birmingham, Birmingham, AL
Northwestern University Feinberg School of Medicine, Chicago, IL
Allegheny Singer Research Institute, Pittsburgh, PA
MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK, Cambridge, United Kingdom
University of Birmingham, Birmingham, United Kingdom
Hanyang University Hospital for Rheumatic Diseases, Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea
Mount Sinai Hospital/University Health Network, Toronto, ON
INCMNSZ, Mexico city, Mexico
Cedars-Sinai/UCLA, Los Angeles, CA
Montreal General Hospital, Montreal, QC
Seizure disorders are serious manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE). We wished to determine the frequency, attribution and outcome of seizures in a long-term study of SLE.
The study was conducted by an international research network of academic centers. Patients were enrolled close to the time of SLE diagnosis and assessed annually for up to 10 years for the occurrence of seizures and other NP events using the ACR case definitions. The attribution of seizures to SLE and non-SLE causes was determined centrally using a priori decision rules. Physician outcome scores of seizure disorders were recorded on a 7 point Likert scale. Patient outcomes were derived from the mental (MCS) and physical (PCS) component summary scores of the SF-36. Statistical analyses included Cox regression for time-to-seizure resolution (adjusting for correlation of multiple seizures in the same patient) and linear regression for MCS and PCS summary scores by generalised estimating equations (adjusting for correlation between multiple MCS and PCS measurements for the same patient).
Of the 1631 enrolled patients 89.4% were female and the mean (± SD) age was 35.0 ± 13.4 years. The mean disease duration at enrollment was 5.6 ± 4.8 months and the mean length of followup was 3.5 ± 2.9 years. A total of 75/1631 (4.6%) patients had >= 1 seizure with the majority (79%) having a single event. In these 75 patients there were a total of 91 seizures (66% generalized; 34% focal) of which 78/91 (86%) were attributed to SLE. Although seizures occurred over the entire observation period, the majority presented early in the disease course with a median (range) interval from the time of diagnosis of SLE to onset of first seizure of 0.14 (-0.50 7.57) years. More patients with seizures attributed to SLE stopped taking anti-seizure drugs at the first followup assessment compared to patients with seizures attributed to non-SLE causes (19/66=29% vs. 2/12=17%) and similarly by the second followup assessment (32% vs. 11%). Using physician assessment, those seizures attributed to SLE were more likely to resolve (59/78, (76%)) compared to seizures attributed to non-SLE causes (7/13, (54%)). Using patient self-report the mean (± SD) MCS score in patients with seizures and no other NP events was comparable to patients without NP events (45±13.1 vs. 48.5 ± 10.9; p=0.21). A similar outcome was seen in the mean (± SD) PCS scores (40.0 ± 10.8 vs. 42.8 ± 11.2; p=0.34).
Most seizures in SLE patients are attributable to lupus and occur in close proximity to the time of diagnosis of SLE. In the majority of cases the seizures resolve, do not require long-term anti-seizure medication and are not associated with a negative impact on mental or physical health-related quality of life.
To cite this abstract, please use the following information:
Hanly, John G., Urowitz, Murray B., Su, Li, Gordon, Caroline, Bae, Sang-Cheol, Sanchez-Guerrero, Jorge, et al; A Prospective Study of Seizures in Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :591