Features associated with epilepsy in the antiphospholipid syndrome

Yehuda Shoenfeld, Shaul Lev, Ilan Blatt, Miri Blank, Joseph Font, Philipp Von Landenberg, Nirit Lev, Joseph Zaech, Ricard Cervera, Jean Charles Piette, Munther A. Khamashta, Maria L. Bertolaccini, Graham R V Hughes, Pierre Youinou, Pierre Luigi Meroni, Vittorio Pengo, J. Delgado Alves, Angela Tincani, Gyula Szegedi, Gabriella LakosGunnar Sturfelt, Andreas Jönsen, Takao Koike, Marielle Sanmarco, Amelia Ruffatti, Zdenka Ulcova-Gallova, Sonja Praprotnik, Blaz Rozman, Margalit Lorber, Joab Chapman, Peter J C Van-Breda-Vriezman, Jan Damoiseaux

Research output: Contribution to journalArticlepeer-review

Abstract

Objective. To assess the frequency of epilepsy in primary and secondary antiphospholipid syndrome (APS); to analyze the clinical and laboratory features characterizing those with epilepsy in a cohort of 538 patients with APS; and to find associated features that would suggest risk factors for epilepsy in APS. Methods. We analyzed the clinical features of patients with APS who had epilepsy and compared them to the clinical features of non-epileptic APS patients. Results. Of 538 APS patients, 46 (8.6%) had epilepsy. Epilepsy was more prevalent among APS secondary to systemic lupus erythematosus (SLE) compared to primary APS (13.7% vs 6%; p <0.05). The patients with epilepsy had a higher prevalence of central nervous system (CNS) manifestations including focal ischemic events (strokes or transient ischemic events, 54.3% vs 24.6%; p <0.0001) and amaurosis fugax (15.2% vs 4.9%; p <0.05). APS patients with epilepsy had a higher frequency of valvular pathology (30.4% vs 14.6%; p <0.01), thrombocytopenia (43.5% vs 25%; p <0.05), and livedo reticularis (26.1% vs 11.5%; p <0.01). The multivariate logistic regression analysis found CNS thromboembolic events as the most significant factor associated with epilepsy, with an odds ratio (OR) of 4.05 (95% confidence interval, CI: 2.05-8), followed by SLE (OR 1.4, 95% CI 1.2-4.7), and valvular vegetations (OR 2.87, 95% CI 1-8.27). Conclusion. Epilepsy is common in APS and most of the risk seems to be linked to vascular disease as manifested by extensive CNS involvement, valvulopathy, and livedo reticularis and to the presence of SLE. These factors, however, explain only part of the increased occurrence of epilepsy in APS and other causes such as direct immune interaction in the brain should be investigated.

Original languageEnglish
Pages (from-to)1344-1348
Number of pages5
JournalJournal of Rheumatology
Volume31
Issue number7
Publication statusPublished - Jul 2004

Keywords

  • Antiphospholipid antibodies
  • Antiphospholipid syndrome
  • Epilepsy
  • Livedo reticularis
  • Thrombocytopenia
  • Valvular heart disease

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

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