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, G. Szegedi, Gabriella Lakos & 12 others Gunnar 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 journalArticle

91 Citations (Scopus)

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

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Antiphospholipid Syndrome
Epilepsy
Livedo Reticularis
Systemic Lupus Erythematosus
Central Nervous System
Odds Ratio
Amaurosis Fugax
Vascular Diseases
Thrombocytopenia
Logistic Models
Stroke
Regression Analysis
Confidence Intervals
Pathology

Keywords

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

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Shoenfeld, Y., Lev, S., Blatt, I., Blank, M., Font, J., Von Landenberg, P., ... Damoiseaux, J. (2004). Features associated with epilepsy in the antiphospholipid syndrome. Journal of Rheumatology, 31(7), 1344-1348.

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

In: Journal of Rheumatology, Vol. 31, No. 7, 07.2004, p. 1344-1348.

Research output: Contribution to journalArticle

Shoenfeld, Y, Lev, S, Blatt, I, Blank, M, Font, J, Von Landenberg, P, Lev, N, Zaech, J, Cervera, R, Piette, JC, Khamashta, MA, Bertolaccini, ML, Hughes, GRV, Youinou, P, Meroni, PL, Pengo, V, Alves, JD, Tincani, A, Szegedi, G, Lakos, G, Sturfelt, G, Jönsen, A, Koike, T, Sanmarco, M, Ruffatti, A, Ulcova-Gallova, Z, Praprotnik, S, Rozman, B, Lorber, M, Chapman, J, Van-Breda-Vriezman, PJC & Damoiseaux, J 2004, 'Features associated with epilepsy in the antiphospholipid syndrome', Journal of Rheumatology, vol. 31, no. 7, pp. 1344-1348.
Shoenfeld Y, Lev S, Blatt I, Blank M, Font J, Von Landenberg P et al. Features associated with epilepsy in the antiphospholipid syndrome. Journal of Rheumatology. 2004 Jul;31(7):1344-1348.
Shoenfeld, Yehuda ; Lev, Shaul ; Blatt, Ilan ; Blank, Miri ; Font, Joseph ; Von Landenberg, Philipp ; Lev, Nirit ; Zaech, Joseph ; Cervera, Ricard ; Piette, Jean Charles ; Khamashta, Munther A. ; Bertolaccini, Maria L. ; Hughes, Graham R V ; Youinou, Pierre ; Meroni, Pierre Luigi ; Pengo, Vittorio ; Alves, J. Delgado ; Tincani, Angela ; Szegedi, G. ; Lakos, Gabriella ; Sturfelt, Gunnar ; Jönsen, Andreas ; Koike, Takao ; Sanmarco, Marielle ; Ruffatti, Amelia ; Ulcova-Gallova, Zdenka ; Praprotnik, Sonja ; Rozman, Blaz ; Lorber, Margalit ; Chapman, Joab ; Van-Breda-Vriezman, Peter J C ; Damoiseaux, Jan. / Features associated with epilepsy in the antiphospholipid syndrome. In: Journal of Rheumatology. 2004 ; Vol. 31, No. 7. pp. 1344-1348.
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title = "Features associated with epilepsy in the antiphospholipid syndrome",
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.",
keywords = "Antiphospholipid antibodies, Antiphospholipid syndrome, Epilepsy, Livedo reticularis, Thrombocytopenia, Valvular heart disease",
author = "Yehuda Shoenfeld and Shaul Lev and Ilan Blatt and Miri Blank and Joseph Font and {Von Landenberg}, Philipp and Nirit Lev and Joseph Zaech and Ricard Cervera and Piette, {Jean Charles} and Khamashta, {Munther A.} and Bertolaccini, {Maria L.} and Hughes, {Graham R V} and Pierre Youinou and Meroni, {Pierre Luigi} and Vittorio Pengo and Alves, {J. Delgado} and Angela Tincani and G. Szegedi and Gabriella Lakos and Gunnar Sturfelt and Andreas J{\"o}nsen and Takao Koike and Marielle Sanmarco and Amelia Ruffatti and Zdenka Ulcova-Gallova and Sonja Praprotnik and Blaz Rozman and Margalit Lorber and Joab Chapman and Van-Breda-Vriezman, {Peter J C} and Jan Damoiseaux",
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TY - JOUR

T1 - Features associated with epilepsy in the antiphospholipid syndrome

AU - Shoenfeld, Yehuda

AU - Lev, Shaul

AU - Blatt, Ilan

AU - Blank, Miri

AU - Font, Joseph

AU - Von Landenberg, Philipp

AU - Lev, Nirit

AU - Zaech, Joseph

AU - Cervera, Ricard

AU - Piette, Jean Charles

AU - Khamashta, Munther A.

AU - Bertolaccini, Maria L.

AU - Hughes, Graham R V

AU - Youinou, Pierre

AU - Meroni, Pierre Luigi

AU - Pengo, Vittorio

AU - Alves, J. Delgado

AU - Tincani, Angela

AU - Szegedi, G.

AU - Lakos, Gabriella

AU - Sturfelt, Gunnar

AU - Jönsen, Andreas

AU - Koike, Takao

AU - Sanmarco, Marielle

AU - Ruffatti, Amelia

AU - Ulcova-Gallova, Zdenka

AU - Praprotnik, Sonja

AU - Rozman, Blaz

AU - Lorber, Margalit

AU - Chapman, Joab

AU - Van-Breda-Vriezman, Peter J C

AU - Damoiseaux, Jan

PY - 2004/7

Y1 - 2004/7

N2 - 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.

AB - 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.

KW - Antiphospholipid antibodies

KW - Antiphospholipid syndrome

KW - Epilepsy

KW - Livedo reticularis

KW - Thrombocytopenia

KW - Valvular heart disease

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VL - 31

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JO - Journal of Rheumatology

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