Clinical study
Antiphospholipid and antinuclear antibodies in patients with epilepsy or new-onset seizure disorders

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Abstract

PURPOSE: The increased prevalence of autoantibodies in patients with epilepsy has been traditionally regarded to be a consequence of antiepileptic drugs. The purpose of this study was to measure autoantibodies in well-defined groups of patients with seizures to determine the effects of epilepsy and antiepileptic medications on the presence of autoantibodies.

PATIENTS AND METHODS: We studied the frequency of antinuclear antibodies, anti-β2-glycoprotein I antibodies, and anticardiolipin antibodies in 50 patients with therapy-resistant localization-related epilepsy, 50 patients with generalized epilepsy syndromes, 52 patients with a newly diagnosed seizure disorder but no antiepileptic medication, and 83 healthy controls.

RESULTS: Compared with controls, newly diagnosed patients had a significantly greater prevalence of immunoglobulin (Ig) G class anticardiolipin antibodies (21% versus 7%); the prevalence was 14% in patients with localization-related epilepsy and 8% in patients with generalized epilepsy. The prevalence of IgM class anticardiolipin antibodies was significantly greater in all seizure groups (60% in localization-related epilepsy, 42% in generalized epilepsies, and 33% in newly diagnosed patients) compared with controls (7%). Antinuclear antibodies were significantly more common in newly diagnosed patients (21%) and localization-related epilepsy (24%) compared with controls (12%). When patients with generalized epilepsy (8%) were used as the reference group, antinuclear antibodies were also significantly more frequent in localization-related epilepsy (relative risk [RR] = 2.9, 95% confidence interval [CI]: 1.1 to 8.2) and newly diagnosed seizures (RR = 3.4, 95% CI: 1.2 to 9.3). There were no consistent associations between autoantibodies and specific antiepileptic medications.

CONCLUSIONS: The prevalence of autoantibodies is greater in patients with epilepsy, including newly diagnosed seizure disorder. The increased prevalence of autoantibodies is more strongly associated with epilepsy than with antiepileptic drugs, perhaps indicating that immune dysregulation may be commonly associated with epilepsy.

Section snippets

Subjects

Blood was obtained at regularly scheduled clinical visits from 152 patients with seizure disorders after obtaining informed consent. The study was approved by the Ethics Committees of Tampere University Hospital and the University of Oulu Faculty of Medicine. Blood was processed for the collection of serum and stored in aliquots at −20°C.

Clinical records of the patients were reviewed retrospectively without knowledge of laboratory data to determine the patient’s age, use of antiepileptic drugs,

Results

The clinical characteristics of the patients are presented in Table 1. Patients with epilepsy tended to have a greater prevalence of autoantibodies (except IgM class anti-β2-glycoprotein I antibodies), which were statistically significant for IgG class anticardiolipin antibodies in newly diagnosed patients with seizure disorder, for IgM class anticardiolipin antibodies in all seizure groups, and for antinuclear antibodies in newly diagnosed patients and localization-related epilepsy Table 2,

Discussion

The major finding in our study was a stronger association between various epileptic syndromes and the prevalence of autoantibodies than between antiepileptic medications and autoantibodies. We found a substantial prevalence of anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, and antinuclear antibodies among patients with newly diagnosed, untreated epileptic seizures, which strongly suggests that the occurrence of autoantibodies cannot be due to antiepileptic medications alone. In

Acknowledgements

We would like to thank T. Dyba, MSc, for performing the statistical analyses and P. Tenkilä, MA, for reviewing the manuscript for fluency in English.

References (16)

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