TY - JOUR T1 - Seizure disorders in systemic lupus erythematosus results from an international, prospective, inception cohort study JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 1502 LP - 1509 DO - 10.1136/annrheumdis-2011-201089 VL - 71 IS - 9 AU - John G Hanly AU - Murray B Urowitz AU - Li Su AU - Caroline Gordon AU - Sang-Cheol Bae AU - Jorge Sanchez-Guerrero AU - Juanita Romero-Diaz AU - Daniel J Wallace AU - Ann E Clarke AU - EM Ginzler AU - Joan T Merrill AU - David A Isenberg AU - Anisur Rahman AU - M Petri AU - Paul R Fortin AU - DD Gladman AU - Ian N Bruce AU - Kristjan Steinsson AU - MA Dooley AU - Munther A Khamashta AU - Graciela S Alarcón AU - Barri J Fessler AU - Rosalind Ramsey-Goldman AU - Susan Manzi AU - Asad A Zoma AU - Gunnar K Sturfelt AU - Ola Nived AU - Cynthia Aranow AU - Meggan Mackay AU - Manuel Ramos-Casals AU - RF van Vollenhoven AU - Kenneth C Kalunian AU - Guillermo Ruiz-Irastorza AU - Sam Lim AU - Diane L Kamen AU - Christine A Peschken AU - Murat Inanc AU - Chris Theriault AU - Kara Thompson AU - Vernon Farewell Y1 - 2012/09/01 UR - http://ard.bmj.com/content/71/9/1502.abstract N2 - Objective The aim of this study was to describe the frequency, attribution, outcome and predictors of seizures in systemic lupus erythematosus (SLE). Methods The Systemic Lupus International Collaborating Clinics, or SLICC, performed a prospective inception cohort study. Demographic variables, global SLE disease activity (SLE Disease Activity Index 2000), cumulative organ damage (SLICC/American College of Rheumatology Damage Index (SDI)) and neuropsychiatric events were recorded at enrolment and annually. Lupus anticoagulant, anticardiolipin, anti-β2 glycoprotein-I, antiribosomal P and anti-NR2 glutamate receptor antibodies were measured at enrolment. Physician outcomes of seizures were recorded. Patient outcomes were derived from the SF-36 (36-Item Short Form Health Survey) mental component summary and physical component summary scores. Statistical analyses included Cox and linear regressions. Results The cohort was 89.4% female with a mean follow-up of 3.5±2.9 years. Of 1631 patients, 75 (4.6%) had ≥1 seizure, the majority around the time of SLE diagnosis. Multivariate analysis indicated a higher risk of seizures with African race/ethnicity (HR (CI): 1.97 (1.07 to 3.63); p=0.03) and lower education status (1.97 (1.21 to 3.19); p<0.01). Higher damage scores (without neuropsychiatric variables) were associated with an increased risk of subsequent seizures (SDI=1:3.93 (1.46 to 10.55); SDI=2 or 3:1.57 (0.32 to 7.65); SDI≥4:7.86 (0.89 to 69.06); p=0.03). There was an association with disease activity but not with autoantibodies. Seizures attributed to SLE frequently resolved (59/78 (76%)) in the absence of antiseizure drugs. There was no significant impact on the mental component summary or physical component summary scores. Antimalarial drugs in the absence of immunosuppressive agents were associated with reduced seizure risk (0.07 (0.01 to 0.66); p=0.03). Conclusion Seizures occurred close to SLE diagnosis, in patients with African race/ethnicity, lower educational status and cumulative organ damage. Most seizures resolved without a negative impact on health-related quality of life. Antimalarial drugs were associated with a protective effect. ER -