系统性红斑狼疮继发癫痫的诊断预测因素

Factors at diagnosis predict subsequent occurrence of seizures in syste mic lupus erythematosus

Objective: To determine the factors associated with seizures in systemic lupu s erythematosus (SLE). Methods: One hundred ninety- five patients with SLE were followed at the University of Maryland Lupus Clinics from January 1992 until Ju ne 2004. Neuropsychiatric (NP) manifestations were defined according to the Amer ican College of Rheumatology nomenclature and case definitions for NP- SLE synd romes, and seizures were defined using the International Classification of Epile ptic Seizures. At the end of the study period, 28 of the 195 (14% )- patients with SLE had seizures (21 generalized convulsive, 7 partial) during their course of disease. Recurrent seizures or epilepsy occurred in 12 of 28 patients (43% ). The baseline features of those patients with seizures and those without them were compared to determine their contribution to the occurrence of isolated seiz ures and epilepsy. Results: Isolated seizures in SLE are common; epilepsy is les s frequent but nonetheless important. Certain clinical features at baseline were independent predictors of seizures including disease activity, in particular ps ychosis, moderate- to high- titer serum anti- cardiolipin and anti- Smith an tibodies, and damage accrual. Higher disease activity at baseline, concurrent mu ltiple NP- SLE manifestations, prior strokes, and male gender were predictive o f epilepsy. Conclusion: The risk of seizure and epilepsy in systemic lupus eryth ematosus (SLE) is increased in those patients with higher disease activity at ba seline, prior neuropsychiatric SLE disease, and anti- cardiolipin and anti- Sm ith antibodies.