Risk of epilepsy in patients with systemic lupus erythematosus – a retrospective cohort study

Abstract

Jeng-Dau Tsai,1,2 Cheng-Li Lin,3,4 Cheng-Chieh Lin,5–7 Fung-Chang Sung,3,4,7,* Ko-Huang Lue1,2,* 1Institute of Medicine, Chung Shan Medical University Hospital, 2Department of Pediatrics, Chung Shan Medical University and Hospital, 3Institute of Clinical and Medical Science, China Medical University, 4Management Office for Health Data, China Medical University Hospital, 5Department of Family Medicine, China Medical University School of Medicine, 6Division of Family Medicine, China Medical University Hospital, 7Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan *These authors contributed equally to this work Background: Systemic lupus erythematosus (SLE) affects central and peripheral nervous systems, manifesting neuropsychiatric disorders that vary from subtle signs to life-threatening complications. This study compared the risk of epilepsy between a general population and patients with SLE.Methods: From the national insurance claims data of the Taiwan National Health Research Institutes, we identified 32,301 patients with newly diagnosed SLE from 1997–2010 and, for comparison, 129,204 randomly selected people without SLE; the frequencies of both groups were matched by sex, age, and diagnosis date. The incidence of epilepsy was estimated for both cohorts by the end of 2010. Results: The incidence of epilepsy was 2.86-fold higher in the SLE cohort than in the non-SLE cohort (9.10 per 10,000 person-years versus 3.18 per 10,000 person-years), with a Cox method estimated adjusted hazard ratio (aHR) of 2.33 (95% confidence interval [CI] =1.89–2.88) for the SLE cohort. The incidence increased with age in the non-SLE cohort, while it decreased with the increase of age in the SLE cohort. Compared with the non-SLE cohort, the age-specific aHR of epilepsy for the SLE cohort decreased from 8.05 (95% CI =4.30–15.0) for those aged ≤20 years to 0.90 (95% CI =0.57–1.42) for those aged 60 years and above (P=0.01). Comorbidities that had a significant association with epilepsy included infarction (aHR =7.62), intracerebral hemorrhage (aHR =5.75), aseptic meningoencephalitis (aHR =5.35), and psychiatric disorder (aHR =3.31).Conclusion: Patients with SLE are at higher risk of epilepsy than the general population, especially younger SLE patients. Neurologic comorbidities and psychiatric disorders increase the epilepsy risk further. Keywords: epilepsy, incidence, lupus, health insurance data, cohort study