Background/Purpose: About 50% of SLE patients make an antiphospholipid antibody and 10% develop classic antiphospholipid syndrome.  Seizures are one of the components of the SLICC classification criteria, and can occur due to SLE itself or secondary to stroke.  Because seizures have been proposed as an inflammatory (non-thrombotic) manifestation of antiphospholipid antibodies, we determined whether seizures in SLE were associated with the lupus anticoagulant.

Methods: 2206 SLE patients were enrolled in a prospective cohort.  Their mean age was 43 years; 93% were female, 55% Caucasian, 38% African-American and 7% other ethnicity.  27% had a history of lupus anticoagulant, 9% stroke and 10% seizures.  The association of seizure with lupus anticoagulant and then excluding those with stroke was determined using chi-squared analyses.  The lupus anticoagulant was determined by dRVVT with confirmatory testing. 

Results:

Table One shows the association of seizure with the lupus anticoagulant (p = 0.0017).

Table 1 – Association between Lupus Anticoagulant and Seizure (All Patient Analysis)

	LA Pos (N=591)	LA Neg (N=1615)	P-value
Seizure	13.03%	8.54%	0.0017

Table 2 shows the association of seizure with the lupus anticoagulant, but excluding those with stroke.  The p-value was 0.22. 

Table 2 – Association between Lupus Anticoagulant and Seizure (Excluding Those with Stroke)

	LA Pos (N=493)	LA Neg (N=1515)	P-value
Seizure	9.33%	7.59%	0.22

Conclusion:

The apparent association of the lupus anticoagulant is explained by the association with stroke.  Thus, seizures in the absence of stroke should not be attributed to the lupus anticoagulant.  Seizures should not be added to the classification criteria for antiphospholipid syndrome.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/seizures-in-systemic-lupus-erythematosus-are-not-an-inflammatory-manifestation-of-lupus-anticoagulant/