Background/Purpose: We identified the rate and risk factors for first occurrences of seizure based on a large closely followed longitudinal cohort of patients with systemic lupus erythematosus.

Methods: Rates of incident seizure were calculated overall and in subgroups defined by demographic and clinical variables.  Adjusted estimates of association of risk factors were derived using pooled logistic regression.

Results: Of 2203 patients with no history of seizure prior to SLE diagnosis, 157 (7.1%) had the first seizure occurrence at the time of (37 patients, 1.63%) or after the diagnosis of (120 patients, 5.44%) SLE.  The rate of incident seizure was 4.9 per 1000 person-years.  The risk of seizure occurring around the time of SLE diagnosis was higher in patients with a history of malar rash (p = 0.002), proteinuria (p = 0.004), and psychosis (p < 0.000).  Multivariable analysis of the first seizure occurring after the diagnosis of SLE showed that history of low C3 (RR = 1.763, p = 0.0078), psychosis (RR = 2.432, p < 0.0001), cranial or peripheral neuropathy (RR = 2.212, p = 0.0043), anti-Smith (RR = 1.518, p = 0.0551), renal involvement (urine dipstick protein positive 3+) (RR = 2.888, p = 0.0177) and current prednisone dose (RR = 9.960, p < 0.0001) were independently associated with a higher risk of incident seizure.  SELENA-SLEDAI was not predictive and hydroxychloroquine was not protective after adjusting for the other variables in the model.

Conclusion: Seizure in SLE is multi-factorial.  The risk of seizure in SLE is independently increased in those patients with prior psychosis, neuropathy, proteinuria, anti-Sm, low C3 and current corticosteroid use.  Anti-Sm is of particular interest as it has also been incriminated in other CNS-SLE syndromes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-incident-seizure-in-systemic-lupus-erythematosus/