Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)

ABSTRACT: Objective To examine the predictors of time-to-seizure occurrence and their impact on damage accrual and mortality in LUMINA, a multiethnic (Hispanic, African American and Caucasian) cohort of patients with systemic lupus erythematosus. Methods Seizures were defined as per the American Col...

Full description

Autores:
Andrade, R.M.
Alarcón, G.S.
González Naranjo, Luis Alonso
Fernández, M.
Apte, M.
Vilá, L.M.
McGwin, J.R.
Reveille, J.D.
Tipo de recurso:
Article of investigation
Fecha de publicación:
2008
Institución:
Universidad de Antioquia
Repositorio:
Repositorio UdeA
Idioma:
eng
OAI Identifier:
oai:bibliotecadigital.udea.edu.co:10495/25977
Acceso en línea:
http://hdl.handle.net/10495/25977
Palabra clave:
Lupus Eritematoso Sistémico
Lupus Erythematosus, Systemic
Convulsiones
Seizures
Mortalidad
Mortality
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc/2.5/co/
id UDEA2_028cbe5cc4bc0bab0f45711f0def7177
oai_identifier_str oai:bibliotecadigital.udea.edu.co:10495/25977
network_acronym_str UDEA2
network_name_str Repositorio UdeA
repository_id_str
dc.title.spa.fl_str_mv Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)
title Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)
spellingShingle Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)
Lupus Eritematoso Sistémico
Lupus Erythematosus, Systemic
Convulsiones
Seizures
Mortalidad
Mortality
title_short Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)
title_full Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)
title_fullStr Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)
title_full_unstemmed Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)
title_sort Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)
dc.creator.fl_str_mv Andrade, R.M.
Alarcón, G.S.
González Naranjo, Luis Alonso
Fernández, M.
Apte, M.
Vilá, L.M.
McGwin, J.R.
Reveille, J.D.
dc.contributor.author.none.fl_str_mv Andrade, R.M.
Alarcón, G.S.
González Naranjo, Luis Alonso
Fernández, M.
Apte, M.
Vilá, L.M.
McGwin, J.R.
Reveille, J.D.
dc.subject.decs.none.fl_str_mv Lupus Eritematoso Sistémico
Lupus Erythematosus, Systemic
Convulsiones
Seizures
Mortalidad
Mortality
topic Lupus Eritematoso Sistémico
Lupus Erythematosus, Systemic
Convulsiones
Seizures
Mortalidad
Mortality
description ABSTRACT: Objective To examine the predictors of time-to-seizure occurrence and their impact on damage accrual and mortality in LUMINA, a multiethnic (Hispanic, African American and Caucasian) cohort of patients with systemic lupus erythematosus. Methods Seizures were defined as per the American College of Rheumatology (ARC) nomenclature and case definitions for neuropsychiatric lupus syndromes. Factors associated with time-to-seizure occurrence occurring at or after diagnosis (TD) of systemic lupus erythematosus were examined by univariable and multivariable Cox proportional hazard regression analyses. The impact of seizures on damage accrual and mortality was also examined by multivariable analyses after adjusting for variables known to affect these outcomes. Results A total of 600 patients were included in these analyses. Of them, 40 (6.7%) developed seizures at or after TD; by multivariable analyses, disease activity and younger age were independent predictors of a shorter time-to-seizure occurrence (HR = 1.10 and 1.04; 95% CI 1.04 to 1.15 and 1.00 to 1.08, p = 0.0004 and 0.0304, respectively) whereas mucocutaneous involvement (HR = 0.34, 95% CI 0.16 to 0.41, p = 0.0039) and hydroxychloroquine use (HR = 0.35, 95% CI 0.15 to 0.80, p = 0.0131) were independent predictors of a longer time-to-seizure occurrence. Seizures were an independent contributor to damage accrual but not to mortality. Conclusions Seizures tend to occur early in the course of systemic lupus erythematosus, and contribute to damage accrual. Younger age and disease activity are independent predictors of a shorter time-to-seizure occurrence; antimalarials appear to have a protective role in seizure occurrence. Neuropsychiatric manifestations of systemic lupus erythematosus (SLE) comprise a complex array of neurological, psychiatric and behavioural manifestations. Seizures are probably one of the most ominous and relevant clinical expressions of damage accrual in SLE,1 hence, of its long-term prognosis. Different mechanisms of nervous tissue injury have been described in SLE but a precise one is yet to be elucidated. Indeed, the secretion of pro-inflammatory cytokines (such as interleukin 1 and 6, and tumour necrosis factor-α) leads to the activation of the hypothalamic—pituitary—adrenal axis with the consequent reduction of the seizure threshold.2-4 In this setting of ongoing inflammation, anti-neuronal antibodies have been recognised in the serum of patients with SLE suffering from neurological manifestations such as encephalopathies and seizures.2 5 Focal ischaemia and/or infarcts resulting from vascular occlusion secondary to thrombosis, embolism, vasculopathy or haemorrhage are also recognised as possible causative factors of seizures in SLE.2 6 Furthermore, these patients may experience other clinical events that may increase their risk of developing seizures and the occurrence of seizures may associate with other serious clinical events. Given these evidences, we decided to examine the factors associated with time-to-seizure occurrence, as a primary manifestation of SLE, in LUMINA, a large multiethnic cohort. We hypothesised that patients with other serious disease manifestations and higher levels of disease activity will experience seizures early in the course of their disease and that seizures will contribute to damage accrual and mortality.
publishDate 2008
dc.date.issued.none.fl_str_mv 2008
dc.date.accessioned.none.fl_str_mv 2022-02-11T19:00:59Z
dc.date.available.none.fl_str_mv 2022-02-11T19:00:59Z
dc.type.spa.fl_str_mv info:eu-repo/semantics/article
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dc.type.local.spa.fl_str_mv Artículo de investigación
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dc.identifier.citation.spa.fl_str_mv Andrade, R. M., Alarcón, G. S., González, L. A., Fernández, M., Apte, M., Vilá, L. M., McGwin, G., Jr, Reveille, J. D., & LUMINA Study Group (2008). Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV). Annals of the rheumatic diseases, 67(6), 829–834. https://doi.org/10.1136/ard.2007.077594
dc.identifier.issn.none.fl_str_mv 0003-4967
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/10495/25977
dc.identifier.doi.none.fl_str_mv 10.1136/ard.2007.077594
dc.identifier.eissn.none.fl_str_mv 1468-2060
identifier_str_mv Andrade, R. M., Alarcón, G. S., González, L. A., Fernández, M., Apte, M., Vilá, L. M., McGwin, G., Jr, Reveille, J. D., & LUMINA Study Group (2008). Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV). Annals of the rheumatic diseases, 67(6), 829–834. https://doi.org/10.1136/ard.2007.077594
0003-4967
10.1136/ard.2007.077594
1468-2060
url http://hdl.handle.net/10495/25977
dc.language.iso.spa.fl_str_mv eng
language eng
dc.relation.ispartofjournalabbrev.spa.fl_str_mv Ann. Rheum. Dis.
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dc.publisher.spa.fl_str_mv BMJ Publishing Group
dc.publisher.group.spa.fl_str_mv Grupo de Reumatología Universidad de Antioquia -GRUA-
dc.publisher.place.spa.fl_str_mv Londres, Inglaterra
institution Universidad de Antioquia
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spelling Andrade, R.M.Alarcón, G.S.González Naranjo, Luis AlonsoFernández, M.Apte, M.Vilá, L.M.McGwin, J.R.Reveille, J.D.2022-02-11T19:00:59Z2022-02-11T19:00:59Z2008Andrade, R. M., Alarcón, G. S., González, L. A., Fernández, M., Apte, M., Vilá, L. M., McGwin, G., Jr, Reveille, J. D., & LUMINA Study Group (2008). Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV). Annals of the rheumatic diseases, 67(6), 829–834. https://doi.org/10.1136/ard.2007.0775940003-4967http://hdl.handle.net/10495/2597710.1136/ard.2007.0775941468-2060ABSTRACT: Objective To examine the predictors of time-to-seizure occurrence and their impact on damage accrual and mortality in LUMINA, a multiethnic (Hispanic, African American and Caucasian) cohort of patients with systemic lupus erythematosus. Methods Seizures were defined as per the American College of Rheumatology (ARC) nomenclature and case definitions for neuropsychiatric lupus syndromes. Factors associated with time-to-seizure occurrence occurring at or after diagnosis (TD) of systemic lupus erythematosus were examined by univariable and multivariable Cox proportional hazard regression analyses. The impact of seizures on damage accrual and mortality was also examined by multivariable analyses after adjusting for variables known to affect these outcomes. Results A total of 600 patients were included in these analyses. Of them, 40 (6.7%) developed seizures at or after TD; by multivariable analyses, disease activity and younger age were independent predictors of a shorter time-to-seizure occurrence (HR = 1.10 and 1.04; 95% CI 1.04 to 1.15 and 1.00 to 1.08, p = 0.0004 and 0.0304, respectively) whereas mucocutaneous involvement (HR = 0.34, 95% CI 0.16 to 0.41, p = 0.0039) and hydroxychloroquine use (HR = 0.35, 95% CI 0.15 to 0.80, p = 0.0131) were independent predictors of a longer time-to-seizure occurrence. Seizures were an independent contributor to damage accrual but not to mortality. Conclusions Seizures tend to occur early in the course of systemic lupus erythematosus, and contribute to damage accrual. Younger age and disease activity are independent predictors of a shorter time-to-seizure occurrence; antimalarials appear to have a protective role in seizure occurrence. Neuropsychiatric manifestations of systemic lupus erythematosus (SLE) comprise a complex array of neurological, psychiatric and behavioural manifestations. Seizures are probably one of the most ominous and relevant clinical expressions of damage accrual in SLE,1 hence, of its long-term prognosis. Different mechanisms of nervous tissue injury have been described in SLE but a precise one is yet to be elucidated. Indeed, the secretion of pro-inflammatory cytokines (such as interleukin 1 and 6, and tumour necrosis factor-α) leads to the activation of the hypothalamic—pituitary—adrenal axis with the consequent reduction of the seizure threshold.2-4 In this setting of ongoing inflammation, anti-neuronal antibodies have been recognised in the serum of patients with SLE suffering from neurological manifestations such as encephalopathies and seizures.2 5 Focal ischaemia and/or infarcts resulting from vascular occlusion secondary to thrombosis, embolism, vasculopathy or haemorrhage are also recognised as possible causative factors of seizures in SLE.2 6 Furthermore, these patients may experience other clinical events that may increase their risk of developing seizures and the occurrence of seizures may associate with other serious clinical events. Given these evidences, we decided to examine the factors associated with time-to-seizure occurrence, as a primary manifestation of SLE, in LUMINA, a large multiethnic cohort. We hypothesised that patients with other serious disease manifestations and higher levels of disease activity will experience seizures early in the course of their disease and that seizures will contribute to damage accrual and mortality.COL00109596application/pdfengBMJ Publishing GroupGrupo de Reumatología Universidad de Antioquia -GRUA-Londres, Inglaterrainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://purl.org/coar/resource_type/c_2df8fbb1https://purl.org/redcol/resource_type/ARTArtículo de investigaciónhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc/2.5/co/http://purl.org/coar/access_right/c_abf2https://creativecommons.org/licenses/by-nc/4.0/Seizures in patients with systemic lupus erythematosus: data from LUMINA, a multiethnic cohort (LUMINA LIV)Lupus Eritematoso SistémicoLupus Erythematosus, SystemicConvulsionesSeizuresMortalidadMortalityAnn. Rheum. Dis.Annals of the Rheumatic Diseases829834676ORIGINALAndradeRM_2008_.pdfAndradeRM_2008_.pdfArtículo de investigaciónapplication/pdf337113http://bibliotecadigital.udea.edu.co/bitstream/10495/25977/1/AndradeRM_2008_.pdf16394f28704da5db3a642c2bf1cf6467MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8933http://bibliotecadigital.udea.edu.co/bitstream/10495/25977/2/license_rdfc0c92b0ffc8b7d22d9cf56754a416a76MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://bibliotecadigital.udea.edu.co/bitstream/10495/25977/3/license.txt8a4605be74aa9ea9d79846c1fba20a33MD5310495/25977oai:bibliotecadigital.udea.edu.co:10495/259772022-02-11 14:00:59.857Repositorio Institucional Universidad de Antioquiaandres.perez@udea.edu.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