PT - JOURNAL ARTICLE AU - Yehuda Shoenfeld AU - Shaul Lev AU - Ilan Blatt AU - Miri Blank AU - Joseph Font AU - Philipp von Landenberg AU - Nirit Lev AU - Joseph Zaech AU - Ricard Cervera AU - Jean-Charles Piette AU - Munther A Khamashta AU - Maria L Bertolaccini AU - Graham R V Hughes AU - Pierre Youinou AU - Pierre Luigi Meroni AU - Vittorio Pengo AU - J Delgado Alves AU - Angela Tincani AU - Gyula Szegedi AU - Gabriella Lakos AU - Gunnar Sturfelt AU - Andreas Jönsen AU - Takao Koike AU - Marielle Sanmarco AU - Amelia Ruffatti AU - Zdenka Ulcova-Gallova AU - Sonja Praprotnik AU - Blaz Rozman AU - Margalit Lorber AU - Joab Chapman AU - Peter J C van-Breda-Vriezman AU - Jan Damoiseaux TI - Features associated with epilepsy in the antiphospholipid syndrome. DP - 2004 Jul 01 TA - The Journal of Rheumatology PG - 1344--1348 VI - 31 IP - 7 4099 - http://www.jrheum.org/content/31/7/1344.short 4100 - http://www.jrheum.org/content/31/7/1344.full SO - J Rheumatol2004 Jul 01; 31 AB - OBJECTIVE: To assess the frequency of epilepsy in primary and secondary antiphospholipid syndrome (APS); to analyze the clinical and laboratory features characterizing those with epilepsy in a cohort of 538 patients with APS; and to find associated features that would suggest risk factors for epilepsy in APS. METHODS: We analyzed the clinical features of patients with APS who had epilepsy and compared them to the clinical features of non-epileptic APS patients. RESULTS: Of 538 APS patients, 46 (8.6%) had epilepsy. Epilepsy was more prevalent among APS secondary to systemic lupus erythematosus (SLE) compared to primary APS (13.7% vs 6%; p < 0.05). The patients with epilepsy had a higher prevalence of central nervous system (CNS) manifestations including focal ischemic events (strokes or transient ischemic events, 54.3% vs 24.6%; p < 0.0001) and amaurosis fugax (15.2% vs 4.9%; p < 0.05). APS patients with epilepsy had a higher frequency of valvular pathology (30.4% vs 14.6%; p < 0.01), thrombocytopenia (43.5% vs 25%; p < 0.05), and livedo reticularis (26.1% vs 11.5%; p < 0.01). The multivariate logistic regression analysis found CNS thromboembolic events as the most significant factor associated with epilepsy, with an odds ratio (OR) of 4.05 (95% confidence interval, CI: 2.05-8), followed by SLE (OR 1.4, 95% CI 1.2-4.7), and valvular vegetations (OR 2.87, 95% CI 1-8.27). CONCLUSION: Epilepsy is common in APS and most of the risk seems to be linked to vascular disease as manifested by extensive CNS involvement, valvulopathy, and livedo reticularis and to the presence of SLE. These factors, however, explain only part of the increased occurrence of epilepsy in APS and other causes such as direct immune interaction in the brain should be investigated.