Abstracts

Rationale: Seizures are frequently found in patients with autoimmune diseases such as lupus and antiphospholipid syndrome (APS). Recent publications concluded that antiphospholipid antibodies (APLAs) are associated with seizures and their presence results in poorer control. Conversely, the presence of auto-antibodies directed against different targets, including APLAs, has been identified in up to 20% of newly-diagnosed epilepsy patients and there is increasing evidence of their pathogenic role. We sought to evaluate the relationship between APLAs and epilepsy.Methods: We conducted a systematic review between 1980 to May 2015 to evaluate the relationship between APLAs (including anticardiolipin Ab (aCL), anti-beta-2-glycoprotein-1 Ab (anti-b2-GPI), and lupus anticoagulant) and epilepsy. We searched MEDLINE, EMBASE, Healthstar, the Cochrane library, LILACS, Scopus and grey literature. We included cohort, case-control, and cross-sectional studies studying the prevalence of epilepsy in patients with APS and/or APLA, the prevalence of APLA and/or APS in patients with epilepsy, and the severity of the seizures in patients with APLA and/or APSResults: The search retrieved 964 relevant references and 88 were retrieved for full review. We included in the final review 24 studies (19 case-control, 3 cohort and 2 cross-sectional). In 3 cohorts, including 1585 patients with APS, the overall frequency of epilepsy ranged between 6.3 and 8.5%. In 19 case-control studies, including 4677 patients, the OR for epilepsy in patients with APLA and/or APS ranged from 0.54 to 13.3 in individual studies. No meta-analysis was conducted due to the high heterogeneity of designs. In 4 studies, an association was found between APLA and seizure frequency and severity. In positive studies there was no correlation between APLA, epilepsy and cerebral ischemiaConclusions: We conclude that APLA/APS might be related with higher risk and severity of epilepsy, however further studies using accepted consensus definitions for APLA positivity, more stringent methodology and appropriate subgroup analysis are needed