How do seizures manifest in patients with CNS lupus?

Updated: May 04, 2021
  • Author: Pradeep C Bollu, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Seizures are already known to occur in 14-25% of patients with lupus compared with 0.5-1% in the general population. [14] Seizures may result from cerebral vasculitis (ischemic or hemorrhagic manifestations), cardiac embolism, opportunistic infection, drug intoxication, or associated metabolic derangements. A seizure focus may result from an acute insult or from the development of a seizure focus in an area of previous brain insult. Partial or secondarily generalized seizures are most common, but all seizure types have been reported.

Electrolyte disturbance and medication effects should be excluded, especially those resulting from antidepressants, stimulant medications used to treat fatigue, or withdrawal from sedatives or alcohol. Opportunistic infections should be considered in patients receiving immunosuppressive therapy. Steroid therapy, especially high-dose pulse therapy, has been associated with status epilepticus.

Joseph et al identified that primary neurologic presentation of SLE was more common than anticipated (10/41 patients) and included both seizures (4 cases) and movement disorders such as parkinsonism and myoclonus (4 cases). [15] The investigators found a higher overall frequency of seizures (42%), as an early manifestation in 27% of patients, and, in 10%, seizures were the first SLE symptom. Previous to this, there had been no case reports of myoclonus in SLE as a presenting feature. [15]

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