The association between systemic autoimmune disorders and epilepsy and its clinical implications
Brain, vol. 144, pp. 372–390
Abstract
Systemic autoimmune disorders occur more frequently in patients with epilepsy than in the general population, suggesting shared disease mechanisms. The risk of epilepsy is elevated across the spectrum of systemic autoimmune disorders but is highest in systemic lupus erythematosus and type 1 diabetes mellitus. Vascular and metabolic factors are the most important mediators between systemic autoimmune disorders and epilepsy. Systemic immune dysfunction can also affect neuronal excitability, not only through innate immune activation and blood-brain barrier dysfunction in most epilepsies but also adaptive immunity in autoimmune encephalitis. The presence of systemic autoimmune disorders in subjects with acute seizures warrants evaluation for infectious, vascular, toxic and metabolic causes of acute symptomatic seizures, but clinical signs of autoimmune encephalitis should not be missed. Immunosuppressive medications may have antiseizure properties and trigger certain drug interactions with antiseizure treatments. A better understanding of mechanisms underlying the co-existence of epilepsy and systemic autoimmune disorders is needed to guide new antiseizure and anti-epileptogenic treatments. This review aims to summarize the epidemiological evidence for systemic autoimmune disorders as comorbidities of epilepsy, explore potential immune and non-immune mechanisms, and provide practical implications on diagnostic and therapeutic approach to epilepsy in those with comorbid systemic autoimmune disorders.
Authors 5
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NYU Langone Health · New York University
Affiliation as printed
Department of Neurology, New York University School of Medicine, New York, NY, USA
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Affiliation as printed
Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Mario Negri Institute for Pharmacological Research
Affiliation as printed
Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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UCL Biomedical Research Centre · Stichting Epilepsie Instellingen Nederland · UCL Queen Square Institute of Neurology · University College London
Affiliation as printed
Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, Bucks, UK
NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands
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Leiden University · Leiden University Medical Center · UCL Biomedical Research Centre · Stichting Epilepsie Instellingen Nederland · UCL Queen Square Institute of Neurology · University College London
Affiliation as printed
Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands
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