Autoimmune Diseases Frequently Co-occur with Epilepsy

A retrospective study published March 31, 2014, in JAMA Neurology, suggests patients with autoimmune disorders should be monitored for epilepsy, and vice versa.

For their population-based study, Mark P. Gorman, MD, and colleagues at Boston Children’s Hospital analyzed 2,518,034 claims placed through employer-provided healthcare plans between 1999 and 2006.

In their investigation of a relationship between epilepsy and autoimmune disorders, the researchers focused on the risk of epilepsy in the presence of 12 autoimmune diseases: type 1 diabetes mellitus, psoriasis, rheumatoid arthritis (RA), Graves’ disease, Hashimoto’s thyroiditis, Crohn’s disease, ulcerative colitis, systemic lupus erythematosus (SLE), antiphospholipid syndrome, Sjögren’s syndrome, myasthenia gravis, and celiac disease.

According to the study authors, the risk of epilepsy was “significantly heightened among patients with autoimmune diseases and was especially pronounced in children.” In addition, the elevated risk was “consistently observed across all 12 autoimmune diseases.”

Among the psoriasis patients, the highest epilepsy occurrence was recorded in those with antiphospholipid syndrome.

“The increase in risk of epilepsy varied by form of autoimmunity, ranging from 1.9-fold for psoriasis to 9.4-fold for antiphospholipid syndrome,” the researchers noted in a statement. “In addition, the increase in risk was greater among children (5.2-fold) than adults (4.3-fold).”

In the statement, Kenneth Mandl, MD, MPH, a contributor to the study, commented on the possibility of focusing on autoimmunity for epilepsy patients.

"We may be overlooking a treatable mechanism in epilepsy patients," Mandl said. "We need to change how we think about clinical management of these conditions."

The study authors concluded that “epilepsy and autoimmune disease frequently co-occur, (so) patients with either condition should undergo surveillance for the other. The potential role of autoimmunity must be given due consideration in epilepsy so that we are not overlooking a treatable cause.”

Based on those findings, Gorman recommended launching a concerted effort between neurologists and rheumatologists to control the association between epilepsy and autoimmune disorders.

"There are subtle signs of epilepsy that may suggest to an immunologist that a patient should be assessed by a neurologist," Gorman said. "Similarly, a referral to an immunologist may be warranted if a patient shows subtle signs of autoimmunity."