Correlation between Antiphospholipid Antibodies and Epilepsy: A Systematic Review (P02.154)

Abstract

Objective: To evaluate the relationship between antiphospholipid antibody (APLA) syndrome (APS) and epilepsy. Background Seizures are frequently found in patients with autoimmune diseases such as lupus and APS. Recent publications concluded that APLAs are associated with seizures and their presence results in poorer control. Conversely, the presence of auto-antibodies directed against different targets, including APLA, voltage-gated potassium channels, c-aminobutyric acid B receptor, GAD, and others, have been identified in up to 20% of newly-diagnosed epilepsy patients and there is increasing evidence of their pathogenic role. Design/Methods: We conducted a systematic review to evaluate the relationship between APLA (including anticardiolipin Ab, anti beta-2-glycoprotein-1 Ab, 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 APS. Results: The search retrieved 837 relevant references and 79 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 ischemia. Conclusions: 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. Disclosure: Dr. Rahman has nothing to disclose. Dr. Burneo has received personal compensation for activities with UCB Canada as a scientific advisory board member. Dr. Burneo has received research support from UCB Canada. Dr. Del Pozzo-Magana has nothing to disclose. Dr. Boyce has nothing to disclose. Dr. Lazo-Langner has nothing to disclose.