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. 2014 May;71(5):569-74.
doi: 10.1001/jamaneurol.2014.188.

Population-level evidence for an autoimmune etiology of epilepsy

Mei-Sing Ong  1 , Isaac S Kohane  2 , Tianxi Cai  3 , Mark P Gorman  4 , Kenneth D Mandl  2
Affiliations

Population-level evidence for an autoimmune etiology of epilepsy

Mei-Sing Ong et al. JAMA Neurol. 2014 May.

Abstract

Importance: Epilepsy is a debilitating condition, often with neither a known etiology nor an effective treatment. Autoimmune mechanisms have been increasingly identified.

Objective: To conduct a population-level study investigating the relationship between epilepsy and several common autoimmune diseases.

Design, setting, and participants: A retrospective population-based study using claims from a nationwide employer-provided health insurance plan in the United States. Participants were beneficiaries enrolled between 1999 and 2006 (N = 2 518 034).

Main outcomes and measures: We examined the relationship between epilepsy and 12 autoimmune diseases: type 1 diabetes mellitus, psoriasis, rheumatoid arthritis, Graves disease, Hashimoto thyroiditis, Crohn disease, ulcerative colitis, systemic lupus erythematosus, antiphospholipid syndrome, Sjögren syndrome, myasthenia gravis, and celiac disease.

Results: The risk of epilepsy was significantly heightened among patients with autoimmune diseases (odds ratio, 3.8; 95% CI, 3.6-4.0; P < .001) and was especially pronounced in children (5.2; 4.1-6.5; P < .001). Elevated risk was consistently observed across all 12 autoimmune diseases.

Conclusions and relevance: Epilepsy and autoimmune disease frequently co-occur; 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.

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Conflict of interest statement

Competing interests: The authors have no potential conflicts of interest to be disclosed.

Figures

Figure 1
Figure 1. The risk of epilepsy in children (<18 years of age) and non-elderly adults (<=65 years of age) with autoimmune diseases, compared with individuals without autoimmune diseases
Epilepsy susceptibility is consistently heightened in patients with autoimmune disorders (P<0.001). Collectively, patients with any of the autoimmune diseases under study constituted 17.5% of the total epilepsy population.
Figure 2
Figure 2. The risk of epilepsy in children (<18 years of age) with autoimmune diseases, compared with children without autoimmune diseases
Overall, children with an autoimmune condition have a five-fold increased risk of epilepsy (P<0.001 in all cases, except otherwise indicated; *P=0.006; **P=0.008).
Figure 3
Figure 3. The risk of epilepsy in non-elderly adults (<=65 years of age) with autoimmune diseases, compared with non-elderly adults without autoimmune diseases
Overall, adults with an autoimmune condition have a four-fold increased risk of epilepsy (P<0.001 in all cases).
See this image and copyright information in PMC

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