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

Population-level evidence for an autoimmune etiology of epilepsy.

Author information

1
Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia2Children's Hospital Informatics Program at Harvard-Massachusetts Institute of Technology Health Sciences and Technology, Boston Children's Hospital, Boston, Massac.
2
Children's Hospital Informatics Program at Harvard-Massachusetts Institute of Technology Health Sciences and Technology, Boston Children's Hospital, Boston, Massachusetts3Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts.
3
Department of Biostatics, Harvard School of Public Health, Boston, Massachusetts.
4
Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts5Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.

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.

PMID:
24687183
PMCID:
PMC4324719
DOI:
10.1001/jamaneurol.2014.188
[Indexed for MEDLINE]
Free PMC Article
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