Overview

Epilepsy is a type of disorder that is characterised by the presence of repeated seizures. Seizures are characterised by abnormal activity in the brain and can cause muscles to spasm and lead to uncontrolled body movement.¹

People who suffer from an autoimmune condition called lupus are more susceptible to developing epilepsy than healthy individuals. It is suspected that epilepsy may arise in these individuals due to the presence of antibodies (proteins produced by the white blood cells) that attack the patient’s own cells and due to chronic inflammation, usually within the brain.² Read on to find out how having lupus may lead to the development of epilepsy and what are your treatment options if you or your loved ones suffer from these conditions.

What is epilepsy?

Epilepsy is a condition which causes unprovoked (occurring without a specific cause/condition) seizures in a repetitive pattern. It is characterised by sudden “fits” that consists of uncontrollable body jerk/shake movements and, in some cases, loss of consciousness. This condition is said to affect 1 in 100 people. Epilepsy can start at any age, from early childhood to elderly age. It can be idiopathic (not caused by a condition) and it can be pure epilepsy, meaning that you don’t experience any symptoms other than seizures, or an underlying brain condition, such as meningitis, can cause it.³

Types of epilepsy

There are four main categories of epilepsy:

• Focal (partial): only specific parts of the brain are involved
• Generalised: the whole body is involved
• Combined focal and generalised
• Unknown type⁴

What is lupus?

Lupus is often referred to as systemic lupus erythematosus (SLE). It is an autoimmune condition that varies largely in severity and region of the body affected. This condition is a dysfunction of the immune system and causes abnormal responses to the body’s own tissues. It involves the formation of antibodies against an individual’s own cells (autoantibodies) in different organs such as kidneys, joints, skin and brain.⁵

Epilepsy and lupus

Epilepsy is more prevalent in patients with neuropsychiatric SLE (NSLE) which is also considered the most common type. In NSLE, the central nervous system (CNS) is severely affected due to autoimmunity-related damage to neurons (nerve cells of the brain and CNS). Hence, epilepsy is more likely to develop due to abnormal functioning of the brain and the CNS in these individuals. However, the exact mechanism of how it happens is yet to be identified.^6,7

Causes and risk factors of epilepsy in lupus patients

The exact cause of SLE is still unknown. However, there are some factors that are suspected to cause and influence the progress of this disease such as:

• Genetics
• Endocrine
• Immunological
• Environmental⁵

Nevertheless, research shows that individuals who are assigned female at birth (AFAB) are more likely to develop seizures as one of the SLE symptoms. Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) indicates the severity of the disease and the more serious it is the higher your chance of developing epileptic seizures earlier on. Some lupus-related conditions have also been linked to faster manifestations of seizures e.g:

• Psychosis
• Serositis
• Stroke

A specific type of autoantibody called antiphospholipid antibody, which is commonly known to cause antiphospholipid syndrome where the body attacks its own cells, as well as other autoantibodies has also been linked to the development of epilepsy in lupus patients.^2,6 

Scientific studies also indicate a genetic risk factor, as it has been found that some individuals with SLE-related epilepsy share the same region within one of their chromosomes which indicates susceptibility to seizures. Lastly, research suggested that treatment with some SLE medications such as cyclophosphamide and glucocorticoids could lead to more frequent epileptic episodes.² 

Symptoms of lupus-related epilepsy

The most common types of epileptic seizures manifested in those with lupus are generalised seizures and focal seizures.^2,6

Symptoms of generalised seizures

Patients with SLE usually experience either generalised seizures in a tonic-clonic manner or focal (partial) seizures. Tonic refers to a seizure that causes your body to become rigid, while clonic refers to a seizure that causes involuntary jerks of whole muscle groups, e.g. leg or arm, as well as fainting. Tonic-clonic is a combination of the two when you experience both types of seizures.³

Symptoms of focal seizures

Focal seizures will affect only a part of the individual’s brain. The symptoms are dependent on which part of the brain is affected and they might consist of:

• Alterations in sight and/or hallucinations
• Smelling in an unusual way (Phantosmia)
• Distorted hearing and/or auditory hallucinations
• Twitches in various parts of the body
• Unusual body movements:
  • Walking aimlessly 
  • Stuttering
  • Unusual facial expressions³

Post-epileptic attack symptoms 

Additionally, individuals suffering from epilepsy also have to deal with the “aftermath”. You may feel fatigued, sleepy, and experience other symptoms such as:

• Slurred speech
• Temporary paralysis
• Temporary memory issues

A severe epileptic attack may also lead to some injuries, such as bruising from a fall or biting your tongue. Lastly, epilepsy can be mentally distressing if you are worried about when the next episode will happen. In such a situation, speaking to a counsellor, psychotherapist or your GP may be beneficial. Remember, you’re not alone.³

Epilepsy diagnosis

As the first step of diagnosis, your doctor will assess your medical history to confirm the type of seizures and whether they are likely to be epilepsy. Following the discussion, your doctor may perform a physical and neurological examination to observe any neurological or physical abnormalities such as non-responsiveness or twitching during a suspected seizure.

Initially, a blood test for electrolytes (minerals in the body that have an electric charge) is performed that could indicate an imbalance that leads to seizures. If there’s suspicion of other conditions excluding lupus, other tests may be done:

• Neuroimaging
• Serology
• Blood glucose and sodium level test
• Pregnancy test

If your doctor suspects that the seizures you experience may indeed be epileptic then an electroencephalography (EEG) test is recommended to confirm that the pattern of the seizures experienced is epileptic. EEG measures the electric activity in the brain and can help identify whether the seizures are generalised or focal.^1,8

In lupus patients, neuroimaging such as magnetic resonance imaging (MRI) is an essential part of diagnosis. The doctor will also do tests to exclude thrombosis (blood clotting) and vasculitis (inflammation of blood vessels).²

Treatment for epileptic seizures in lupus patients 

There is no specific treatment for epilepsy in SLE individuals. The approach will vary depending on how severe the epilepsy is and what type of seizures the patient is experiencing. 

Medication is only recommended for individuals who are likely to experience recurrent epileptic attacks. The therapy includes the administration of antiepileptic medicines such as sodium valproate or lamotrigine. Otherwise, the treatment focuses on treating the underlying issue, in this case, lupus. Therefore, initially, you are likely to receive immunosuppressive medication such as:

• Glucocorticoids
• Intravenous cyclophosphamide 
• Intravenous hydroxychloroquine

Since epilepsy in SLE patients arises due to the disease affecting the CNS, it is crucial to get evaluated promptly and start treatment as soon as possible. This can help to diminish the severity of lupus-related damage and improve quality of life.²

FAQs

Do lupus seizures show up on an EEG?

Yes, systemic lupus seizures can be recognised on electroencephalogram (EEG). The type of seizure can be determined, including the epileptic pattern of the seizures.²

What disease mimics epilepsy?

Fainting or psychogenic non-epileptic seizures (caused by psychological distress), such as in panic or dissociative disorders, are most likely to mimic an epileptic attack. This is because of the similarity of certain visible symptoms such as losing consciousness, muscle twitching or other seizure-like symptoms.⁹

Can lupus be misdiagnosed as epilepsy?

It is possible that lupus-related epilepsy may be misdiagnosed as just an epileptic disorder or encephalitis (viral infection). This could be because other lupus symptoms might not have been obvious at the moment of diagnosis.¹⁰

Summary

• Epilepsy is a repeated seizure disorder that can arise from an autoimmune condition known as systemic lupus erythematosus (SLE). In lupus, the patient’s immune system attacks their own tissues leading to a variety of organ damage
• Seizures usually consist of involuntary body “jerks”, and sometimes loss of consciousness. Epilepsy is more often seen when the central nervous system (CNS) is affected in the neuropsychiatric type of SLE (NPSLE)
• The exact cause of epilepsy in lupus is still unknown, but it has been linked to genetics, immunological disorders and other conditions e.g. stroke. Symptoms of epilepsy depend on its type 
• Generalised epilepsy in SLE patients manifests as body rigidity and uncontrollable shakes, while focal (partial) epilepsy affects only certain functions like the sense of smell, vision or speech
• Epilepsy is diagnosed by medical history, physical examination, blood tests, neuroimaging and electroencephalography (EEG)
• Currently, there is no specific therapy for lupus-related epilepsy and the main line of treatment is usually SLE medication such as glucocorticoids and secondary treatment can include anti-epileptic medicines