Evaluation and treatment of seizures in patients with systemic lupus erythematosus

Seizures associated with systemic lupus erythematosus (SLE) occur in 9 to 58% of patients in reported series, often early in the disease course. Approximately half of seizures reported in SLE patients are associated with infection and with metabolic or iatrogenic complications. However, in clinical practice, this number might be much larger, as relatively few prospective studies are available. The seizure type in nearly 75% of SLE patients is generalized tonic-clonic. These often begin with and recur, even without anticonvulsant treatment, only during an SLE disease flare. In contrast, seizures in SLE patients with a focal onset often recur without anticonvulsant treatment, irrespective of SLE disease activity. This review offers a practical diagnostic and management approach to the SLE patient with new or recurrent seizures and takes into consideration the effects of immunosuppressive therapy and multi-organ failure. This approach is based on a synthesis of the literature regarding seizures and epilepsy in SLE patients and on the authors' personal experience.