Population-level evidence for an autoimmune etiology of epilepsy

Mei Sing Ong; Isaac S. Kohane; Tianxi Cai; Mark P. Gorman; Kenneth D. Mandl

doi:10.1001/jamaneurol.2014.188

Population-level evidence for an autoimmune etiology of epilepsy

Mei Sing Ong, Isaac S. Kohane, Tianxi Cai, Mark P. Gorman, Kenneth D. Mandl^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

180 Citations (Scopus)

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.

Original language	English
Pages (from-to)	569-574
Number of pages	6
Journal	JAMA Neurology
Volume	71
Issue number	5
DOIs	https://doi.org/10.1001/jamaneurol.2014.188
Publication status	Published - May 2014

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title = "Population-level evidence for an autoimmune etiology of epilepsy",

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, Sj{\"o}gren 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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AU - Kohane, Isaac S.

AU - Cai, Tianxi

AU - Gorman, Mark P.

AU - Mandl, Kenneth D.

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N2 - 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.

AB - 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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Population-level evidence for an autoimmune etiology of epilepsy

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