Systemic lupus erythematosus, commonly known as lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. The brain and central nervous system are susceptible to lupus’s effects, and seizures are a recognized manifestation of the disease. This neurological involvement, often categorized as neuropsychiatric systemic lupus erythematosus (NPSLE), arises from the immune system’s attack on brain tissues, leading to inflammation and various neurological symptoms. Understanding this connection is important for those affected by lupus.
The Connection Between Lupus and Seizures
Lupus can lead to seizures through complex pathways involving the central nervous system. When lupus affects the brain and spinal cord, it is often categorized as neuropsychiatric systemic lupus erythematosus (NPSLE). This involves the immune system’s attack on brain tissues, leading to inflammation and neurological symptoms.
One mechanism involves specific autoantibodies. For example, antiphospholipid antibodies (aPL) are found in many lupus patients and increase the risk of blood clot formation. These clots can impede blood flow to the brain, potentially causing strokes or microinfarcts that damage brain tissue and trigger seizures.
Another contributing factor is vasculitis, the inflammation of blood vessels. In lupus, vasculitis can affect the brain’s blood vessels, leading to damage or blockages that disrupt normal brain function and increase seizure likelihood. Lupus autoantibodies may also directly cross the blood-brain barrier and attack neurons, causing inflammation and neuronal damage that lowers the seizure threshold. While exact mechanisms are still being understood, the interplay of inflammation, blood vessel abnormalities, and direct neuronal attack by autoantibodies can predispose individuals with lupus to seizure activity. Seizures can occur at any stage of the disease, sometimes even before a lupus diagnosis is confirmed.
Recognizing Seizures in Lupus
Seizures in individuals with lupus can manifest differently, from barely noticeable episodes to severe, generalized events. The most common type is the generalized tonic-clonic seizure, involving sudden muscle stiffening, loss of consciousness, and rhythmic jerking movements. This type can be alarming and may lead to falls or injuries.
Focal onset seizures, formerly partial seizures, begin in a specific brain area. These can result in varied symptoms such as involuntary limb movements, sensory disturbances like unusual smells or tastes, or temporary altered awareness without complete loss of consciousness. Subtle seizures can sometimes be mistaken for “spacing out” or daydreaming.
Not all neurological symptoms in lupus are seizures. Other conditions, including infections, metabolic imbalances, or certain medications, can cause seizure-like symptoms, highlighting the importance of thorough medical evaluation.
Diagnosis and Management of Seizures in Lupus
Diagnosing seizures in lupus requires a comprehensive medical evaluation due to varied potential causes. A neurologist conducts a thorough neurological examination, followed by diagnostic tests such as an electroencephalogram (EEG), which measures electrical activity in the brain to detect abnormal patterns.
Brain imaging, including magnetic resonance imaging (MRI) and computed tomography (CT) scans, helps identify structural changes, inflammation, or blood clots in the brain contributing to seizures. Blood tests assess lupus disease activity, identify specific autoantibodies, and rule out other potential causes like metabolic imbalances or infections. A lumbar puncture, or spinal tap, may also analyze cerebrospinal fluid for signs of inflammation or infection within the central nervous system.
Management of lupus-related seizures involves two main approaches: controlling the seizures and treating the underlying lupus disease activity. Anti-seizure medications, also known as anticonvulsants, are prescribed to prevent and reduce seizure frequency. Treatments suppressing the immune system and reducing inflammation are also used to address lupus. These may include corticosteroids, such as prednisone, and immunosuppressants, like cyclophosphamide, which help mitigate the autoimmune attack on the brain.
Living with Lupus-Related Seizures
Managing lupus-related seizures involves ongoing care. Adherence to prescribed treatment plans, including anti-seizure medications and lupus therapies, is important for controlling symptoms and minimizing seizure recurrence. Regular monitoring by healthcare providers helps adjust medications and assess overall lupus activity.
Lifestyle adjustments can support seizure management. Identifying and avoiding potential triggers, such as stress or sleep deprivation, can be beneficial. A multidisciplinary care team, including neurologists, rheumatologists, and other specialists, provides comprehensive care. Support resources and patient communities offer valuable emotional and practical support.