Population-Level Evidence for an Autoimmune Etiology of Epilepsy.
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.
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.
Further Readings of Interest
Combining two genome analysis approaches supports immune system contribution to autism
Comorbidity Clusters in Autism Spectrum Disorders: An Electronic Health Record Time-Series Analysis.
The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders
Comorbidity of allergic and autoimmune diseases in patients with autism spectrum disorder: A nationwide population-based study
Previous clinical and genetic studies have suggested autism spectrum disorders (ASDs) is associated with immunological abnormalities involving cytokines, immunoglobulins, inflammation, and cellular immunity, but epidemiological reports are still limited.
Patients with ASDs were identified in the National Health Insurance Database from 1996 to 2010, and compared with age and gender-matched controls (1:4) in an investigation of the association between ASDs and allergic/autoimmune diseases.
A total of 1596 patients with ASDs were identified, and were found to have a significantly higher prevalence of allergic and autoimmune diseases than the control group.
Patients with ASDs had increased risks of
asthma (OR = 1.74, 95%CI = 1.51–1.99),
allergic rhinitis (OR = 1.70, 95%CI = 1.51–1.91),
atopic dermatitis (OR = 1.52, 95%CI = 1.30–1.78),
urticaria (OR = 1.38, 95%CI = 1.12–1.69) and
type 1 diabetes (OR = 4.00, 95%CI = 1.00–16.00), and a trend toward increasing comorbidity with
Crohn’s disease (OR = 1.46, 95%CI = 0.90–2.35).