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| | From:  SamIam1084 (Original Message) | Sent: 6/3/2008 1:42 PM |
http://www.medscape.com/viewarticle/575320?sssdmh=dm1.356379&src=nldne
Seizures Usually Seen Early in Lupus CME
News Author: Anthony J. Brown, MD
CME Author: Charles Vega, MD
Complete author affiliations and disclosures, and other CME information, are available at the end of this activity.
Release Date: May 30, 2008; Valid for credit through May 30, 2009
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;
Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details.
Learning Objectives
Upon completion of this activity, participants will be able to:
Identify the relationship between systemic lupus erythematosus and seizures.
List factors which influence the risk for seizures among patients with systemic lupus erythematosus.
Authors and Disclosures
Anthony J. Brown, MD
Disclosure: Anthony J. Brown, MD, has disclosed no relevant financial relationships.
Charles Vega, MD
Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.
Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
May 30, 2008 — When seizures occur in patients with systemic lupus erythematosus (SLE), they typically occur early in the course of the disease, new research suggests.
The results, which appear in the Annals of the Rheumatic Diseases for June, also indicate that seizure occurrence frequently coincides with important disease activity and with serious clinical manifestations. Seizures are also key indicators of damage accrual with SLE, which, therefore, affects long-term prognosis.
The good news is that treatment with the antimalarial agent hydroxychloroquine helps prevent or at least delay seizure onset, according to the report.
In their new study, Dr. Graciela S. Alarcon, of The University of Alabama at Birmingham, and colleagues examined factors that predicted time-to-seizure in 600 patients in the LUMINA cohort, a multiethnic group of SLE patients. In addition, the team also assessed the relationship between seizures and damage accrual and mortality.
Nearly 90% of the subjects were female with an average age at recruitment of 36.5 years. The mean disease duration was 17.3 months.
Overall, 6.7% of patients developed seizures at or after being diagnosed with SLE, the report indicates. Roughly two thirds of these patients developed seizures within 1 year of diagnosis. In the remaining patients, seizure onset was delayed for up to 8 years after diagnosis.
On multivariate analysis, younger age (p = 0.03) and greater disease activity (p = 0.0004) were independently linked to a shorter time-to-seizure onset. Conversely, mucocutaneous involvement (p = 0.0039) and hydroxychloroquine use (p = 0.0131) were predictors of a longer time.
Although seizures were independently linked to damage accrual, they were not tied to mortality, the investigators found. The types of damage associated with seizures involved the neuropsychiatric, renal, musculoskeletal, diabetes, and gonadal domains of the Systemic Lupus International Collaborating Clinics Damage Index.
"In terms of the importance of seizures as indicative of worse things to come, we have shown that over and above other patients' characteristics known to be associated with the accrual of damage, such as age, gender, disease activity, glucocorticoid use and disease duration, the occurrence of seizures is an important contributor to the accrual of damage," the investigators conclude.
Ann Rheum Dis. 2008;67:829-834.
Reuters Health Information 2008. © 2008 Reuters Ltd.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Identify the relationship between systemic lupus erythematosus and seizures.
List factors which influence the risk for seizures among patients with systemic lupus erythematosus.
Clinical Context
Seizures are a clinical manifestation of SLE and can occur at any point in the disease course. Up to 11% of neuropsychiatric manifestations of SLE are present before the establishment of the diagnosis of SLE. The pathophysiology of seizures in SLE is not well established, although SLE is associated with a prothrombotic state and creates arterial stenosis, which, in turn, may promote microvascular changes in the central nervous system. In addition, antibodies associated with SLE may increase neuronal excitability.
The current study assesses risk factors for seizure activity among patients with SLE and also examines the effect of seizures on the prognosis of SLE.
Study Highlights
Patients in the LUpus in MInorities: NAture versus Nurture (LUMINA) cohort were at least 16 years old and met 4 American College of Rheumatology revised and updated criteria for SLE. All subjects had SLE for less than 5 years. Subjects who had seizures before the diagnosis of SLE were excluded from the current analysis.
Participants underwent an analysis at baseline for socioeconomic, demographic, clinical, immunologic, genetic, and behavioral/psychological variables.
The main outcome of the current study was the predictive power of the above-listed variables for the time to incident seizure. Seizures were defined by self-report (if a witness could confirm the seizure) or from the medical record.
Researchers also examined how seizures affected disease activity of SLE, as measured by the Systemic Lupus Activity Measure–Revised. Finally, the relationship between seizures and mortality was assessed.
600 patients were included in the current analysis, 89.8% of whom were women.
6.7% of the study cohort experienced seizures related to SLE.
In 62.5% of participants with incident seizures, seizures developed within 1 year of the diagnosis of SLE.
Sex, ethnicity, and other socioeconomic variables did not affect the time to incident seizures.
On multivariable analysis, younger age was associated with a shorter time to incident seizure (hazard ratio [HR], 1.04), as was a higher degree of SLE disease activity (HR, 1.10). In contrast, mucocutaneous manifestations of SLE (HR, 0.34) and the use of hydroxychloroquine (HR, 0.35) were independent predictors of a longer time to first seizure.
Seizures were independently associated with an increased risk for the accrual of organ damage in SLE, particularly damage to the kidneys and brain.
Seizures did not have a significant independent effect on the risk for overall mortality.
Pearls for Practice
Seizures may complicate SLE at any point in the disease course, including before the diagnosis of SLE. SLE may promote seizures through the promotion of thrombosis, atherosclerosis, and increased neuronal excitability.
In the current study, younger age and a higher degree of SLE disease activity reduced the time to first seizure among patients with SLE. In contrast, mucocutaneous manifestations of SLE and the use of hydroxychloroquine were independent predictors of a longer time to first seizure.
Which of the following statements regarding SLE and seizures is most accurate?
Seizures are only diagnosed early in the disease course of SLE
Seizures do not predate the diagnosis of SLE
Antibodies in SLE may increase neuronal excitability
The effects of SLE on the microvasculature have been demonstrated to be unrelated to the pathophysiology of seizures
Which of the following variables is correctly associated with its attendant risk for seizure in the current study of patients with SLE by Alarcon and colleagues?
Younger age: reduced time to first seizure
Higher degree of SLE disease activity: increased time to first seizure
Mucocutaneous manifestations of SLE: reduced time to first seizure
Use of hydroxychloroquine: reduced time to first seizure
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There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
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Study the educational content online or printed out.
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Target Audience
This article is intended for primary care clinicians, rheumatologists, neurologists, and other specialists who care for patients with systemic lupus erythematosus.
Goal
The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.
Accreditation Statements
For Physicians
Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape Medical News has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins 09/01/07. Term of approval is for 1 year from this date. This activity is approved for 0.25 Prescribed credits. Credit may be claimed for 1 year from the date of this activity. AAFP credit is subject to change based on topic selection throughout the accreditation year.
AAFP Accreditation Questions
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity: [email protected]. For technical assistance, contact [email protected].
Authors and Disclosures
As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
News Author
Anthony J. Brown, MD
Anthony Brown, MD, is a freelance writer for Reuters Health
Disclosure: Anthony J. Brown, MD, has disclosed no relevant financial relationships.
CME Author
Charles P. Vega, MD
Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.
Brande Nicole Martin
is the News CME editor for Medscape Medical News.
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
Reuters Health Information 2008. ©2008 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Legal Disclaimer
The material presented here does not necessarily reflect the views of Medscape or companies that support educational programming on www.medscape.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.
Registration for CME credit and the post test must be completed online.
To access the activity Post Test, please go to:
http://www.medscape.com/viewarticle/575320
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