On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

What is the connection between lupus and seizures?

1     *Lupus/di,dt [Diagnosis, Drug Therapy]    results=25   

Reference Librarian comments

I wish I had a way to determine whether you were satisfied with the results, but I think the one-liner search strategy probably didn't give you anything particularly useful. You should break the concepts down into the two parts:

a) lupus

b) seizures

... and then combine those ideas.

There's an additional "gotcha" with LUPUS, per se, and that is that we usually want "systemic lupus erythematosus" and not lupus. How you're supposed to know this I have no idea. [Actually, there are "scope notes" in the Medline interface, near the little red "I" (for information) icons, found only if you're really snooping around in the Ovid Medline interface -- and then there's always calling or e-mailing your favorite medical reference librarian...]

I did the search (admittedly rather quickly...) and here below is my strategy and results.

Medline 1991 to January 2000

#
Search History
Results
1
exp *Lupus erythematosus, systemic/
6784
2
exp *Seizures/
4552
3
exp *Epilepsy/
13567
4
exp *Convulsions/
1064
5
1 and (2 or 3 or 4)
23
6
limit 5 to (human and english language)
17
7
from 6 keep 1-17
17

Results of your search (set 6): limit 5 to (human and english language)
Citations available: 17
Citations displayed: 1-17

<1>
AN 99393812
AU Khoshbin S. Glanz BI. Schur PH.
TI Neuropsychiatric syndromes in systemic
lupus erythematosus: a new look [editorial]. [Review] [64
refs]
SO Clinical & Experimental Rheumatology. 17(4):395-8, 1999 Jul-Aug.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.

<2>
AN 99044193
AU Barbero DJ. Archer TP. Mazzaferri EL.
IN Department of Internal Medicine, Ohio State University College of Medicine
and Public Health, Columbus, USA.
TI Seizure in a woman with lupus.
SO Hospital Practice (Office Edition). 33(11):51-2, 55-6, 1998 Nov 15.
LM Pre-1993 at Dana,1993-date at MFHSL.

<3>
AN 98429231
AU Eros E. Geher P. Gomor B. Czeizel AE.
IN Department of Human Genetics and Teratology, National Institute of Public
Health - WHO Collaborating Centre for the Community Control of Hereditary
Diseases, Budapest, Hungary.
TI Epileptogenic activity of folic acid after drug induces SLE (folic acid and
epilepsy).
SO European Journal of Obstetrics, Gynecology, & Reproductive Biology.
80(1):75-8, 1998 Sep.
LM Dana Biomedical Library (Dana).
AB OBJECTIVE: To study the effect of folic acid-containing multivitamin
supplementation in epileptic women before and during pregnancy in order to
determine the rate of structural birth defects and
epilepsy-related side effects. STUDY DESIGN: First a
randomised trial, later periconception care including in total 12225 females.
RESULTS: Of 60 epileptic women with periconceptional folic acid (0.8
mg)-containing multivitamin supplementation, no one developed
epilepsy-related side effects during the periconception
period. One epileptic woman delivered a newborn with cleft lip and palate.
Another patient exhibited with a cluster of seizures after
the periconception period using another multivitamin. This 22-year-old
epileptic woman was treated continuously by carbamazepine and a folic acid (1
mg)-containing multivitamin from the 20th week of gestation. She developed
status epilepticus and later symptoms of systemic
lupus erythematodes. Her pregnancy ended with stillbirth.
CONCLUSIONS: The epileptic pregnant patient's autoimmune disease (probably
drug-induced lupus) could damage the blood-brain barrier,
therefore the therapeutic dose (> or =1 mg) of folic acid triggered a cluster
of seizures. Physiological dose (<1 mg) of folic acid both
in healthy and 60 epileptic women, all without any autoimmune disease, did
not increase the risk for epileptic seizures.

<4>
AN 98324234
AU Glanz BI. Schur PH. Khoshbin S.
IN Department of Neurology, Brigham and Women's Hospital, Harvard Medical
School, Boston, Massachusetts 02115, USA.
TI EEG abnormalities in systemic lupus
erythematosus.
SO Clinical Electroencephalography. 29(3):128-31, 1998 Jul.
LM Dana Biomedical Library (Dana).
AB The medical records of 478 SLE patients were reviewed. Ninety-five patients
(19.9%) with a history of seizures were identified. EEG
reports were available on 62. EEGs were interpreted as normal in 8 (12.9%)
and abnormal in 54 (87.1%). Abnormal EEGs were reviewed for the presence of
unilateral and bilateral abnormalities. Left hemisphere abnormalities were
identified in 43 (79.6%), right hemisphere abnormalities in 4 (7.4%), and
bilateral abnormalities in 7 (13.0%) patients with SLE. Abnormalities
included theta and delta slowing and sharp wave activity. In 32 of the 43
(74.4%) patients with left hemisphere abnormalities, the abnormalities were
localized to the left temporal leads. These findings suggest selective damage
to the left temporolimbic region in patients with SLE.

<5>
AN 97373331
AU Formiga F. Mitjavila F. Pac M. Moga I.
TI Epilepsy and antiphospholipid antibodies in
systemic lupus erythematosus patients
[letter; comment].
CM Comment on: Lupus 1996 Aug;5(4):307-12
SO Lupus. 6(5):486, 1997.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.

<6>
AN 97157699
AU Gigli GL. Scalise A. Silvestri G. Diomedi M. Placidi F. Pomponi MG.
Masala C.
IN Clinica Neurologica, Universita Tor Vergata, Roma, Italy.
TI Clinical case report: multiple idiosyncratic adverse effects of
antiepileptic drugs in trisomy 9p.
SO International Journal of Neuroscience. 87(3-4):181-9, 1996 Nov.
LM Dana. Incomplete holdings, check catalog.
AB We report the case of a mentally retarded 30 y.o. patient with partial
trisomy of chromosome 9, affected by epilepsy. Following
treatment with antiepileptic drugs (AEDs), the patient developed several rare
complications: after beginning therapy with phenytoin, the patient developed
pseudolymphoma; after monotherapy with carbamazepine (CBZ), the patient
thereafter developed myoclonic jerks of upper and lower limbs upon awakening;
after one year of treatment with valproate (VPA) the patient developed
clinical and immuno-haematological signs of SLE. Gradual withdrawal of AED,
obtained clinical remission. The possibility that the chromosomal abnormality
of the patient was responsible for the three rare complications observed
during AED therapy is considered.

<7>
AN 97023544
AU Liou HH. Wang CR. Chen CJ. Chen RC. Chuang CY. Chiang IP. Tsai MC.
IN Department of Neurology, National Taiwan University Hospital, Taipei.
TI Elevated levels of anticardiolipin antibodies and epilepsy
in lupus patients [see comments].
CM Comment in: Lupus 1997;6(5):486
SO Lupus. 5(4):307-12, 1996 Aug.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB To examine the association between anticardiolipin (aCL) antibodies and
epilepsy, we investigated the serum titers of aCL antibodies
in a total 252 systemic lupus erythematosus
(SLE) patients recruited in a prospective study. Twenty-one cases with
epilepsy which were not attributable to any causes other
than SLE were identified after being followed-up for five years. The clinical
manifestations were recorded and blood samples were tested for the presence
of aCL antibodies (IgG, IgM and IgA isotypes). Among 21 patients with
epilepsy, 12 (57.1%), 2 (9.5%) and 2 (9.5%), respectively,
had elevated baseline serum levels of IgG, IgM and IgA aCL antibodies. There
was a dose-response relationship between risk of seizure and the baseline
serum level of aCL antibodies (P < 0.01). The odds ratio of developing
seizure were 3.7 for those who had a high level of aCL antibodies compared
with those without a detectable level of aCL antibodies as the referent. Our
results indicate that epilepsy as a primary neuropsychiatric
event among lupus patients is associated with a high titer
of aCL antibodies.

<8>
AN 96406062
AU Vyas SD. Nayak US. Gandhi DJ. Shah AR.
IN Department of Paediatrics, SSG Hospital, Baroda Medical College.
TI Childhood systemic lupus erythematosus
presenting with neuropsychiatric manifestations.
SO Journal of the Indian Medical Association. 94(2):71, 73, 1996 Feb.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.

<9>
AN 96237824
AU Gigli GL. Scalise A. Pauri F. Silvestri G. Diomedi M. Placidi F.
Grazia Pomponi M. Masala C.
IN Clinica Neurologica, Universita Tor Vergata, Rome, Italy.
TI Valproate-induced systemic lupus
erythematosus in a patient with partial trisomy of chromosome 9 and
epilepsy.
SO Epilepsia. 37(6):587-8, 1996 Jun.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB We report a mentally retarded 30-year-old woman with partial trisomy of
chromosome 9 (46, XX-6, +der(6)t(6,9)pat) who has had
epilepsy since age 11 months. She had been treated with
various combinations of drugs. After 1 year of treatment with valproate (VPA)
and ethosuximide (ESM), the patient developed arthralgias, muscle weakness,
fatigue, and fever. Laboratory examination showed increased sedimentation
rate, hypergammaglobulinemia, and high titers of antinuclear antibodies
(ANA). The possibility of VPA-induced systemic
lupus erythematosus (SLE) was considered. This diagnosis was
supported by detection of antihistone antibodies and the HLA-DR4 antigen. VPA
dosage was tapered and discontinued, with accompanying resolution of
clinical, immunological and hematological signs of SLE 6 weeks after VPA
discontinuation. This is the fourth reported case of VPA-induced SLE.

<10>
AN 95372148
AU Gieron MA. Khoromi S. Campos A.
IN Department of Pediatrics, University of South Florida, College of Medicine,
Tampa 33606, USA.
TI MRI changes in the central nervous system in a child with
lupus erythematosus.
SO Pediatric Radiology. 25(3):184-5, 1995.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB We report on a 10-year-old girl with systemic
lupus erythematosus who presented in status epilepticus as
the only manifestation of central nervous system involvement. MRI of the
brain showed diffuse gray and white matter lesions which almost completely
resolved after treatment with methylprednisolone. MRI findings in this child
are similar to those in adults with diffuse clinical manifestations. The
study is essential in the initial evaluation of patients suspected of central
nervous system lupus.

<11>
AN 95295794
AU Needles CF.
TI Clinical problem-solving: decision making by analogy [letter; comment].
CM Comment on: N Engl J Med 1995 Mar 2;332(9):592-6
SO New England Journal of Medicine. 333(2):128; discussion 129, 1995 Jul 13.
LM Dana(complete) &MFHSL(1990-date);also Web,check catalog .

<12>
AN 94197791
AU Herranz MT. Rivier G. Khamashta MA. Blaser KU. Hughes GR.
IN Rayne Institute, St. Thomas's Hospital, London, England.
TI Association between antiphospholipid antibodies and
epilepsy in patients with systemic
lupus erythematosus.
SO Arthritis & Rheumatism. 37(4):568-71, 1994 Apr.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB OBJECTIVE. To determine whether the occurrence of seizures
is correlated with the presence of serum antiphospholipid antibodies (aPL) in
systemic lupus erythematosus (SLE)
patients. METHODS. The study included 221 unselected patients with SLE. Of
these, 21 patients with epileptic seizures not attributed to
any cause other than SLE were identified. Epilepsy was
diagnosed by clinical history and electroencephalography. Blood samples were
tested for the presence of antibodies to cardiolipin (aCL, IgG and IgM
isotypes) and lupus anticoagulant (LAC). RESULTS. LAC was
detected in 43.8% of the patients with epilepsy and in 20.8%
of controls (P = 0.057). A statistically significant association was found
between moderate-to-high titers of IgG aCL and the presence of
seizures (P = 0.02). Brain computed tomography and/or
magnetic resonance imaging scanning was performed in 14 patients. All
patients with abnormal features found on these tests had positive aPL (P =
0.03). Nine patients (42.9%) had at least 1 of the classic features
associated with the aPL syndrome. CONCLUSION. We confirmed that
epilepsy as a primary neuropsychiatric event is
significantly associated with moderate-to-high titers of IgG aCL in SLE
patients. Our results suggest that aPL could have a role in the
etiopathogenesis of epilepsy in SLE.

<13>
AN 94203000
AU Liou HH. Wang CR. Chou HC. Arvanov VL. Chen RC. Chang YC. Chuang CY.
Chen CY. Tsai MC.
IN Department of Neurology, College of Medicine, National Taiwan University,
Taipei, R.O.C.
TI Anticardiolipin antisera from lupus patients with
seizures reduce a GABA receptor-mediated chloride current in
snail neurons.
SO Life Sciences. 54(15):1119-25, 1994.
LM Dana. Incomplete holdings, check catalog.
AB The effects of circulating anticardiolipin (ACL) antisera in
lupus patients on the LP5 central neuron of snail were
studied. Both GABA and glutamate increased a chloride conductance of the LP5
neuron. The ACL antisera decreased the GABA-elicited responses in a
concentration dependent manner while it had no effect on glutamate-elicited
responses. The ACL antisera affected neither the resting membrane current,
nor the membrane conductivity of neuron. Antisera without the activity of
anticardiolipin did not decrease the GABA-elicited responses. The seizure
incidence of the patients with higher ACL antisera levels is also higher. It
is concluded that ACL antisera inhibited the GABA ionophore receptor complex
in a snail central neuron.

<14>
AN 94093619
AU Brinciotti M. Ferrucci G. Trasatti G. Priori R. Squilloni E. Valesini
G.
IN Dipartimento di Scienze Neurologiche e Psichiatriche dell'Eta Evolutiva,
Universita La Sapienza, Roma, Italy.
TI Reflex seizures as initial manifestations of
systemic lupus erythematosus in childhood.
SO Lupus. 2(4):281-3, 1993 Aug.
LM Not at Dartmouth/DHMClibraries;request on interlibrary loan.
AB We report a 10-year-old girl with reflex seizures
characterized by visual and acoustic hallucinations, induced by visual and
acoustic stimulations. The EEG showed atypical spike-wave discharges on the
left temporo-occipital area, markedly activated by visual and acoustic
stimuli (intermittent light, pattern-reversal stimulation and monoaural right
pure tone). The patient was treated with carbamazepine and seizure stopped
within 7 months. After 10 months from the start of the therapy she developed
signs of systemic lupus erythematosus.

<15>
AN 93159459
AU Mevorach D. Raz E. Shalev O. Steiner I. Ben-Chetrit E.
IN Department of Medicine, Hadassah University Hospital, Mount Scopus, Israel.
TI Complete heart block and seizures in an adult with
systemic lupus erythematosus. A possible
pathophysiologic role for anti-SS-A/Ro and anti-SS-B/La autoantibodies.
SO Arthritis & Rheumatism. 36(2):259-62, 1993 Feb.
LM Pre-1993 at Dana,1993-date at MFHSL.
AB OBJECTIVE. To determine the serum autoantibody profile in an adult patient
with systemic lupus erythematosus
manifested by complete heart block (CHB) and seizures, and
to investigate the source of autoantibodies found in the patient's
cerebrospinal fluid (CSF). METHODS. The serum and CSF autoantibody profiles
were determined by serologic testing and Western blot studies. An antibody
activity index was devised to determine the source of the autoantibodies
found in the CSF. RESULTS. The patient's serum contained anti-SS-A (52 kd and
60 kd), anti-SS-B, anti-U1 RNP, and anti-Sm autoantibodies. Studies of her
CSF, however, revealed only anti-SS-A and anti-SS-B autoantibodies, with a
high antibody activity index. CONCLUSION. The finding of anti-SS-A (52 kd and
60 kd) and anti-SS-B autoantibodies was similar to reported findings in
congenital CHB. Intrathecal synthesis of anti-SS-A and anti-SS-B was the
source of autoantibodies found in the CSF. This patient's symptoms may be
pathophysiologically linked to an immune reaction between the anti-SS-A and
anti-SS-B autoantibodies and neural tissue in the brain and heart.

<16>
AN 93000347
AU Suenaga R. Abdou NI.
IN Immunology Research Laboratory, St. Luke's Hospital, Kansas City, MO 64111.
TI Expression of inactive stage anti-dsDNA idiotypes on anti-ssDNA antibodies
in a lupus patient during active stage of
lupus cerebritis.
SO Journal of Autoimmunity. 5(3):379-92, 1992 Jun.
LM Some Web & Print available, check catalog for details.
AB The possibility that idiotypes (Ids) defined on anti-double stranded DNA
(dsDNA) antibodies during active and inactive stages of
lupus (1/84 Id and 4/90 Id, respectively) were expressed on
anti-DNA antibodies during a subsequent active period (9/90) of the disease
was investigated in a lupus patient with
lupus cerebritis. Using rabbit (R)-anti-Ids specific to 1/84
Id and 4/90 Id in inhibition assays, the 4/90 Id was shown to be expressed on
the framework regions of anti-single stranded DNA (ssDNA) but poorly on
co-existing anti-dsDNA antibodies of active (9/90) stage. The 1/84 Id was
poorly expressed on both types of 9/90 anti-DNA antibodies. While the 9/90
anti-ssDNA significantly bound to immobilized ssDNA and several
single-stranded polynucleotides, only ssDNA inhibited the binding of the
anti-ssDNA to ssDNA, suggesting its monospecificity toward ssDNA. Western
blot analysis following isoelectric focusing showed that a spectrotype
pattern of 4/90 Id-positive 9/90 anti-ssDNA IgG was similar to that of the
4/90 anti-dsDNA, suggesting that they are of related clonal origin. The
present study suggests the idiotypic heterogeneity of anti-DNA antibodies and
the shift of antigen specificity within an idiotypically related anti-DNA
population during exacerbation of the disease.

<17>
AN 92322049
AU Futrell N. Millikan C.
TI Interpreting brain scans of lupus patients taken after
seizures or migraines [letter; comment].
CM Comment on: Arthritis Rheum 1991 Apr;34(4):432-41
SO Arthritis & Rheumatism. 35(7):843-4, 1992 Jul.
LM Pre-1993 at Dana,1993-date at MFHSL.