JAMA Network | JAMA Neurology | 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
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.

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