OBJECTIVE: The aim of this study was to describe the frequency, attribution, 
outcome and predictors of seizures in systemic lupus erythematosus (SLE).
METHODS: The Systemic Lupus International Collaborating Clinics, or SLICC, 
performed a prospective inception cohort study. Demographic variables, global 
SLE disease activity (SLE Disease Activity Index 2000), cumulative organ damage 
(SLICC/American College of Rheumatology Damage Index (SDI)) and neuropsychiatric 
events were recorded at enrolment and annually. Lupus anticoagulant, 
anticardiolipin, anti-β(2) glycoprotein-I, antiribosomal P and anti-NR2 
glutamate receptor antibodies were measured at enrolment. Physician outcomes of 
seizures were recorded. Patient outcomes were derived from the SF-36 (36-Item 
Short Form Health Survey) mental component summary and physical component 
summary scores. Statistical analyses included Cox and linear regressions.
RESULTS: The cohort was 89.4% female with a mean follow-up of 3.5±2.9 years. Of 
1631 patients, 75 (4.6%) had ≥1 seizure, the majority around the time of SLE 
diagnosis. Multivariate analysis indicated a higher risk of seizures with 
African race/ethnicity (HR (CI): 1.97 (1.07 to 3.63); p=0.03) and lower 
education status (1.97 (1.21 to 3.19); p<0.01). Higher damage scores (without 
neuropsychiatric variables) were associated with an increased risk of subsequent 
seizures (SDI=1:3.93 (1.46 to 10.55); SDI=2 or 3:1.57 (0.32 to 7.65); SDI≥4:7.86 
(0.89 to 69.06); p=0.03). There was an association with disease activity but not 
with autoantibodies. Seizures attributed to SLE frequently resolved (59/78 
(76%)) in the absence of antiseizure drugs. There was no significant impact on 
the mental component summary or physical component summary scores. Antimalarial 
drugs in the absence of immunosuppressive agents were associated with reduced 
seizure risk (0.07 (0.01 to 0.66); p=0.03).
CONCLUSION: Seizures occurred close to SLE diagnosis, in patients with African 
race/ethnicity, lower educational status and cumulative organ damage. Most 
seizures resolved without a negative impact on health-related quality of life. 
Antimalarial drugs were associated with a protective effect.