FINDINGS SUGGESTIVE OF SYSTEMIC LUPUS ERYTHEMATOSUS IN SUBJECTS ON CHRONIC ANTICONVULSANT THERAPY

Systemic lupus erythematosus (SLE)-like syndromes associated with carbamazepine therapy

Records of 80 cases of systemic lupus erythematosus (SLE)-like syndromes associated with use of carbamazepine entered in the single case files of Central Drug Monitoring, Ciba-Geigy, Basel, were reviewed. Included in these were 11 cases reported in the literature. These were assessed in light of the current concepts of both idiopathic and drug-induced forms of SLE. Even allowing for under-reporting of adverse drug reactions, the number of such cases is far below the prevalence rates for SLE. This adverse drug reaction remains allocated to the category 'isolated cases' i.e. frequency is less than 0.001% of the cases treated. Antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) tests were not helpful in differentiating between idiopathic and drug-induced SLE. IgG antihistone antibodies in the absence of high titres of dsDNA antibodies is the only reliable test. Symptoms of SLE-like syndromes which manifest after carbamazepine therapy usually subside after discontinuation of the drug. Persistence of symptoms support the diagnosis of idiopathic SLE.

Effects of antiepileptic drugs on concentration of serum proteins and immunoglobulins of epileptic patients

Serum of normal volunteers and serum of epileptic patients receiving either a single drug or combined antiepileptic therapy with Phenytoin (Phen); Carbamazepine (Cbz); Primidone (Prim); Phenobarbital (Phb) were examined and showed: No differences with regard to total proteins, albumins and A/G ratio. The alpha 1-globulin fraction increased to 4.4% with Phen/Cbz (P less than 0.001) and decreased to 1.7% with Phen/Prim = (P less than 0.001). The alpha 2-globulins corresponded to 7.2% (P less than 0.001) with Phen/Prim and 15.5% (P less than 0.001) with Phen/Phb treatments. beta-Globulins decreased to 7.1% (P less than 0.05) when received Phen/Phb treatment. Low concentrations of serum gamma-Globulins were found in Phb (P less than 0.001), Prim (P less than 0.001, Phen (P less than 0.001) treated patients. However, with Cbz, Phen/Phb, Phen/Prim this electrophoretic fraction remained within the upper range of normal. IgA of patients treated with Phen showed a mean of 60 mg/dl. Those patients with Phen serum levels below or above 12-20 micrograms/ml remained normal. Prim and Phb treatment also decreased IgA. IgD was normal in patients treated with Phen/Prim. Alterations of immune humoral responses to all antiepileptic drugs were found.

Effects of phenytoin on man's immunity. Evaluation of changes in serum immunoglobulins, complement, and antinuclear antibody

To determine the effects of phenytoin on serum immunoglobulins, complement, and antinuclear antibody conversion, a prospective, five-year longitudinal study was undertaken in 118 patients. Three major diagnostic groups were evaluated: 27 patients with idiopathic epilepsy, 50 with secondary epilepsy, and 41 with neuropathic syndromes without epilepsy. In addition, 83 normal volunteers were studied in a similar manner. Evaluations were performed prior to administration of phenytoin and at six-month intervals thereafter. Prior to treatment, patients with idiopathic epilepsy had a higher than expected incidence (13.5 percent, p less than 0.01) of low serum IgA (less than 61 mg/dl). Patients with secondary epilepsy and neuropathic disorders without epilepsy had a greater than expected incidence (9.2 percent, p less than 0.01; and 12 percent, p less than 0.01, respectively) of high serum IgA (greater than 417 mg/dl). Phenytoin treatment was associated with further decreases in serum IgA in patients with idiopathic epilepsy (p = 0.063) and secondary epilepsy (p = 0.008). Total serum IgE concentrations also decreased significantly in all patient categories during treatment with phenytoin. Minor decreases in serum IgG and IgM were noted, but serum IgD and complement remained unaffected. Antinuclear antibodies were observed with essentially the same frequency (10 percent) before and after phenytoin therapy.

Systemic lupus erythematosus syndrome induced by practolol

Three patients with angina pectoris treated with practolol in varying doses developed a syndrome of arthralgia, particularly of the small joints of the hands, rash, fever, a raised E.S.R., and positive tests for lupus erythematosus (L.E.) cells and antinuclear antibody. The syndrome responded partly to withdrawal of the drug, but steroids were required to produce adequate symptomatic improvement. These disease features suggest that this is an example of drug-induced systemic lupus erythematosus (S.L.E.). The impaired ability of lymphocytes from these patients to transform in vitro indicates a testable hypothesis for the pathogenesis of the syndrome.