The burden of neurological comorbidities in six autoimmune bullous diseases: a population-based study

Background: Apart from bullous pemphigoid (BP), the association of other autoimmune bullous diseases (AIBDs) with neurological conditions is poorly understood. Objective: To estimate the association between a wide array of AIBDs and neurological conditions. Methods: A retrospective cross-sectional study recruited patients with BP, mucous membrane pemphigoid (MMP), epidermolysis bullosa acquisita (EBA), pemphigoid gestationis (PG), pemphigus vulgaris (PV) and pemphigus foliaceus (PF). These patients were compared with their age- and sex-matched control subjects with regard to the lifetime prevalence of Parkinson's disease (PD), Alzheimer's disease (AD), stroke, epilepsy and multiple sclerosis (MS). Logistic regression was used to calculate OR for specified neurological disorders. Results: The current study included 1743, 251, 106, 126, 860 and 103 patients diagnosed with BP, MMP, EBA, PG, PV and PF, respectively. These patients were compared with 10 141, 1386, 606, 933, 5142 and 588 matched controls, respectively. Out of the investigated neurological conditions, PD associated with BP (OR, 2.71; 95% CI, 2.19–3.35); AD with BP (OR, 2.11; 95% CI, 1.73–2.57), MMP (OR, 2.37; 95% CI, 1.03–5.47), EBA (OR, 6.00; 95% CI, 1.90–18.97) and PV (OR, 2.24; 95% CI, 1.40–3.60); stroke with BP (OR, 1.84; 95% CI, 1.55–2.19) and EBA (OR, 2.79; 95% CI, 1.11–7.01); and epilepsy with BP (OR, 2.18; 95% CI, 1.72–2.77) and PV (OR, 1.80; 95% CI, 1.19–2.73). MS did not significantly cluster with any of the six AIBDs. Conclusion: In addition to BP, EBA and PV were found to cluster with neurological comorbidities. Patients with these AIBDs with compatible symptoms may be carefully assessed for comorbid neurological disorders.