Lupus Neurology


"Lupus neurology:- Here we deal with all the neurological manifestations of lupus including epilepsy, headache,and psychiatric problems"

Systemic Lupus Erythematosus (SLE or lupus for short) is disease of the immune system (autoimmune disease) affecting many different organ systems throughout the body.

Neurological and psychiatric symptoms occur in many patients due to the disease process itself however the issue is further complicated by the fact that drugs used in SLE and other "rheumatological" conditions may have a variety of neurological side effects. In addition neurological problems may result from damage to other organ systems such as the liver and kidneys.

Lupus Neurology:- Neurological features of SLE

SLE is characterized by the presence of circulating antibodies which attack the host ("autoantibodies")

lupus myelitis

A wide variety of neurological symptoms may occur in patients previously diagnosed with SLE. However, patients ultimately diagnosed with SLE may initially present with neurological symptoms and have no obvious involvement of other organ systems on initial clinical evaluation. Therefore many patients originally going to a neurologist with neurological syndromes should be screened for clinical and laboratory features of SLE.

On the other hand, neurological evaluation of patients with established SLE may not be straightforward, as neurological problems may be a direct consequence of the disease, a result of other organ involvement or due to therapeutic interventions. The American College of Rheumatology defined 19 neuropsychiatric syndromes (NPS) occurring in SLE. These represent conditions directly associated with SLE and does not include conditions occurring because of other organ involvement or therapy.

The antiphospholipid antibody syndrome (APLAS) is a frequent accompaniment to SLE and the frequency of nervous system involvement is higher in SLE patients with antiphospholipid antibodies, particularly anticardiolipin antibodies. Furthermore, neuropsychiatric syndromes frequently occur in APLAS without SLE

Various neurological problems may be interrelated. For example, cerebrovascular disease or stroke may lead to "focal deficits" such as weakness of one side, cognitive problems, seizures and a movement disorder . Similarly, inflammation of the spinal cord ("myelitis") may either be isolated, or reflect the co-existence of Neuromyelitis optica or Devic disease, or multiple sclerosis (MS) both of which which are sometimes an issue in "lupus neurology".

A severe syndrome of short term memory loss due to bilateral hippocampal inflammation known as "limbic encephalitis" may occasionally occur.

Although headache is often considered to be one of the neurological manifestations of SLE the association is controversial. Headache is probably no more frequent in SLE when compared to the general population, while migraine with aura may be commoner in SLE sufferers especially with anticardiolipin antibodies. In children with SLE, headache may be associated with CNS involvement and may lead to referral for an MRI.

To summarize:- neurological dysfunction is an important cause of disability in SLE and many neurological disorders will prompt a neurologist to exclude the presence of a co-existing rheumatic condition such as SLE.

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