Clinical Evaluation of Neuropsychiatric Lupus Erythematosus.
- Author:
Chan Hee LEE
1
;
Ji Soo LEE
;
Chang Ho SONG
;
Soo Kon LEE
Author Information
1. Division of Rheumatology, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Neuropsychiatric lupus;
Clinical feature;
Antiphospholipid antibody
- MeSH:
Adjustment Disorders;
Antibodies, Anticardiolipin;
Antibodies, Antiphospholipid;
Brain;
Cause of Death;
Cerebral Hemorrhage;
Cerebrospinal Fluid;
Cyclophosphamide;
Diagnosis;
Diagnostic Tests, Routine;
Electroencephalography;
Female;
Follow-Up Studies;
Hemorrhage;
Humans;
Magnetic Resonance Imaging;
Male;
Mortality;
Plasmapheresis;
Retrospective Studies;
Serologic Tests;
Shock, Septic;
Status Epilepticus;
Thrombocytopenia
- From:The Journal of the Korean Rheumatism Association
1996;3(2):126-133
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVES: To evaluate the clinical characteristics, diagnostic METHOD:s, serologic tests and treatment modalities of neuropsychiatric lupus (NPSLE). METHODS: Systemic lupus erythematosus(SLE) patients manifesting NPSLE at Severance Hospital, Yonsei University College of Medicine were retrospectively studied in the period of Jan 1994 to March 1996. RESULTS: The results were as follows; 1) Neuropsychiatric manifestations were observed in 24 patients of the total 144 SLE patients(16. 6%). 2) Of the 24 NPSLE patients, there was i male, 23 female and the mean age was 32 years(range 14 - 70). 3) Eight patients presented neuropsychiatric symptoms as an initial manifestation and the rest presented during the follow up period(mean: 25 months, range: 2 months - 10 years). 4) Preceding cause was identified in seven patients and was classified as secondary NPSLE: drug in 1 case, infection in 2 cases, reactive depression in 2 cases, and cerebral hemorrhage due to thrombocytopenia in 2 case. 5) NPSLE was classified into diffuse manifestation and focal manifestation. The diffuse manifestation was found in 22 cases and the focal manifestation was found in 6 cases. Patients with focal manifestation showed higher rate of anticardiolipin antibody or lupus anticoagu]ant test than patients with diffuse manifestation with of 100%(3/3) in the former and 30%(6/20) in the latter (p(0.01). 6) The sensitivity of diagnostic tests were as follows: cerebrospinal fluid study 7.l% (1/ll), electroencephalogram 62.5% (5/8), brain computed tomogram 52.9%(9/17), magnetic resonance imaging 66.7% (6/9), cerebral angiogram 100% (1/1), and myelogram 0%(0/1). 7) The treatment modalities were as follows; high dose steroid (lmg/kg/day) or steroid pulse therapy (intravenous methylprediniso]one lg/day for 3 days) alone in 13 cases, high dose steroid or steroid plus other drugs (anticonvulants, psychiatric medication, warfarin) in 5 cases, steroid pulse plus plasmapheresis in 3 cases, steroid pulse and plasmapheresis plus other drugs (intravenous cyclophosphamide, anticonvulsant) in 2 patients, low dose steroid (alone or with analgesics) in 2 patient, psychiatric treatment in 2 patients and no treatment in 1 patient. 26 patients responded to treatment. 8) The mortality rate was 12. 5~ (3/24) and the cause of death was pulmonary hemorrhage, septic shock, and status epilepticus. CONCLUSIONS: NPSLE is a frequent and morbid manifestation of SLE but diagnosis is difficult due to lack of specific test. Focal manifestation of NPSLE was associated with antiphospholipid antibody.
