Studies revealed that is possible for systemic lupus erythematosus to affect the nervous system. Patients with lupus may experience confusion, difficulty with concentrating, headaches, fatigue, strokes or other signs that show nervous system involvement.
Studies suggested that the nerve tissue may be damaged when antibodies attack nerve cells or blood vessels. It is known that the nervous system requires an uninterrupted flow of blood, that is needed to supply with oxygen and nutrients its tissues. When this flow of blood is slowed or interrupted, the nervous cells are unable to function normally, and there appear symptoms. The symptoms vary, depending where the tissue injury is situated.It is good to know that the nervous system contains three parts. The central nervous system comprises the brain and spinal cord, the peripheral nervous system nerve fibers that have the role to provide the skin and muscles the power needed for sensation and movement, and the third part is the autonomic nervous system that has the role to regulate spinal, peripheral nerves and to innervate the internal organs.
An inflammation of the blood vessels of the brain that appears to 10% of all lupus patients is called the central nervous system vasculitis.This disease usually requires hospitalization and high doses of corticosteroids. Some of the symptoms that appear are high fevers, seizures, psychosis and meningitis-like stiffness of the neck. If it is not aggressively managed, the central nervous system vasculitis rapidly progresses to stupor and coma.
People with mild to moderated systemic lupus erythematosus can experience the cognitive dysfunction. That is a group of symptoms that appear at about 50% of these patients, and we can mention here fatigue, memory impairment, feelings of confusion, and difficulty to express the thoughts. By taking a neuropsychological test or a test called the positron emission tomography, these symptoms can be clearly documented.It is known that cognitive dysfunction may come and go on its own, but no optimal therapy is available. Also, it is not known which is the reason for the symptoms that appear. Dealing with a cognitive dysfunction is frustrating, and often counseling a person in developing coping skills may be helpful.
About 20% of the patients having systemic lupus erythematosus experience the lupus headache. This manifests by severe headaches, is similar to migraine and can be often seen in persons who have also Raynaud’s phenomenon. As a treatment, it is useful the same one used in tension headaches or migraine, and sometimes corticosteroids.
It is known that about a third of the patients having lupus can have a false positive syphilis test, a positive anticardiolipin antibody, or a prolonged clotting time test.This is known under the name of the lupus anticoagulant or the antiphospholipid antibody. About 1/9 of the patients having lupus will develop blood clots in various parts of the body, which is called the antiphospholipid syndrome.If blood clots appear in the nervous system, they can cause a stroke, and symptoms of a stroke include the painless onset of neurologic deficits without any signs of active lupus.If a stroke appears, there must be taken blood-thinning medications. We can mention here low-dose aspirin, coumadin or heparin.
Among patients having systemic lupus erythematosus there is a percentage of 20% that have fibromyalgia syndrome as well. These patients experience increased pain in the soft tissues, tender points, and, in addition cognitive dysfunction, decreased ability to concentrate, lack of stamina and difficulty sleeping. As a treatment, we can mention anti-depressants, counseling, and physical therapy if needed.
It was discovered that medications used to treat systemic lupus erythematosus can develop symptoms like those of the central nervous system lupus.Psychosis can appear due to anti-malarials in very high doses; headache, dizziness, and in rare situations meningitis-like symptoms can be provoked by nonsteroidal anti-inflammatory drugs. Also if a patient uses corticosteroids, there can appear moods swings, psychosis, depression, agitation, confusion, if there are taken high doses can appear seizures, and anti-hypertensive medications may be associated with depression or loss of libido.
A study discovered that people that have both lupus and Sjogren’s syndrome may be predisposed to develop vasculitis or cognitive dysfunction. Sometimes, circulating proteins in the blood can lead to cryoglobulinemia or hyperviscosity syndrome.Plasmapheresis or filtering the blood can ease these complications.Sometimes, pronounced decreases in platelet counts may be associated with bleeding.People with thrombotic thrombocytopenic purpura or who lack Protein S or Protein C may clot, and those with lupus, idiopathic thrombocytopenic purpura and kidney failure may bleed.
In peripheral nervous system lupus, involvement of the cranial nerves can cause visual disturbances, drooping of the eyelid(s), ringing in the ear(s), facial pain and dizziness.Symptoms of numbness or tingling in the arms or legs can appear if there is an inflammation of the blood vessels supplying the peripheral nerves. There can also appear symptoms due to other conditions than lupus and electromyogram and nerve conduction tests are usually helpful to determine if symptoms are due to some other cause. Corticosteroids are used to treat inflammation of the peripheral nerves.
It is important for your doctor to know if you experience nervous system symptoms. It is possible that these symptoms to appear due to lupus, due to a medication or a particular aspect of your life. The doctor will ask you about the symptoms you experience, he will perform a physical examination and a laboratory evaluation including a blood chemistry panel, complete blood count and urinalysis. Also, diagnostic tests like sedimentation rate, ANA, anti-DNA, anti-ribosomal P antibodies and complement may be useful in order to determine nervous system involvement.There are neurodiagnostic tests, that include CT and MRI brain scans, brain waves or electroencephalogram and spinal taps.In a few hospitals, there can also be performed PET scans.The spinal fluid may be examined for cells, protein components and antineuronal antibodies. In patients with cognitive dysfunction, neuropsychologic tests may be helpful.
The treatment for nervous system lupus depends upon its source, and can include immunosuppressants, blood thinners, antibiotics, steroids, anti-depressants, counseling or surgery. If there are evident diagnostic difficulties, a rheumatologist and/or neurologist should be involved in your care. It was seen that for many people with lupus, nervous system involvement is completely reversible.