lupus and your brain

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Systemic Lupus And The Nervous System

J. Wallace, M.D., FACP, FACR

Clinical Professor of Medicine

Cedars Sinai

Medical Center/

UCLA School of Medicine

Los Angeles, CA

The

Body's Nervous System

How

Does Lupus Affect The Nervous System?

Signs

and Symptoms of Central Nervous System (CNS) Lupus

Central

Nervous System (CNS) Vasculitis

Cognitive

Dysfunction

Lupus

Headache

The

Antiphospholipid Syndrome (APS)

Organic

Brain Syndrome

Fibromyalgia

(Fibrositis Syndrome)

Central

Nervous System Symptoms Due to Medication

Uncommon

Causes of CNS Symptoms In SLE

Signs

and Symptoms of Peripheral Nervous System Lupus

How

Your Doctor Evaluates Symptoms

How

Your Doctor Treats Symptoms

Lupus

Foundation of America

Related

Information

Introduction

Although nervous system involvement in systemic lupus erythematosus (SLE) is

unclear and controversial, people with lupus do often experience signs

associated with the body's nervous system, such as:

headaches

confusion

difficulty with concentration

fatigue

occasional seizures or strokes

Therefore, this brochure will:

briefly discuss the nervous system and how it may

be affected by lupus

categorize the many signs and symptoms associated

with nervous system involvement

review the diagnostic work-up

discuss disease management.

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The Body's Nervous System

The nervous system is divided into three parts:

The central

nervous system (CNS) consists of the brain and spinal cord.

The peripheral

nervous system is comprised of nerve fibers that supply the

skin and muscles with the power needed for sensation and movement.

The autonomic

nervous system helps to regulate spinal nerves and peripheral

nerves, and innervates, or supplies nerves to, the internal organs. Its

role in SLE is poorly defined.

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How Does Lupus Affect The Nervous System?

The nervous system requires an uninterrupted flow of blood to supply its

tissues with oxygen and nutrients necessary for normal functioning. A number of

possibilities have been suggested to explain how lupus may cause the many

symptoms of nervous system involvement:

Nerve tissue may be damaged when antibodies

attack nerve cells or blood vessels.

Nutrients and oxygen are delivered through blood

vessels that feed the brain, spinal cord and nerves. If blood flow is

slowed or interrupted, the cells of the nervous system are injured, unable

to function normally, and symptoms develop.

The symptoms that occur vary depending on the

location and extent of the tissue injury.

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Signs And Symptoms of Central Nervous System

Lupus

Central Nervous

System (CNS) Vasculitis

CNS vasculitis is inflammation of the blood vessels of the brain. It is the

most serious form of systemic lupus. CNS vasculitis is characterized by:

high fevers

seizures

psychosis

meningitis-like stiffness of the neck.

It can rapidly progress to stupor and coma if not aggressively managed.

Seizures occur when injured or scarred brain tissue becomes the focus of

abnormal electrical discharges.

These seizures may be a one-time occurrence or a

persistent problem.

Anti-convulsant medications are used to prevent

seizures by controlling the brain's abnormal electrical discharges.

CNS vasculitis usually requires hospitalization and high doses of

corticosteroids.

Infection should be ruled out before treatment is

initiated.

CNS vasculitis occurs in up to 10 percent of all

lupus patients

It is the only form of central nervous system

disease that is included in the American

College of

Rheumatology (ACR) criteria for defining SLE.

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Cognitive

Dysfunction

At some point during the course of their lupus, up to 50 percent of lupus

patients describe feelings of

confusion,

fatigue,

memory impairment, and

difficulty expressing their thoughts.

This collection of symptoms is called cognitive dysfunction and is

found in people with mild to moderately active SLE. These symptoms may be

clearly documented by neuropsychological testing, and a newer neurodiagnostic

test called the single positron emission computed tomography (SPECT) scan shows

reproducible blood flow abnormalities.

The

reasons for these symptoms are not known. It may have something to do with

changes in how a group of chemicals known as cytokines are handled or may be

related to certain parts of the brain not getting enough oxygen.

Other tests including:

Spinal taps,

brain wave tests (EEG),

magnetic resonance imaging (MRI) or

computerized tomography (CT) scans of the brain

may all be normal.

Cognitive dysfunction may come and go on its own, so the management of

cognitive dysfunction is often frustrating and currently no optimal therapy is

available.

Antimalarials and/or steroids may be useful.

Counseling, cognitive behavioral therapy and

other interventions that assist a person in developing coping skills may

be helpful.

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Lupus Headache

People with lupus experience headaches which are unrelated to their lupus,

i.e., sinus headache, tension headache and bone spurs from osteoarthritis.

Approximately 20 percent of patients with SLE experience severe headaches which

are related to the disease and known as lupus headache.

The lupus headache phenomenon is similar to

migraine and may be seen more often in people who also have Raynaud's

phenomenon.

SPECT scans indicate abnormalities in blood

vessel tone or the ability of a vessel to dilate or constrict.

Lupus

headache is treated like tension headaches or migraine, although

corticosteroids are occasionally useful.

From: megl2001

Sent: Saturday, June 26, 2004 7:17

PM

To: LUPIES

Subject: lupus and your

brain

Hi all

Anyone out there suffering from the neuro.

effects of this disease?

For some reason when I am in a flare it goes

straight to my head

(literally). My doc and I discusssed it and

he said we should wait on

trying something like cytoxan since its a

really potent med. I am

Meg

..

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