People with lupus often experience headaches, confusion, difficulty with concentrating, fatigue, and occasionally have seizures, strokes, or other signs of nervous system involvement. nervous system involvement in lupus is unclear and very controversial.

HOW DOES LUPUS AFFECT THE NERVOUS SYSTEM?

A number of possiblities have been suggested to explain how lupus may cause the many symptoms of nervous system involvement. Nerve tissue may bedamaged when antibodies attack nerve cells or blood vessels. The nervous sytem requires an uninterrrupted flow of blood to supply its tissues with oxygen and nutrients needed for normal functioning. Nutrients and oxygen are delivered thorugh blood vessels that feed the brain, spinal cord and nerves. If blood flow is slowed or interrupted, the cells of the nervous systgem are injured, unable to function normally, and symptoms develop. The symptoms develop accoridng to which area is involved and the extent of involvement. The nervous system is divided into three parts. The central nervous system, which consists of the brain and spinal cord. The peripheral nervous system is comrpised of nerve fibers that supply the skin and muscles with power needed for sensations and movement. The autonomic nervous system heps to regulate spinal, peripheral nerves and innervates the internal organs. Its role in lupus is poorly defined.

SYMPTOMS OF CENTRAL NERVOUS SYSTEM LUPUS

Central nervous system (CNS) represents inflammation of the blood vessels in the brain. it occurs in up to 10 percent of all lupus patients. With increases yearly. This is teh only form of CNS disease that is included in the American College of Rheumatology criteria for defining lupus. Characterized by high fevers, seiaures, psychosis, and meningitis-like stiffness of the nex, it can rapidly progress to stupor and coma if not aggressively managed. CNS vasculitis is the most serious form of lupus and usually requris hospitalization and high doses of orticosteroids. Infection should be ruled out before treatment is initiated. Seizures occur when injured or scarred brain tissue becomes the focus of abnormal electrical discharges. They may be a one-time occurrence or a persistent problem. Anti-convolsant meds are used to prevent seizures by controlling the brain's abnormal electrical discharges.

At some point during the course of lupus up to 50% of 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 lupus. These symptoms may be clearly documented by neuropsycholgoical testing, and a newer neurodiagnostic test called positron emission tomography scan shows reproducible blood flow abnormalities. The reason for these symptoms is not known but it may have something to do with changes in how a group of chemicals known as cytokines are handled or may be relatd to certain parts of the brain not getting enough oxygen. Antimalrials and/or steroids may be useful, but management of cognitive dysfunciton is often frustrating and currently no optimal therapy is available.

People with lupus often experience headaches which are unrelated to lupus. Approximately 20 percent of patients with lupus experience severe headaches which are related to the disease and are known as "lupus headaches." This phenomenon is similar to migraine and may be seen more often in people who also have Raynaud's phenomenon. PET scans indicate abnormalities in blood vessel tone or the ability of a vessel to dilate or constrict.

One-third of all people with lupus have a falst positive syphilis test, a positive anticardioplipin antibody or prolonged clotting time called PTT. This is known as the lupus anticoagulant or the antiphopholipid antibody. One-third of these patients will develop blood clots in various parts of the body. These patients have the antiphospholipid syndrome. When a blood clot develops in the nervous system, it can cause a stroke. A stroke is managed with blood thinning medications such as low dose aspirin, coumadin or heparin.

Patients with a history of stroke or vasculitis experience damage to the brain that is repaired by scar tissue. This results in seizures as well as varying degrees of difficulty with muscular movement, memory, concentration and orientation. These patients have organic brain syndrome and usually show no evidence of lupus activity in the blood or spinal fluid. Steroids make symptoms worse. Organic brain syndrome is treated with emotional support.

Up to 20 percent of people with lupus have a simultaneous fibromyalgia syndorme manifested by tender points and increased pain in soft tissues. In addition, patients may experience cognitive dysfunction, decreased ability to concentrate, difficulty sleeping and lack of stamina. This syndrome is treated with anti-depressants, counseling and physical therapy if needed.

Medications used to treat lupus can cause side effects that are similar to the symptoms of central nervous system lupus. These included nonsteroidal anti-inflammatory drugs which occasionally cause headaches dizziness, and, although rarely, meningitis-like symptoms. Anti-malarials in very high doses may cause psychosis. Corticosteroids are associated with agitation, confusion, moods swings, psychosis, depression, and in highg doses, seizures. Withdrawal from sterois can lead to fatigue, aching, weakness, or seizures. Anti-hypertensive medications may be associated with loss of libido or depression.

SYMPTOMS OF PERIPHERAL NERVOUS SYSTEM LUPUS

In peripheral nervous system lupus, a variety of symptoms may occur depending on which are involved. Involvement of the cranial nerves can cause visual disturbances, facial pain, drooping of the eyelid(s), ringing in the ear(s), dizziness. Inflammation of the blood vessels supplying the peripheral nerves can lead to symptoms of numbess or tingling in the arms or legs. Occasionally, loss of sensation or muscular weakenss in extremities (e.g. carpal tunnel syndrome) can occur. These symptoms may be due to conditions other than lupus. Electircal studies such as electromyogram and nerve conduction tests are usually helpful in determining if symptoms are due to some other cause.

HOW YOUR DOCTOR EVALUATES NERVOUS SYSTEM SYMPTOMS

If you have any nervous system symptoms, it is important for your doctor to know. The cause of your symptoms may be due to a condition other than lupus, a medication or a particular aspect of your life style. The workup consists of an interview with your doctor, a physica exam and lab work including a blood chemistry panel, complete blood count, and urinalysis. Diagnosis is difficult as there is not one specific diagnostic test to detect nervous system involvement in lupus. Diagnostic tests such as a sed rate, ANA, anti-dna, anti-ribosomal P antibodies and complement may be useful in determining nervous system involvement. Neurodiagnostic tests currently available include CP and MRI brain scans, brain waves, EEG, and spinal taps. PET scans are only available at a few hospitals. Spinal fluid may be examined for cells, protein components, and anti-neuronal antibodies. Neuropsychologic tests may be helpful in patients with cognitive dysfunction.

Treatment of nervous system lupus depends upon its source. Treatment may include steroids, immunosuppressants, blood thinnners, antibiodics, anti-convulsants, anti-depressans, beta-blockers, calcium-channel blockers and for some counseling or surgery. If any diagnostic difficulties afre evident, a rheum and/or neurologist should be involved in the case.







I GOT MY BORDER BACKGROUND SET FROM: