Studies have revealed that systemic lupus erythematosus may affect the nervous system. Lupus patients may experience confusion, difficulty concentrating, headaches, fatigue, strokes, or other signs of nervous system involvement.
Studies suggest that nerve tissue can be damaged when antibodies attack nerve cells or blood vessels. It is known that the nervous system requires an uninterrupted flow of blood, which is necessary to supply its tissues with oxygen and nutrients. When this blood flow is slowed or interrupted, nerve cells cannot function normally and symptoms develop. The symptoms vary, depending on where the tissue injury is located. It is good to know that the nervous system consists of three parts. The central nervous system comprises the brain and spinal cord, the nerve fibers of the peripheral nervous system that have the function of providing the skin and muscles with the necessary power for sensation and movement, and the third part is the autonomic nervous system. It has the function of regulating spinal cords, peripheral nerves and innervating internal organs.
An inflammation of the blood vessels in the brain that occurs in 10% of all lupus patients is called central nervous system vasculitis. This disease usually requires hospitalization and high doses of corticosteroids. Some of the symptoms that appear are high fever, seizures, psychosis, and a stiff neck similar to meningitis. If not aggressively treated, central nervous system vasculitis rapidly progresses to a stupor and coma.
People with mild to moderate systemic lupus erythematosus may experience cognitive dysfunction. That is a group of symptoms that appear in around 50% of these patients, and we can mention here fatigue, memory impairment, feelings of confusion and difficulty expressing thoughts. By taking a neuropsychological test or a test called a positron emission tomography, these symptoms can be clearly documented. It is known that cognitive dysfunction can come and go on its own, but there is no optimal therapy available. In addition, it is not known what is the reason for the symptoms that appear. Dealing with cognitive dysfunction is frustrating, and coaching a person in developing coping skills can often be helpful.
About 20% of patients who have systemic lupus erythematosus experience lupus headache. This is manifested by severe headaches, is similar to migraine and can often be seen in people who also have Raynaud’s phenomenon. The same treatment used for tension or migraine headaches, and sometimes corticosteroids, is useful as a treatment.
It is known that about one third of lupus patients may have a false positive syphilis test, a positive anticardiolipin antibody, or a prolonged clotting time test. This is known as a lupus anticoagulant or antiphospholipid antibody. About 1/9 of patients who have lupus will develop blood clots in various parts of the body, called antiphospholipid syndrome. If blood clots appear in the nervous system, they can cause a stroke, and the symptoms of a stroke include painless pain. appearance of neurological deficits without any signs of active lupus. If a stroke occurs, anticoagulant medications should be taken. We can mention here low-dose aspirin, coumadin or heparin.
Among patients who have systemic lupus erythematosus there is a percentage of 20% who also have fibromyalgia syndrome. These patients experience increased soft tissue pain, tender points, and additionally cognitive dysfunction, decreased ability to concentrate, lack of energy, and difficulty sleeping. As treatment, we can mention antidepressants, counseling and physiotherapy if necessary.
It was found that drugs used to treat systemic lupus erythematosus can develop symptoms like those of central nervous system lupus; antimalarial psychosis can occur at very high doses; headache, dizziness and, rarely, meningitis-like symptoms can be caused by non-steroidal anti-inflammatory drugs. Also if a patient uses corticosteroids, mood swings, psychosis, depression, agitation, confusion may occur, seizures may occur if high doses are taken, and antihypertensive drugs may be associated with depression or loss of libido.
One study found that people who have lupus and Sjogren’s syndrome may be predisposed to developing vasculitis or cognitive dysfunction. Sometimes circulating proteins in the blood can lead to cryoglobulinemia or hyperviscosity syndrome. Plasmapheresis or filtering of the blood can alleviate these complications. Sometimes pronounced decreases in platelet counts can be associated with bleeding. C can clot, and people with lupus, idiopathic thrombocytopenic purpura, and kidney failure can bleed.
In peripheral nervous system lupus, involvement of the cranial nerves can cause visual disturbances, drooping eyelid(s), ringing in the ears, facial pain, and dizziness. Symptoms of numbness or tingling in the arms or legs may appear if there is inflammation of the blood vessels that supply the peripheral nerves. Symptoms may also occur due to conditions other than lupus, and EMG and nerve conduction tests are often helpful in determining whether symptoms are due to something else. Corticosteroids are used to treat inflammation of the peripheral nerves.
It is important that your doctor knows if you are experiencing nervous system symptoms. These symptoms may be caused by lupus, a medication, or a particular aspect of your life. The doctor will ask about the symptoms you are experiencing, perform a physical exam, and perform a laboratory evaluation that includes a blood chemistry panel, complete blood count, and urinalysis. In addition, diagnostic tests such as sedimentation rate, ANA, anti-DNA, anti-ribosomal P antibodies, and complement may be helpful in determining nervous system involvement. Spinal taps.In some hospitals, PET scans may also be performed.Cerebrospinal fluid may be examined for cells, protein components, and anti-neuronal antibodies. In patients with cognitive dysfunction, neuropsychological testing may be helpful.
Treatment for nervous system lupus depends on its origin and may include immunosuppressants, blood thinners, antibiotics, steroids, antidepressants, counseling, or surgery. If there are obvious diagnostic difficulties, a rheumatologist and/or neurologist should be involved in your care. It was found that for many people with lupus, the involvement of the nervous system is completely reversible.