Background Neuropsychiatric symptoms of systemic lupus erythematosus (SLE) are one of the more common features and are the least understood.
Objectives To clarify the association of clinical manifestations and instrumental investigation findings in children with neurolupus.
Methods 20 children (aged 5–15 years) that met 4 or more ARA criteria of SLE were examened. Investigations included immune system changes indicating increased lupus activity, lupus anticoagulant, anticardiolipin antibodies by ELISA, electroencephalogram (EEG), in 10 patients magnetic resonance imaging (MRI).
Results The clinical manifestations of neurolupus were transient ischaemic attack (2), epilepsy (3), chorea (1), coordination disturbance (4), low extremity paresis (1). Eighteen children demonstrated psychiatric disturbances (psychosis, hysteria, fobia, anorexia, behavioural abnormalities). In all 20 children intensity of neuropsychiatric symptoms correlated with lupus activity. The most severe neuropsychiatric clinical manifestations were associated with the presence antiphospholipid antibodies. Instrumental assessment revealed pathologic abnormalities in both: children with subtle clinical symptoms and children with severe brain damage. EEG demonstrated diffuse abnormalities in 12 patients, epilepsy in 3, but not sensitive enough for diagnosis. MRI visualised diffuse and focal changes in 10 children: widening subarachnoid space and cortex atrophy.
Conclusion MRI can visualise diffuse and focal changes even in children with no history of overd symptoms of neurolupus and seems to be of real help in diagnosis. Antiphospholipid antibodies appeared to be the laboratory parameter most frequently relied apon in the diagnosis of neuropsychiatric SLE and in decision regarding treatment.
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