Antineuronal antibodies and electroneurophysiological studies in pediatric patients with neuropsychiatric systemic lupus erythematosus

Abstract

Neuropsychiatric systemic lupus erythematosus (NPSLE) is one of the most difficult manifestations of lupus to diagnose. Measurement of serum brain autoantibodies and assessment of cognitive function by electroneurophysiological studies (electroencephalogram (EEG) and P300) have contributed to an earlier and a more specific diagnosis of NPSLE. Thus, we were stimulated to assess the value of serum antineuronal antibodies and electroneurophysiological studies in diagnosis and early prediction of NPSLE. To investigate this, assessment of serum antineuronal antibodies and cognitive function (clinically and by electroneurophysiological studies) was done in 30 lupus patients [14 (46.7%) with and 16 (53.3%) without clinical evidence of NPSLE] in comparison with 30 healthy matched subjects. Patients without clinical evidence of NPSLE were followed-up clinically by monthly neuropsychiatric evaluation for 18 months. Seropositivity for antineuronal antibodies and abnormalities of EEG and P300 (prolonged latency and/or low amplitude) were found in 60%, 50% and 70%, respectively of lupus patients. During follow-up, 8 out of the 16 patients without clinical evidence of NPSLE developed such evidence [six (75%) had antineuronal seropositivity, five (62.5%) had abnormal EEG, six (75%) had P300 abnormalities and all had at least one abnormal result of these parameters at the time of initial evaluation before clinical presentation of NPSLE]. In conclusion, serum antineuronal antibodies and electroneurophysiological studies may be reliable parameters for diagnosis and early prediction of NPSLE, especially when combined together, before clinical manifestations ensue. Further studies on a large scale are warranted to evaluate the predictive value of these parameters in NPSLE.

Neuropsychiatric manifestations and associated autoantibodies in systemic lupus erythematosus patients from Western India

“…The same can be said about anti-neuronal nuclear antibodies (ANNA). How et al [17][18][19][20] had reported that ANNA antibodies were strongly associated with NP manifestations in SLE. In our study, the incidence of true anti-neuronal antibodies after absorption of ANNA showed no statistically significant difference the incidence of Rib-P antibodies between NPSLE and SLE patients without neuropsychiatric involvement.…”

P300 as an auxiliary method in clinical practice: A review of literature

“…Moreover, with P300 testing, damage of cognitive functions resulting from taking different medicines, especially antiepileptic drugs, can also be monitored (61)(62)(63). Additionally, P300 characteristics help diagnosing cognitive damage resulting from systemic diseases, such as anaemia, uremia (renal insufficiency), hepatic encephalopathy, systemic lupus erythematosus, diabetes mellitus, hypothyreosis, as well as COPD (64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76). Moreover, cognitive function damage in patients with HIV-1 neurologically asymptomatic seropositive can be assessed with P300 testing (78).…”

“…Cognitive damage in some systemic diseases can be assessed with CEP P300 (64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78). Improvements in the treatment and recovery can be followed in the same way.…”

Biomarkers for CNS Involvement in Pediatric Lupus

“…Subsequent studies determining their clinical utility to detect cNPSLE have, however, been mixed; some studies report that serum antineuronal antibodies in adults with lupus are neither sensitive nor specific [84,85], making them poor biomarkers in either the detection of disease or in confirming that disease is primary cNPSLE. In the few studies in pediatrics, there are also mixed findings in regards to an association between cNPSLE and serum antineuronal antibodies [86–88], but little data concerning CSF antibodies. In general, it appears that CSF antineuronal antibodies have improved sensitivity and specificity compared with serum antibodies and there may be little utility in these as a marker from peripheral blood [82,89].…”