Neurometabolite Markers of Cerebral Injury in the Antiphospholipid Antibody Syndrome of Systemic Lupus Erythematosus

Sabet, Arman; Sibbitt, Wilmer L.; Stidley, Christine A.; Danska, Jeff; Brooks, William M.

doi:10.1161/01.str.29.11.2254

Cited by 85 publications

(65 citation statements)

References 33 publications

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“…A number of studies utilized magnetic resonance spectroscopy (MRS) as a measure of neuronal metabolism to more clearly characterize cerebral disease in SLE from other autoimmune diseases (Friedman et al 1998;Lim et al 2000;Peterson et al 2005;Sabet et al 1998). Nacetyl aspartate (NAA), a marker of axonal loss, was reduced in normal appearing white and gray matter, as well as in lesions (Peterson et al 2005).…”

Section: Brain Imaging Findings In Slementioning

confidence: 99%

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

et al. 2008

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In this manuscript, we review literature describing the neuropsychological and brain imaging characteristics of systemic lupus erythematosus (SLE) patients. The findings are compared and contrasted with multiple sclerosis (MS) studies, revealing similarities and differences of interest to clinicians and researchers. While cognitive impairment is somewhat less common in SLE than MS, the diseases share a similar cognitive profile with deficits most prominent on tests emphasizing the speed of information processing, working memory, and visual/spatial learning, and memory. In early or more mildly affected patients, diffuse white matter damage, which may not be apparent on conventional brain imaging, plays a major role in clinical presentation and cognitive testing. The causes of white matter damage are very different, however, and in later stages of the disease MS and SLE appear to give rise to different forms of cerebral pathology. MS may be characterized by increasing brain atrophy affecting especially the cortical and deep gray matter, at least after conversion to secondary progressive course. There is less evidence for neurodegenerative changes in SLE, but patients are increasingly at risk for cerebrovascular disease. We conclude by offering some suggestions for future clinical and imaging research. KeywordsSystemic lupus erythematosus; Multiple sclerosis; Cognition; Memory; Processing speed; MRI; Effect size Systemic lupus erythematosus (SLE) is a relapsing-remitting autoimmune disease with wide ranging organ involvement and clinical symptoms varying from mild and transient symptoms to death. Cognitive impairment is reported in SLE, even among those patients without documented or overt signs of central nervous system (CNS) involvement. Presumably, cognitive disorder is the result of underlying brain disease although the precise mechanisms remain to be elucidated. The prevalence and degree of cognitive impairment is also uncertain.In this article we will endeavor to evaluate the evidence for neuropsychological impairment in SLE, and to compare the findings with that of MS, another immunological disorder whose symptoms wax and wane and which affects women more than men. Unlike SLE, MS is a disease that always impacts the CNS, and the causes of cognitive disorder in MS are better understood.

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Section: Brain Imaging Findings In Slementioning

confidence: 99%

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

et al. 2008

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“…In 10 papers, T1, T2 and fluid-attenuated inversion recovery (FLAIR) were used; 20 25 and MRI, SPECT. 42 Five studies were undertaken in the United States, 21,36,41,44,45 three in Japan, 34,35,46 two in South Korea, 25,32 two from the Netherlands 20,24 and two from Brazil. 38,39 Single studies were undertaken in Turkey, 37 China, 27 Poland, 40 Canada, 42 Germany 43 and Spain, 33 while one study was conducted in both Spain and the United Kingdom.…”

Section: Study Quality Assessmentmentioning

confidence: 99%

Comparison of structural magnetic resonance imaging findings between neuropsychiatric systemic lupus erythematosus and systemic lupus erythematosus patients: A systematic review and meta-analysis

Amin

Kaul

Smith

et al. 2017

Rheumatology Practice and Research

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Introduction: Neuropsychiatric systemic lupus erythematosus is often clinically challenging to diagnose, treat and monitor. Although brain magnetic resonance imaging is frequently performed before lumbar puncture in neuropsychiatric systemic lupus erythematosus, it is not clear from the literature whether specific brain magnetic resonance imaging findings are associated with distinct clinical features of neuropsychiatric systemic lupus erythematosus. Methods: We conducted a systematic review and meta-analysis on published studies of neuropsychiatric systemic lupus erythematosus including brain magnetic resonance imaging and the 1999 American College of Rheumatology-defined clinical neuropsychiatric systemic lupus erythematosus syndromes to determine their relationship. Pooled prevalence and risk ratio for distinct neuropsychiatric systemic lupus erythematosus associations were determined with 95% confidence intervals. Results: Of 821 studies screened, 21 fulfilled inclusion criteria. A total of 818 participants were evaluated (91% female) with 1064 neuropsychiatric systemic lupus erythematosus episodes assessed. Neuropsychiatric systemic lupus erythematosus features included headache (24%), seizures (19%), cerebrovascular disease (18%), cognitive dysfunction (15%) and acute confusional state (14%). Normal magnetic resonance imaging was significant for anxiety disorder (risk ratio: 9.00; 95% confidence interval: 2.40, 33.79), autonomic disorder (risk ratio: 7.00; 95% confidence interval: 0.51, 96.06) and plexopathy (risk ratio: 5.00; 95% confidence interval: 0.81, 31.00). Highest risk ratio of neuropsychiatric systemic lupus erythematosus syndrome with abnormal magnetic resonance imaging was observed for cerebrovascular disease (risk ratio: 0.15; 95% confidence interval: 0.10, 0.24) and demyelination (risk ratio: 0.11; 95% confidence interval: 0.02, 0.72). Conclusion: Normal magnetic resonance imaging in neuropsychiatric systemic lupus erythematosus was the most significant correlate from our meta-analysis for psychological symptoms including anxiety and peripheral nerve features of autonomic disorder and plexopathy. The main abnormal brain magnetic resonance imaging correlates included cerebrovascular disease and demyelination. Brain magnetic resonance imaging correlates poorly with neuropsychiatric systemic lupus erythematosus features, and specific clinical symptoms should be the main determinants of performing magnetic resonance imaging rather than presence of neuropsychiatric systemic lupus erythematosus per se.

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“…Головные боли, включая мигрень, и ишемические инсуль-ты являются главными неврологическими про-явлениями АФС [15,19]. Были изучены и дока-заны влияния таких факторов, как пол, наличие или отсутствие мигрени в семейном анамнезе, использование пероральных контрацептивов, вы-сокое артериальное давление, сахарный диабет, заболевания сердца и курение, на возникновение неврологической симптоматики при АФС [36,46]. Наличие аФЛ -доказанный фактор риска развития инсультов, при этом исследование плаз-менного звена гемостаза необходимо проводить всем молодым людям с мигренью и пациентам до 50 лет с инсультом в анамнезе.…”

Section: поражение центральной нервной системыunclassified

Ischemic and nonischemic manifestations of antiphospholipid syndrome

2015

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Казанский государственный медицинский университетРеферат Гиперкоагуляционный синдром -актуальная мультидисциплинарная проблема последнего десятилетия. Нару-шения гемостаза, приводящие к гиперкоагуляционному синдрому, проявляются различными заболеваниями в нев-рологии, акушерстве, ревматологии, хирургии, в том числе у беременных. Антифосфолипидный синдром является наиболее часто встречающейся формой гиперкоагуляционного синдрома и чаще всего развивается в молодом возрас-те, у детей и даже новорождённых, причём у лиц женского пола в 5 раз чаще, чем у лиц мужского пола. Причины и механизм возникновения антифосфолипидного синдрома остаются не до конца ясными. Особо актуальна эта проблема для беременных. Почти в трети наблюдений привычное невынашивание беременности обусловлено син-тезом антифосфолипидных антител. Основные проявления этой патологии -тромботические осложнения во время беременности и в послеродовом периоде, в том числе церебральная патология как у матери, так и у ребёнка. Пора-жение центральной нервной системы при данном синдроме может иметь как ишемический (нарушение мозгового кровообращения), так и неишемический (первичное иммуноопосредованное повреждение нервной системы) генез. Спектр неврологических нарушений, связанных с антифосфолипидным синдромом, весьма широк: от нарушений мозгового кровообращения, мигрени и мигренозных головных болей до хореи и эпилептических припадков. Голов-ные боли бывают наиболее частым поводом обращения беременных к неврологу. Беременность на фоне высоких титров антифосфолипидных антител часто разрешается мертворождением на раннем этапе гестации. У детей, рож-дённых от матерей с антифосфолипидным синдромом, в 20% случаев развивается неврологическая симптоматика ишемического и неишемического генеза. Таким образом, антифосфолипидный синдром требует особого внимания для своевременной и ранней диагностики, особенно у планирующих беременность женщин и беременных, для про-филактики тяжёлых осложнений, как у самой роженицы, так и у плода.Ключевые слова: гиперкоагуляционный синдром, антифосфолипидный синдром, антифосфолипидные анти-тела, неврологические проявления, центральная нервная система, клинические проявления. ISCHEMIC AND NONISCHEMIC MANIFESTATIONS OF ANTIPHOSPHOLIPID SYNDROME S.I. Tukhfatullina, D.D. Gaynetdinova Kazan State Medical University, Kazan, RussiaHypercoagulability syndrome is an actual multidisciplinary problem of the last decade. Blood clotting disorders leading to hypercoagulability syndrome may manifest as different diseases in neurology, obstetrics, rheumatology, surgery, including diseases of pregnancy. Antiphospholipid syndrome is the most common form of hypercoagulability syndrome, which often develops at a young age, in children and even infants, with female-male ratio of 5. Causes and pathogenesis of antiphospholipid syndrome are not fully clear. This problem is especially important for pregnant women. Almost a third of refractory pregnancy losses are associated with antiphospholipid antibodies formation. Main manifestations of this condition include ...

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Neurometabolite Markers of Cerebral Injury in the Antiphospholipid Antibody Syndrome of Systemic Lupus Erythematosus

Cited by 85 publications

References 33 publications

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

Neuropsychological Impairment in Systemic Lupus Erythematosus: A Comparison with Multiple Sclerosis

Comparison of structural magnetic resonance imaging findings between neuropsychiatric systemic lupus erythematosus and systemic lupus erythematosus patients: A systematic review and meta-analysis

Ischemic and nonischemic manifestations of antiphospholipid syndrome

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