Non-stroke neurological syndromes associated with antiphospholipid antibodies: evaluation of clinical and experimental studies

Abstract

Although many types of neurological disorders and events have been described in association with antiphospholipid antibodies (aPL) and the antiphospholipid syndrome (APS), only ischaemic stroke is reasonably well established and accepted as a diagnostic criterion for the syndrome. We propose to evaluate, classify and rank the association of other neurological manifestations as possible, probable, or definite according to the data available from clinical studies and animal models. By these criteria, none of the neurological disorders or events such as epilepsy, psychiatric disease, dementia, transverse myelitis, multiple sclerosis-like disease, chorea, migraine, Guillian-Barrè syndrome, and sensory-neural hearing loss, can be definitely associated with aPL or APS.

Clinical Characteristics of Stroke Patients with Antiphospholipid Antibodies

“…In the present study, stroke patients in the aPL-positive group had more frequent neurological complications such as epilepsy, myelitis or migraine than those in the aPL-negative group [22, 23]. The association of migraine and APS is controversial, with widely varying results from different series.…”

Generalized chorea as the first presentation of systemic lupus erythematosus: case report and review of literature

“…However, NLSLE pathogenesis is still controversial, and probably involve immune mediated as well as ischemic mechanisms. 16,17 In our patient, the old and new ischemic changes noted on MRI are consistent with an ischemic vascular process, but these can't be explained simply by the procoagulant effects of APL antibodies causing thrombotic occlusion of capillaries. It was hypothesized that an immune process may be responsible for a direct injury to the blood-brain barrier allowing autoantibodies to enter the nervous system and attack neurons involved in nigro-striatal pathways.…”

“…It was hypothesized that an immune process may be responsible for a direct injury to the blood-brain barrier allowing autoantibodies to enter the nervous system and attack neurons involved in nigro-striatal pathways. [16][17][18][19] One meta-analysis showed that NPSLE patients have higher serum levels of certain antibodies including anticardiolipin, lupus anticoagulant, anti-ribosomal P, and antineuronal antibodies when compared with SLE patients who have no neurological involvement. 20 Other secondary factors that also contribute to the pathogenesis include infections associated with immunosuppressive treatments, hypertension, and renal failure.…”

Diffusion tensor imaging in patients with obstetric antiphospholipid syndrome without neuropsychiatric symptoms

“…This is not the only mechanism, however, as psychiatric or neurologic manifestations emerge in APS patients without any evidence of brain vessel occlusions on CT or MRI [22][23][24][25][26]. Indeed, there were no signs of brain abnormalities on FLAIR or T1 images in our cohort, whereas significant differences in DTI-based indices between control and APS groups were observed.…”