Neuropsychiatric Lupus: Classification Criteria in Neuroimaging Studies

Abstract

Neuropsychiatric manifestations occur with frequency in systemic lupus erythematosus (NPSLE) 1 . However, attribution of these manifestations to SLE are considered one of the greatest challenges among behavioural and neuroimaging studies 2 . There still seems to be a long way towards a comprehension of the neuropsychiatric (NP) syndromes in SLE, even though the American College of Rheumatology (ACR) has started to facilitate and to enhance clinical research by developing standards for terminology, definitions and some assessment methods to describe 19 NP syndromes in SLE 3 . Nevertheless, it is still quite a challenge to differentiate the NPSLE from the non-NPSLE, mainly due to the heterogeneity of assessments even after ACR recommendations, not sufficiently reported or unreported methods to classify each syndrome. American College of Rheumatology proposed nomenclature for NPSLE is mainly intended for didactic purposes, clinical research and reporting rather than clinical setting 3 . The general SLE is a recurrent, chronic, systemic, autoimmune disease which causes morbidity in between 161,000 to 322,000 adults 4 . The NPSLE is a set of neurologic syndromes of the central and peripheral nervous system and/or of psychiatric syndromes observed in ABSTRACT: This systematic review described the criteria and main evaluations methods procedures used to classify neuropsychiatric systemic lupus erythematosus (NPSLE) patients. Also, within the evaluations methods, this review aimed to identify the main contributions of neuropsychological measurements in neuroimaging studies. A search was conducted in PubMed, EMBASE and SCOPUS databases with the terms related to neuropsychiatric syndromes, systemic lupus erythematosus, and neuroimaging techniques. Sixty-six abstracts were found; only 20 were completely analyzed and included. Results indicated that the 1999 American College of Rheumatology (ACR) criteria is the most used to classify NPSLE samples together with laboratorial, cognitive, neurological and psychiatric assessment procedures. However, the recommended ACR assessment procedures to classify NPSLE patients are being used incompletely, especially the neuropsychological batteries. Neuropsychological instruments and neuroimaging techniques have been used mostly to characterize NPSLE samples, instead of contributing to their classifications. The most described syndromes in neuroimaging studies have been seizure/cerebrovascular disease followed by cognitive dysfunctions as well as headache disorder. REVIEW ARTICLEpatients with SLE in which other causes are excluded 3,5,6 , by clinical, laboratory, neuroimaging and neuropsychological tests 3 . These syndromes include twelve manifestations from the central nervous system, as follows, "aseptic meningitis, cerebrovascular disease, demyelinating syndrome, headache (including migraine and benign intracranial hypertension), movement disorder (chorea), myelopathy, seizure disorders, acute confusional state, anxiety disorder, cognitive dysfunction, mood disorder, psychosis" and ...

Nervous System Disease in Systemic Lupus Erythematosus: Current Status and Future Directions

“…Given this lack of correlation between clinical and structural abnormalities, imaging modalities that characterize functional properties of the underlying pathology are of interest. Examples include MRI diffusion‐weighted imaging (DWI), magnetization transfer imaging (MTI), and radionuclide imaging such as positron emission computed tomography (PET) and single‐photon emission tomography (SPECT) .…”

Magnetic resonance imaging (MRI) brain abnormalities of neuropsychiatric systemic lupus erythematosus patients in Mansoura city: Relation to disease activity

“…Although arthritis and skin rash are common presenting features, involvement of the central nervous system (CNS) is often seen. Neuropsychiatric systemic lupus erythematosus (NPSLE) is a complex neurological disorder and is one of the most important manifestations of SLE that includes neurological syndromes of the central, peripheral, and autonomic nervous system, as well as psychiatric disorders [1][2][3]. The frequency of NPSLE has been reported in many previous Egyptian studies to range from 23.3% to 35%.…”

“…These manifestations can be the presenting manifestation of SLE or occur at any time during the disease. Controversy exists concerning the factors responsible for psychiatric manifestations in these patients, which have been attributed to pathophysiology of the disease and psychosocial stressors related to chronic disease [2,3,14,15].…”

Temporal And Spatial Changes In Cerebral Blood Flow In Neuropsychiatric Systemic Lupus Erythematosus: A Subtraction Brain Spect Study.

“…Although neuropsychiatric (NP) manifestations are frequent, they still constitute a challenge for behavioral and neuroimaging studies. [3] NP manifestations can precede the onset of SLE or occur at any time during its course [4], and can be single or multiple neurological events in the same individual. [5] The two most important processes under the etiological aspect of NPSLE are changes in rCBF due to the occlusion of vessels that irrigate the nervous tissue, or interactions of autoantibodies with neurons and glia.…”