Neuropsychiatric Lupus in clinical practice

Alessi, Helena; Dutra, Lívia Almeida; Neto, Pedro Braga; Pedroso, José Luiz; Toso, Fabio Fieni; Kayser, Cristiane; Barsottini, Orlando Graziani Póvoas

doi:10.1590/0004-282x20160150

Cited by 14 publications

(18 citation statements)

References 60 publications

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“…The prognosis of patients with major NPSLE manifestations is less optimistic (19). Coma, stroke, and status epilepticus are poor prognostic signs; aggressive evaluation and treatment are needed to prevent death or residual neurologic damage.…”

Section: Severity and Prognosis Of Npslementioning

confidence: 99%

Neuropsychiatric Lupus Erythematosus: Future Directions and Challenges; a Systematic Review and Survey

Yong-wen

Han

Chu

2020

Clinics

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and China National Knowledge Internet (http://www.cnki.net)) were included. In total, 284 original case reports and 24 unpublished cases were collected, and clinical parameters were analyzed. An attempt was made to develop a set of simplified diagnostic criteria for NPSLE based on cases described in the survey and literature; moreover, and pathophysiology and management guidelines were studied. The incidence rate of NPSLE was estimated to be 12.4% of SLE patients in China. A total of 408 NPSLE patients had 652 NP events, of which 91.2% affected the central nervous system and 8.8% affected the peripheral nervous system. Five signs (manifestations, disease activity, antibodies, thrombosis, and skin lesions) showed that negative and positive predictive values were more than 70%, included in the diagnostic criteria. The specificity, accuracy, and positive predictive value (PPV) of the revised diagnostic criteria were significantly higher than those of the American College of Rheumatology (ACR) criteria (w2=13.642, 15.591, 65.010, po0.001). The area under the curve (AUC) for revised diagnostic criteria was 0.962 (standard error=0.015, 95% confidence intervals [CI] =0.933-0.990), while the AUC for the ACR criteria was 0.900 (standard error=0.024, 95% CI=0.853-0.946). The AUC for the revised diagnostic criteria was different from that for the ACR criteria (Z=2.19, po0.05). Understanding the pathophysiologic mechanisms leading to NPSLE is essential for the evaluation and design of effective interventions. The set of diagnostic criteria proposed here represents a simplified, reliable, and costeffective approach used to diagnose NPSLE. The revised diagnostic criteria may improve the accuracy rate for diagnosing NPSLE compared to the ACR criteria.

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Section: Severity and Prognosis Of Npslementioning

confidence: 99%

Neuropsychiatric Lupus Erythematosus: Future Directions and Challenges; a Systematic Review and Survey

Yong-wen

Han

Chu

2020

Clinics

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“…Las convulsiones tónico-clónicas generalizadas ocurren el 67-88% de los casos, resuelven espontáneamente en el 76% de los casos, y suelen ser aisladas o recurrir durante el primer año. 1,6 Estas pueden ser explicadas debido a isquemia cerebral por vasculitis, unión de antiCL, anti ribosomales (anti-P) y anti-Sm al tejido cerebral, complicaciones como trombosis venosas o Síndrome de Encefalopatía Posterior Reversible, entre otros. 1,2,7 Las recurrencias ocurren con mayor frecuencia, en pacientes con aFL, evento cerebrovascular e índice de actividad elevada.…”

Section: Discussionunclassified

“…1,6 Estas pueden ser explicadas debido a isquemia cerebral por vasculitis, unión de antiCL, anti ribosomales (anti-P) y anti-Sm al tejido cerebral, complicaciones como trombosis venosas o Síndrome de Encefalopatía Posterior Reversible, entre otros. 1,2,7 Las recurrencias ocurren con mayor frecuencia, en pacientes con aFL, evento cerebrovascular e índice de actividad elevada. 2 Los episodios psicóticos, se han relacionado con la presencia de anti-P; aunque la psicosis inducida por altas dosis de glucocorticoides no es infrecuente en la enfermedad.…”

Section: Discussionunclassified

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Estatus epiléptico no convulsivo por Lupus Eritematoso Sistémico y Síndrome Antifosfolípido.

Piana-Castillo¹,

Zúñiga-Vera²

2021

revecuatneurol

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“…The neurologic manifestations of SLE may present as a wide spectrum of cognitive, behavioral, sensory, and motor changes, but nearly half of pediatric patients in the acute phase of SLE will develop some degree of neurologic dysfunction. 10 The underlying pathophysiology is multifactorial, and immune mediated alteration of myelin, microvascular thrombosis, and cytokine-induced cerebral inflammation are all suspected to contribute to the neurologic sequelae. 11 Although MRI may reveal white matter changes, cerebral atrophy, and evidence of microthrombi, the lack of a standard pattern on imaging makes screening new patients with SLE less useful.…”

Section: Dr Sarah Risen Pediatric Neurologymentioning

confidence: 99%

From Telemedicine to the ICU—Fever and Rash in a 9-Year-Old Girl

et al. 2021

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A 9-year-old girl presented to her primary care pediatrician via telemedicine during the initial months of the coronavirus disease 2019 pandemic because of 4 days of warmth perceived by her mother, decreased energy, and a new rash on her upper extremities. After 10 additional days of documented fever >38°C, worsening fatigue, and 1 day of nausea, vomiting, and diarrhea, she was allowed to schedule an in-person visit with her pediatrician after testing negative for severe acute respiratory syndrome coronavirus 2. She appeared ill on arrival to clinic, and her pediatrician recommended evaluation in an emergency department. Her initial laboratory testing revealed nonspecific elevation in several inflammatory markers and leukopenia, and she responded well to intravenous hydration. Over the next 2 weeks, her fever persisted, constitutional symptoms worsened, and she developed progressively painful cervical lymphadenopathy and pancytopenia. She was evaluated in clinic by several specialists and eventually was urged to present to the emergency department again, at which time she was admitted to the PICU. After consulting additional specialists and waiting for laboratory results, the team reached a definitive diagnosis and initiated therapy; however, she experienced rapid clinical decline shortly thereafter. The specialists who assisted with identification of the underlying etiology of her symptoms were able to work together to manage the subsequent complications.

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Neuropsychiatric Lupus in clinical practice

Cited by 14 publications

References 60 publications

Neuropsychiatric Lupus Erythematosus: Future Directions and Challenges; a Systematic Review and Survey

Neuropsychiatric Lupus Erythematosus: Future Directions and Challenges; a Systematic Review and Survey

Estatus epiléptico no convulsivo por Lupus Eritematoso Sistémico y Síndrome Antifosfolípido.

From Telemedicine to the ICU—Fever and Rash in a 9-Year-Old Girl

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