A Study on Neuropsychiatric Lupus patients.

Seerala Boopathy, K (2008) A Study on Neuropsychiatric Lupus patients. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Neuropsychiatric systemic lupus erythematosus (NPSLE) could be defined as the neurologic syndromes of the central, peripheral and autonomic nervous system and the psychiatric syndromes observed in patients with SLE in which other causes have been excluded. Hebra and Kaposi in 1875 were the first to note central nervous involvement in lupus and while writing on the erythema group of skin diseases in 1885, Osler discussed cerebral changes in SLE and reported a patient with SLE and hemiplegia. Potential involvement of the nervous system by systemic lupus erythematosus (SLE) has been recognized ever since the multisystem nature of the disease first was appreciated. Clinical features include both neurologic (N) and psychiatric (P) manifestations, which may involve both the central and peripheral nervous systems. Although there have been significant advances in understanding some aspects of neuropsychiatric (NP) SLE in recent years, nervous system disease continues to pose diagnostic, therapeutic, and scientific challenges for physicians and researchers alike. AIMS AND OBJECTIVES : 1. To study the various neurological manifestations in patients with systemic lupus erythematosus. 2. To study the various psychiatric manifestations in patients with systemic lupus erythematosus. 3. To compare the neuropsychiatric manifestations between childhood and adult SLE patients. MATERIALS AND METHODS : One hundred consecutive patients (7 males, 93 females) with systemic lupus erythematosus who attended the Department of Rheumatology, Madras Medical College, Chennai were included as the study population. This is a prospective study done during November 2005-March2008. Inclusion Criteria: Patients who fulfilled 1997 Revised ACR Classification Criteria for systemic lupus erythematosus were included. Exclusion Criteria: 1. Patients with overlap syndrome were excluded. 2. Patients with history of head injury. 3. Patients with chronic renal failure. 4). Patients with alcoholism. All the selected patients were subjected to clinical examination including detailed neurological evaluation. The psychiatric evaluation was done with the help from Institute of Mental health, Madras Medical College. RESULTS : The clinical, laboratory and imaging profile of 100 patients who satisfied the 1997 revised ACR classification criteria for SLE were analyzed. The 100 patients were divided into as to whether they belong to childhood SLE or adult SLE. The age range was 3 years to 55 years. The maximum number of cases occurred in 20 to 35 years. The mean age of study group is 22.44 years and the mean age in patients with NPSLE is 24.10 years. The female to male ratio was 14:1.The mean duration of illness in patients with NPSLE is 3.74 years. Out of 56 patients with NP-SLE manifestations, 41 patients belong to adult group and 15 patients are children (Table 3, 4, 5). The most common manifestations in adults are seizures (39%), headache and CVA (26.8%). In childhood group, the most common manifestations are seizures (80%), headache(26.6%)and psychosis(26.6%).The analysis of the other manifestations showed that the renal involvement was seen in 23(41%) NP-SLE patients. CONCLUSION : There was a female predominance in the patients with neuropsychiatric manifestations due to systemic lupus erythematosus. The Neuropsychiatric manifestations were present in 56% of our study population. The CNS involvement was seen in 96.4% of patients with neuropsychiatric manifestations. The four common NP-SLE syndromes in adult patients were seizures, headache, mood disorder and cerebrovascular disease and in paediatric patients seizures, headache, cerebrovascular disease and psychosis. Out of 30 patients with renal involvement, 23 patients had neuropsychiatric manifestations. The APA positivity was seen in 46% of patients with NP-SLE syndromes. It was associated with cerebrovascular disease in twelve out of fourteen patients. Out of 28 patients with seizures, nine had APA positivity and six had abnormal MRI findings. The most common MRI finding was focal ischemic lesion in both adult and paediatric patients.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Neuropsychiatric Lupus ; patients.
Subjects: MEDICAL > Rheumatology
Depositing User: Subramani R
Date Deposited: 16 Aug 2017 00:47
Last Modified: 16 Aug 2017 06:55
URI: http://repository-tnmgrmu.ac.in/id/eprint/1828

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