Introduction

CNS lupus (also referred to as neuropsychiatric lupus erythematous)¹ with diffuse manifestation appears to be primarily caused by autoantibodies directed to neuronal cells or their products. These autoantibodies are hypothesized to affect neuronal function in a generalized manner. Studies suggest that increased levels of inflammatory cytokines, induction of nitric oxide production, oxidative stress, and excitatory amino acid toxicity also may contribute to diffuse CNS dysfunction in SLE. Patients with acute encephalopathy frequently demonstrate elevated levels of antineuronal antibodies or other evidence of autoantibody production in the cerebrospinal fluid. As in multiple sclerosis, elevated levels of IgG and oligoclonal bands are markers of abnormal autoantibody production within the CNS and are frequently present in CNS lupus with diffuse manifestations. In patients with diffuse CNS lupus who present with primarily psychiatric disease, serum antiribosomal P antibodies appear to be a helpful diagnostic marker.

CNS lupus with focal manifestations is most likely to be related to intravascular occlusion. Magnetic resonance imaging (MRI), which is much sensitive than computed tomography (CT) scanning, almost always shows abnormalities characteristics of ischemic damage in these patients. Furthermore, these patients frequently demonstrate significantly elevated serum levels of antiphospholipid antibodies, which are associated with intravascular occlusion. Less commonly, evidence of vasculitis is apparent.

This study aims to study the cognitive dysfunction and seizure in SLE.

1. ACR Ad Hoc Committee on Neuropsychiatric Lupus Nomenclature: The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes, Arthritis Rheum 42:599,1999.
2. Adapted from Arthritis and Rheumatism 2012; 64; 2677-86.
3. Ainiala H, Loukkola J, et al. the prevalence of neuropsychiatric syndrome in systemic lupus erythemato-sus. Neurology 2001; 57: 496-500.
4. Feinglass EJ, Arnett FC, Dorsch CA, et al. Neuropsychiatric manifestations of Systemic Lupus Eruthematosus: diagnosis, clinical spectrum, and relationship to other features of the disease. Medicine 1976; 55: 323-339.
5. JOHN G. HANLY, GRACE McCURDY, LISA FOUGERE. Neuropsychiatric Events in Systemic Lupus Erythematosus: Attribution and Clinical Significance. The Journal of Rheumatology 2004; 31:21 56-62.
6. Melanie J. Harrison, and Lisa D. Ravdin. Cognitive dysfunction in neuropsychiatric systemic lupus erythematosus. Current Opinion in Rheumatology 2002, 14:501-514.
7. BenchalakManeeton, NarongManeeton; Cognitive Deficit in Patients with Systemic Lupus Erythematosus. ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY (2010) 28: 77-83.
8. Elizabeth Kozora, 1 John G. Hanly, Cognitive Dysfunction in Systemic Lupus Erythematosus. Past, Present and Future; ARTHRITIS &RHEUMATISM Vol. 58, No. 11, November 2008, pp3286-3298.
9. Hanly JG, Cassell K, Fisk JD. Cognitive function in Systemic Lupus Erythema-tosus: results of a five-year prospective study. Arthritis rheum 1997;40:1542-43.
10. Hay EM, Huddy A, Black D, Mbaya P, Tomenson B, Bernstein RM, et al. prospective study of psychiatric disorder and cognitive function in Systemic Lupus Erythematosus. Ann Rheum Dis 1994; 53: 298-303.
11. Brey R, Holiday SL, Saklad AR. Neuropsychiatric Syndrome in Lupus: prevalence using standardized definitions. Neurology. 2002;58(8): 1214-1220.
12. Afeltra A, Garzia P, MitterhoferAP, Vadacca M, Galluzzo S Del Porto F, et al. Neuropsychiatric lupus syndrome. Neurology 2003; 61: 108-10.
13. Herranz MT, Rivier G, Khamashta MA, Blaser KU, Hughes GR. Association between antiphospholipid antibodies and epilepsy in patients with systemic lupus erythematosus. Arthritis Rheum 1994;37: 568-71.
14. Liou HH, Wang CR, Chen RC, Chuang CY, Chiang IP, et al. Elevated levels of anticardiolipin antibodies and epilepsy in lupus patients. Lupus 1996; 5:307-12.
15. Denburg SD, Carbotte RM, Ginsberg JS, Denburg JA. The relationship of antiphospholipid antibodies to cognitive function in patients with systematic lupus erythematosus. J IntNeuropsycholSoc 1997; 3:377-86.
16. SD Denburg and JA Denburg; Cognitie dysfunction and antiphospholipid antibodies in Systemic Lupus Erythematosus; Lupus 2003; 12; 883.
17. West SG. Neuropsychiatric lupus. Rhem Dis Clin North Am 1994; 20; 129-158.

Dr. Suresh Raghavan

Professor, Department of Medicine, Government Medical College, Kottayam,
Medical College Road, Gandhi Nagar, Kottayam, Kerala 686008, India