Neuropsychiatric lupus

Most people are familiar with lupus. Lupus is generally caused by a poor immune system. Lupus has many clinical symptoms. Different people will have different symptoms, and the severity of the disease is also different. Neuropsychiatric lupus is a common lupus disease. In fact, this is a more serious disease after suffering from lupus. However, people don’t know much about neuropsychiatric lupus. Below is a detailed introduction.

What is neuropsychiatric lupus?

Neuropsychiatric lupus refers to a general definition of a series of neurological and psychiatric symptoms directly related to systemic erythema, which may manifest as: epilepsy, cerebrovascular disease, headache, movement disorder, acute confusion state, anxiety, cognitive dysfunction (including overall cognitive slowing, decreased attention, memory impairment, etc.), and may also manifest as mental abnormalities: visual and auditory hallucinations, delusions, stupor, fear; organic encephalopathy syndrome: impaired consciousness, loss of orientation, inattention, poor memory, abnormal behavior; affective disorders: hypomania, depression, anxiety, etc. Epidemiology shows that the prevalence of SLE varies according to age, gender, and race. The incidence of lupus is high in women of childbearing age, and the risk of epilepsy seizures is increased in men. However, there are currently no laboratory or radiological biomarkers or other formal diagnostic and treatment criteria for neuropsychiatric lupus, and clinical decision-making requires an individualized multidisciplinary diagnostic and treatment approach for individuals with suspected or severe symptoms. Among them, the symptoms that are valuable for diagnosis are: epilepsy, mental symptoms, transverse myelitis, stroke, transient ischemic attack, and aseptic meningitis. In addition, it is necessary to improve antibodies, cerebrospinal fluid analysis, neurophysiological testing, head imaging examinations, functional examinations, etc. Given that there is no gold standard, all lupus patients presenting with neurologic symptoms should first exclude other causes such as infection, incidental disease processes, metabolic abnormalities, or medication side effects and then undergo neurologic and psychiatric evaluation. When there is clinical suspicion of cognitive impairment, formal psychological testing must be performed.

In clinical practice, neuropsychiatric lupus can be classified according to the underlying pathophysiological process. Currently, two different pathophysiological processes are believed to be related to the neuropsychiatric symptoms of neuropsychiatric lupus:

1. Inflammation related to pro-inflammatory or autoimmune-mediated

2. Thrombotic/ischemic, which is associated with vascular occlusion, microangiopathy and bleeding. In most patients, both pathophysiological mechanisms coexist. In addition, the neuropsychiatric symptoms of lupus should be excluded from being caused by lupus medications or lupus-related organ damage.

Pathogenesis of neuropsychiatric lupus:

Immune complexes are deposited on the walls of intracranial blood vessels, inducing intracranial vascular inflammation, leading to vascular embolism and cerebral softening;

Antiphospholipid antibodies in lupus patients combine with phospholipids on brain vascular endothelial cells, damaging endothelial cells, increasing arachidonic acid release and prostaglandin synthesis, and inducing platelet aggregation, vascular embolism, and cerebral softening.

Anti-brain cell antibodies bind directly to molecules on neuronal membranes, interfering with the transmission of nerve impulses;

The blood is in a hypercoagulable state, and the Libman-Sacks vegetation formed on the endocardium falls off and embolisms the intracranial blood vessels through the blood circulation.