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Kudsi M, Achmeh B, Khalayli N, Rabah K, Rabah N, Al Darwish L, Alghawe FA. Central neurological manifestations in a sample of Syrian patients with systemic lupus erythematosus: cross-sectional study. Ann Med Surg (Lond) 2024; 86:5096-5100. [PMID: 39238971 PMCID: PMC11374191 DOI: 10.1097/ms9.0000000000002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/30/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction The authors aimed to study systemic lupus erythematosus (SLE) central neurological patterns and their correlations with the disease activity. Patients and methods The authors' retrospective observational study was carried out on admitted SLE patients. The patients' demographic data, clinical examinations, laboratory tests, imaging studies, and systemic lupus erythematosus disease activity index (SLEDAI) were recorded. Results Thirty-six SLE patients had neurological manifestations from 203 patients, but 8 patients were excluded. 90.2% were females. The age of neuro-lupus manifestation was 24.1+2.9 years. Neurological manifestations were the initial presentation in 25% of patients. General seizures were the frequent manifestation. SLEDAI was 29.51±18.43, while it was 18.3±9.2 among patients without neuropsychiatric systemic lupus erythematosus (NPSLE). Twenty-five percent of patients had pleocytosis on cerebrospinal fluid (CSF) analysis. Small lesions were seen in 57.1% of patients on brain MRIs, and large lesions were observed in 10.6%. These findings were compatible with the disease activity. Discussion Central nervous system involvement ranged between 10 and 80%, and much more with active disease. The frequent finding was general seizures. Psychosis and cognitive impairment were relatively frequent. Adult NPSLE manifestations had developed before or around the time of SLE diagnosis and within the first year after diagnosis. These manifestations were directly correlated to the disease activity. Abnormality in CSF is characterized by slight pleocytosis, and elevation of protein with normal fructose. MRI is the neuroimaging test of choice for NPSLE in clinical practice. Conclusion Central neurological involvement in SLE was seen early in the course of the disease, and correlating to the disease activity.
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Affiliation(s)
| | | | | | - Karam Rabah
- Faculty of Medicine, Syrian Private University, Daraa, Syria
| | - Nour Rabah
- Faculty of Medicine, Syrian Private University, Daraa, Syria
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Estiasari R, Tiksnadi A, Tunjungsari D, Maharani K, Aninditha T, Sofyan HR, Savitri I, Pangeran D, Jeremia I, Widhani A, Ariane A. Effectiveness of transcranial direct current stimulation (tDCS) as adjunctive treatment for chronic headache in adults with clinically stable systemic lupus erythematosus (SHADE): a randomised double-blind multiarm sham controlled clinical trial. BMJ Open 2023; 13:e076713. [PMID: 38101851 PMCID: PMC10729133 DOI: 10.1136/bmjopen-2023-076713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Chronic headache is a 'silent' neuropsychiatric systemic lupus erythematosus symptom with heterogeneous prevalence, potentially reaching 54.4%. It may reduce quality of life by increasing the likelihood of depression and sleep disturbance. While pharmacotherapy remains the first-line treatment, the current management is still challenging and needs other non-invasive modalities. An effective, tolerable and disease-specific treatment modality including transcranial direct current stimulation (tDCS) is considered to reduce the frequency of chronic headaches, including in SLE. Until recently, there was no standard protocol for tDCS in treating headaches. METHODS AND ANALYSIS SHADE is a single-centre randomised double-blind multiarm sham-controlled trial for adults with clinically stable SLE, chronic headaches and without history of traumatic brain injury, brain infection, stroke or brain tumour. Random allocation is conducted to 88 subjects into 3 treatment groups (administration at primary motor, primary sensory and dorsolateral prefrontal cortex) and control group in 1:1:1:1 ratio. The primary endpoint is reduced number of headache days after adjunctive tDCS. The secondary endpoints are reduced headache intensity, increased quality of life, increased sleep quality, decreased depression and reduced analgesics use. The outcome is measured monthly until 3-month postintervention using headache diary, 36-Item Short Form Survey, Chronic Headache Quality of Life Questionnaire, Pittsburgh Sleep Quality Index and Mini International Neuropsychiatry Interview version 10 (MINI ICD 10). Intention-to-treat analysis will be performed to determine the best tDCS electrode placement. ETHICS AND DISSEMINATION Ethical approval had been obtained from the local Institutional Review Board of Faculty of Medicine Universitas Indonesia. Results will be published through scientific relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05613582.
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Affiliation(s)
- Riwanti Estiasari
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Amanda Tiksnadi
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dyah Tunjungsari
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kartika Maharani
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tiara Aninditha
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Henry Riyanto Sofyan
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Irma Savitri
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - David Pangeran
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ivan Jeremia
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
| | - Alvina Widhani
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Departement of Internal Medicine Allergy Immunology Division, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Anna Ariane
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine Rheumatology Division, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Thabet AM, Elnwam SA, Mekky JF, Abdelghany HM, Fathy HM. Neurophysiological evaluation of juvenile systemic lupus erythematosus. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peripheral nervous system and the central nervous system involvement in systemic lupus erythematosus (SLE) patients are one of the major causes of morbidity and mortality. The aim of this work was to study the nervous system clinically and electrophysiologically in children with systemic lupus erythematosus.
Results
The study was carried out on thirty-eight children with SLE. Their age ranged from 5 to 16 years. The most encountered neurologic manifestations were tremors. It was observed in 47.4% of children, followed by headache in 39.5%, sensory manifestation as numbness in 23.7%, cerebrovascular stroke in 5.3%, and chorea in 2.6%, which was unilateral mostly in the upper limb, tics, and convulsion had the same percentage. Around 16% of children had positive findings in MRI, such as cerebrovascular disease, minimal hematoma, pseudotumorcerebri, vasculitis, and ectatic ventricles. Subclinical peripheral neuropathy was reported in nearly 52.6% of children, and clinical peripheral neuropathy was reported in 23.6%. Pure sensory subclinical peripheral neuropathy was detected in 13.1% of children, but mixed subclinical peripheral neuropathy was detected in 39.4%. Nearly 53% of studied children had an abnormal somatosensory-evoked potential study of posterior tibial and median nerves.
Conclusion
The current study reported that the clinical neurological manifestations in juvenile SLE is common. Peripheral neuropathy is commonly detected, which could be either clinical or sub-clinical. Somatosensory evoked potential study is of value for early detection of central affection.
So, we recommend more studies to determine the guidelines when to order these informative investigations for children with JSLE.
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