[CIS PIDD] Neuropsychiatric Lupus Erythematosus

[Verbsky, James]

Juan

I would agree with Mikko.  There are no clinical tests to confirm this diagnosis.  MRI/clinical findings are utilized.  An LP with a high cell count, protein, and IgG analysis (oligoclonal bands, IG index) can be helpful.

For treatment..if you have active disease and are convinced its SLE..pulse steroids and Cytoxan are typically given.

Best

James

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Seppänen Mikko
Sent: Thursday, June 21, 2012 4:58 AM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [CIS PIDD] Neuropsychiatric Lupus Erythematosus

Dear Juan,

the dg of neuropsychiatric lupus is extremely challenging, especially if typical (white+grey matter) demyelinating lesions are not shown in MRI (as can be the case), some specific serologic tests and autoantigens have been suggested in the literature. I asked only a few months ago from CNS-autoimmunity expert prof Josip Dalmau/Pennsylvania&Barcelona, and even he did not know an active lab that would offer testing against these suggested autoantibodies.

Thus, unless someone else in this list is better informed, NP-SLE still remains a clinicoradiologic diagnosis (and no superb way to serologicaly to confirm or refute the dg). There are numerous thorough clinical review articles on the subject written, easily found from PubMed.
One specific auto-Ab that however is worth measuring and easily available is GADAb, some lupus patients even without stiff person sdr but with limbic encephalitis/cerebellitis or PERM-type autoimmune encephalitis may have very high titers of GADAb in serum and CSF.

mikko

Mikko Seppänen, MD, PhD ass prof
Helsinki Finland

________________________________
Lähettäjä: pagid-bounces at list.clinimmsoc.org<mailto:pagid-bounces at list.clinimmsoc.org> [mailto:pagid-bounces at list.clinimmsoc.org]<mailto:[mailto:pagid-bounces at list.clinimmsoc.org]> Puolesta Juan Carlos Aldave Becerra
Lähetetty: 20. kesäkuuta 2012 16:49
Vastaanottaja: pagid at list.clinimmsoc.org<mailto:pagid at list.clinimmsoc.org>
Aihe: [CIS PIDD] Neuropsychiatric Lupus Erythematosus
Dear Doctors,

I have a colleague whose children has been diagnosed with neuropsychiatric lupus erythematosus.
Please, can you send me information about current diagnosis approach and therapeutic strategies?
Also it would be great if you know where I can send samples to perform diagnostic studies not available in Peru, if needed (eg. antineuronal antibodies, etc.).

Thank you very much,

Juan Carlos Aldave, MD
Allergy and Clinical Immunology
Rebagliati Martins National Hospital - Lima, Peru
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