Neuropsychiatric manifestations among systemic lupus erythematosus Egyptian children: patterns and outcomes

Abstract

Background Neuropsychiatric systemic lupus erythematosus (NPSLE) is one of the more complex and poorly understood manifestations of juvenile SLE (j-SLE). Involvement of the central nervous system is more frequent in j-SLE than adult SLE (a-SLE) and serves as a marker of severe disease in children. Aim To describe the different clinical manifestations, immunological laboratory features, imaging findings and outcomes of NPSLE in Egyptian children. Patients and methods This 10 years retrospective cohort study included 30 children with NPSLE, aged less than or equal to 18 years old, both sexes, diagnosed with j-SLE according to systemic lupus international collaborating clinics 2012 criteria and have NPSLE according to American college of rheumatology/systemic lupus international collaborating clinics 2012 NPSLE criteria. All patients were subjected to SLE disease activity index assessment. Results In all 30% of patients with j-SLE had NP manifestations and in all cases the NP manifestations appeared at diagnosis: [headache (93.3%), acute confusion state (63.3%), depression (63.3%), psychosis (50%), cognitive dysfunction (50%), cerebrovascular disease (43.3%), seizure (33.3%)] and during course of the study 30% were inactive, 30% had mild activity, 20% had moderate activity, 13.3% had severe activity and 6.7% died. The outcome after immunosuppressive therapy was good. Conclusion Careful assessment and follow-up of all patients with j-SLE is mandatory for early detection of NP manifestations that cause increased morbidity and mortality unless treated early.