There is no permanent cure for neuropsychiatric systemic lupus erythematosus (NPSLE). Management of NPSLE depends on the severity of symptoms and the underlying cause.
- Hydroxychloroquine is effective in the long-term treatment of NPSLE. Immunosuppressive medicines help inhibit the activity of the immune system, which can be useful in treating NPSLE.
- Corticosteroids and other immunosuppressants are effective against active lupus.
- Blood thinners could be beneficial to treat blood clots, which lead to stroke.
- Antiseizure medications could effectively control seizures associated with lupus.
There are different levels of treatment for neuropsychiatric lupus. After ruling out other potential causes, and physicians confirming the symptoms are due to systemic lupus erythematosus (SLE), a treatment strategy based on the symptom manifestations and their severity will be implemented.
Treatment strategy for NPSLE
The treatment strategy for NPSLE may include:
- A general therapeutic approach, such as the treatment of other SLE
- Primary prevention
- Management of inflammatory NPSLE
- Management of cerebrovascular disease
General treatment may involve treatment of the symptoms and other alternative therapies.
Symptomatic treatment or therapy to manage symptoms is the initial step, which is even before confirming the diagnosis. Some of the common medications prescribed to manage the symptoms include:
- Antipsychotic agents
- Antianxiety drugs
- Antiepileptic drugs
- Nonsteroidal anti-inflammatory drugs
- Dopamine agonists
- Migraine treatment for specific headaches
Cognitive dysfunction, one of the most common symptoms of NPSLE, cannot be easily managed with a symptomatic approach. Hence, alternative therapies, such as counseling or psychotherapy, are recommended to treat symptoms of cognitive dysfunction.
These are mandatory treatments for SLE. The following two classes of drugs are commonly used to prevent further progression of the disease:
- Antimalarial: Hydroxychloroquine and chloroquine are usually prescribed as the first-line treatment for any type of SLE. The treatment with antimalarials for SLE resulted in a reduction in the death rate associated with SLE.
- Reduce the risk of cerebrovascular disease
- Reduces the risk of blood clotting
- Protective effect against seizures
- Statins: Statins are known to reduce the inflammatory proteins responsible for neurologic symptoms caused by SLE. The risk of coronary artery disease is higher in people with SLE. Because statins can effectively treat coronary artery disease, they are highly recommended to prevent coronary artery disease associated with SLE.
Management of inflammatory NPSLE
To treat inflammation or prevent clotting associated with NPSLE, the physician may prescribe immunosuppressants, such as corticosteroids, as a single therapy or in combination with other immunosuppressive therapy, such as:
- Mycophenolate mofetil
- Cyclosporin A
In addition, the physician may recommend the following therapies:
- Intravenous immunoglobulins involve injecting immunoglobulins to suppress the immune activity in severe cases of SLE
- Stem cell transplantation to reset the immune system is effective in people who are not responding to other immunosuppressive treatment
Management of cerebrovascular disease
To prevent the formation of blood clots and further development of stroke, the physician may recommend the following drugs:
- Antiplatelet treatment
- Anticoagulant therapy
IMAGESBrowse our medical image collection to see of photos of autoimmune, vascular, and other systemic conditions See Images
Neuropsychiatric lupus treatment chart
|Aseptic meningitis (Inflammation of the membranes around the brain)||
|Demyelinating syndrome (a condition that causes damage to the myelin sheath)||
|Myelopathy (injury to the spinal cord caused by severe compression)||
|Acute confusional state||
How is neuropsychiatric lupus diagnosed?
To diagnose if the neurologic symptoms are caused by systemic lupus erythematosus (SLE), the physicians may use the following techniques to confirm the diagnosis:
- Complete blood cell count to screen for anemia and thrombocytopenia
- Antinuclear antibody test
- Serum creatinine for kidney disease
- Urinalysis for kidney disease
- Erythrocyte sedimentation rate and C-reactive protein for inflammation
- Liver function tests
- Radiographic tests, such as computed tomography scans, magnetic resonance imaging, and joint radiograph, to detect abnormalities
- Ultimately, a skin biopsy is performed to confirm the diagnosis
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Bollu PC. CNS Lupus Workup. Medscape. https://emedicine.medscape.com/article/1146456-workup
Magro-Checa C, Zirkzee EJ, Huizinga TW, Steup-Beekman GM. Management of Neuropsychiatric Systemic Lupus Erythematosus: Current Approaches and Future Perspectives. Drugs. 2016 Mar;76(4):459-83. doi: 10.1007/s40265-015-0534-3.
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