What Are the Neurological Symptoms of Lupus?

1. Cognitive dysfunction

Cognitive dysfunction is the most common neurological symptom of neurolupus, affecting 80% of people with systemic lupus erythematosus (SLE). Signs may include:

• Cloudy (unclear) thinking
• Confusion
• Impaired memory

Causes of cognitive dysfunction may be abnormalities in blood flow that lead to decreased oxygen delivery to certain parts of the brain.

Usually, cognitive dysfunction doesn’t worsen over time, and there is no real treatment for treating the symptoms. Therapies that may help include cognitive therapy and counseling. 

2. Headache

Some people with SLE may experience migraine-like headaches. These headaches are different from lupus headaches caused by active lupus that requires a lumbar puncture or blood vessel study.

Treatment may include the following:

• Migraine prevention diet may be recommended.
• Nortriptyline can be used to reduce headache frequency and severity when diet alone is insufficient.
• Corticosteroids are usually recommended for true lupus headaches.

3. Fibromyalgia

Most people with lupus have fibromyalgia, and most of the pain people feel is due to fibromyalgia. Fibromyalgia is a chronic pain sensitization disorder characterized by widespread:

• Tenderness
• General fatigue
• Non-restful sleep

The exact cause of fibromyalgia is unknown. However, it is believed to occur due to the rewiring of pain pathways that lead to the spinal cord and brain. As a result, the CNS experiences an enhanced sensitivity to pain signals. 

To check for fibromyalgia, your doctor may touch several points on the muscles of your body. People with fibromyalgia often feel pain with light pressure applied to these sites.

Drugs approved for the treatment of fibromyalgia include:

• Pregabalin
• Duloxetine
• Milnacipran

Other ways to manage fibromyalgia symptoms include regular exercise, frequent rest times, and managing stress.

4. Organic brain syndrome

Organic brain syndrome is a condition that leads to impaired brain function, likely due to brain edema secondary to autoimmunity. Some other names for this syndrome include cerebritis, encephalopathy, and acute confusional state.

This condition is usually diagnosed with the help of lumbar puncture and electroencephalography. Before confirming a diagnosis, the following conditions may be ruled out:

• Drug use
• Infections
• Cancer
• Metabolic problem

If lupus is the cause of organic brain syndrome, high-dose steroids may be recommended to combat the effects.

5. CNS vasculitis

CNS vasculitis is a rare complication of lupus that involves inflammation of blood vessels in the brain. Magnetic resonance angiography or computed tomography angiography of the brain can detect the presence of vasculitis. Treatment of CNS vasculitis involves the use of high-dose steroids.

6. Seizures

Seizures occur in 14%-25% of people with lupus. Some of the reasons for seizures associated with SLE include:

• Inflammation of blood vessels in the brain
• Clot formation
• Infections
• Side effects of SLE drugs

Damage to the brain caused by lupus can lead to uncontrollable muscle movements, loss of consciousness, and periods of confusion. Steroids or anticonvulsant medications may be recommended to treat seizures.

7. Transverse myelitis

Myelitis refers to the inflammation of the spinal cord and occurs in 1% of people with lupus. Some of the symptoms include:

• Numbness
• Tingling
• Loss of sensation
• Pain
• Weakness
• Loss of bowel and bladder control
• Paraplegia or inability to move the limbs

Treatment options for myelitis include:

• High dose prednisone
• Cyclophosphamide
• Anticoagulants

8. Stroke

People with neuropsychiatric lupus are at a high risk of a stroke. The presence of antiphospholipid antibodies may increase the risk of a stroke. Treatment options include:

• Anticoagulants
• Immunosuppressive therapy
• Aspirin
• Statins

9. Peripheral neuropathies

Peripheral neuropathies occur in about 18% of people with lupus due to nerve damage or inflammation. Common symptoms include:

• Severe pain
• Weakness
• Numbness
• Pins-and-needles sensation

Treatment options for neuropathy include:

• Corticosteroids
• Other immunosuppressive drugs

Treatment with corticosteroids and other systemic lupus erythematosus drugs can lead to certain complications including:

• Reversible posterior leukoencephalopathy syndrome, which is characterized by the brain-capillary leak, characterized by symptoms of headache, visual loss, seizures, and altered mental functioning
• Serious infections of the central nervous system such as encephalitis 
• Mood disorders
• Memory impairment

Tips to manage neurological symptoms of lupus may include:

• Adopting healthy lifestyle habits such as eating a nutritious diet and getting quality sleep
• Light stretching activities such as tai chi and yoga to relax muscles and prevent pain associated with fibromyalgia
• Engaging in moderate to heavy intensity exercises for at least 30 minutes a day, which can improve mood 
• Reducing stress
• Finding supportive social networks