Pediatric Rheumatology Online Journal → July 2003 → Childhood Lupus→ Clinical Presentation, course and Outcomes → Abstract #95

NEUROPSYCHIATRIC MANIFESTATIONS IN PEDIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS AND ASSOCIATION WITH ANTIPHOSPHOLIPID ANTIBODIES

L. Harel,¹ C. Sandborg,² T. C. Lee,² E. von Scheven.³

¹Pediatrics C, Schneider Children's Medical Center,Tel Aviv University Israel, Petah-Tikva, Israel; ²Department of Pediatrics Division of Rheumatology, Lucille Packard Children's Medical Center, Stanford University, Stanford, CA; ³Pediatric Immunology\Rheumatology, Children's Medical Center, University of California San Francisco, San Francisco, CA

Background: Neuropsychiatric (NP) complications are common in children with systemic lupus erythematosus (SLE). Few studies have included NP complications and none have used standardized instruments for headache (HA)assessment. The association between NP SLE in children and antiphospholipid antibodies (aPL) has not been established.
Methods: This multi-center cohort study was conducted at UCSF and Stanford University. Clinical data was obtained by retrospective chart review and a prospective (HA) questionnaire using the criteria of the International Headache Society. All patients met ACR criteria for SLE and the ACR NP criteria were used for defining NP SLE syndromes. Pearson's Chi-square test and Fisher's exact test were utilized to assess group differences.
Results: 106 patients were evaluated, 78% females; mean age 17 yrs (SD 3.8 yrs); 61 (57.5%) had NP manifestations including HA 53.8%, mood disorders 12.3%, cognitive dysfunction 10.4%, seizures 9.4%, CVA, psychosis and pseudotumor 2.8% each, aseptic meningitis 1.9%, and acute confusional state, anxiety and cranial neuropathy at 0.9% each.
First NP event occurred up to 6.4 years (mean 1.2) after diagnosis of SLE, 50% developed NP events within 7 months. Anticardiolipin antibodies (aCL) were found in 65/104 patients 63.5%; aCL IgG in 56%; aCL IgM in 34.9%; False-positive RPR in 13.5%; and Lupus Anticoagulant in 21.9%. The only significant association between NP SLE and aPL was between CVA and aCL IgM (p=0.04). Although not statistically signicificant, 100% of all 6 subjects with psychosis had detectable aPL.
Conclusions: NP manifestations are very common in children with SLE with 50% of patients developing a NP event within 7 months of diagnosis. Headache is the most frequent symptom. As expected, aPL were associated with CVA.