AB0978 NEUROLOGICAL MANIFESTATIONS OF PEDIATRIC SYSTEMIC LUPUS ERYTHEMTOSUS IN EGYPTION PATIENTS
Authors: yasser gazar, Sameh Rashed
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> SLE is a complex autoimmune disorder, characterized by multisystem involvement including the nervous system, juvenile onset SLE has more aggressive clinical course in comparison with adult-onset SLE. <h3>Objectives</h3> To study the neuropsychiatric manifestations of SLE in Egyptian children. <h3>Methods</h3> We reviewed the charts of all children and adolescents who were diagnosed with SLE and evidence of neuropsychiatric manifestations was defined by full neuropsychiatric history and examination. <h3>Results</h3> Out of 54 children with SLE, 30 (55.6%) had neuropsychiatric (NP) manifestations, the mean age at onset of the disease was 13.6 years. The mean period between onset of SLE and NP manifestations 15.5 months. NP manifestations was the presenting feature in 3 patients. Headache was the initial symptom of central nervous system (CNS) involvement in 35% of patients seizures was the most frequent CNS finding seen in 7(23.3%) patients, 6 (20%) patients had congnifive impairment, 6(20%) patient had cognitive impairment, 6(20%) patients had CVA, 2(6.7%) had chorea, 2(6.7%) had psychosis, 2(6.7%) had depression, 1(3.3) had cerebritis, 1(3.3%) had peripheral neuropathy. Lupus anticoagulant was high in patients with chorea, seizures or cerebrovascular accidents (CVA). Electroencephalogram (EEG) was abnormal in 30% of patients presented by seizures and rarely helpful in patients with diffuse NP symptoms. Magnetic resonance imaging (MRI) was abnormal in 13 cases, long term outcome was good, 3 patients had significant persistent CNS deficits, the majority of patients (90%) had excellent recovery from neuropsychiatric SLE. <h3>Conclusion</h3> NPSLE is one of the most common serious complications of pediatric SLE, so early recognition and management are of paramount importance. CNS involvement was observed in 55% of our pediatric patients with SLE, 76% of whom developed symptoms during the first year of onset of the disease Headache and seizures were the most common neurological manifestations of pediatric SLE, followed by CVA and intellectual disability. Psychosis, depression and chorea were less frequent in our study group, while peripheral neuropathy and cerebritis were rare. <h3>References</h3> [1] Smith PP and Gordon C (2010): Systemic lupus erythematosus: clinical presentations. Autoimmunity Reviews, 10(1): 43–45. [2] Khajezadeh M (2016): The prevalance of neurologic manifestation of children diagnosed by systemic lupus erythematous refer to the children medical center since during 10 years. in MD (speciality of Pediatrics) disertation, Tehran University of Medical Sciences, In Persian. [3] Fernandes M, Trevisani V, Castro AA, Ferreira Neves Neto J, Atallah AAN (2013): Cyclophosphamide versus methylprednisolone for treating neuropsychiatric involvement in systemic lupus erythematosus. Cochrane Database Syst Rev., (2):CD002265. [4] Zambrano YC, Ramos JD, Vargas NE, Ramirez DC, Rodriguez SM, Niño AC, Bello áH (2014): Risk factors for neuropsychiatric manifestations in children with systemic lupus erythematosus: case-control study. Pediatric Neurology, 51(3):403-9. [5] Bader-Meunier B, Armengaud JB, Haddad E, Salomon R, Deschênes G, Koné-Paut I, Leblanc T, Loirat C, Niaudet P, Piette JC, Prieur AM (2005): Initial presentation of childhood-onset systemic lupus erythematosus: a French multicenter study. The Journal of Pediatrics, 146(5):648-53. [6] Singh S, Gupta MK, Ahluwalia J, Singh P, Malhi P (2009): Neuropsychiatric manifestations and antiphospholipid antibodies in pediatric onset lupus: 14 years of experience from a tertiary center of North India. Rheumatology International, 29(12):1455-61 <h3>Disclosure of Interests</h3> None declared