Nervous System and Lupus Part 2

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I started this information with what I gathered from the LFA’s website. Now let’s see that another website says about this subject. I got this information from www.hopkinslupus.org. It is another interesting article on this subject.

Nervous System

Lupus can affect both the central nervous system (the brain and spinal cord) and the peripheral nervous system. Lupus may attack the nervous system via antibodies that bind to nerve cells or the blood vessels that feed them, or by interrupting the blood flow to nerves.

Cognitive Dysfunction

The most common manifestation of neuro-lupus is cognitive dysfunction, which is characterized by clouded thinking, confusion, and impaired memory. Eighty percent of lupus patients who have had lupus for ten years or more will experience this condition. Single positron emission computed tomography (SPECT) scans of SLE patients with cognitive dysfunction show abnormalities in blood flow, indicating that the condition may be the result of decreased oxygen delivery to certain parts of the brain. Unfortunately, there is no real treatment for cognitive dysfunction. Normally, it does not get worse over time. However, some people find that counseling and other forms of cognitive therapy help them to cope with associated symptoms.

Headache

About 20% of patients with lupus have migraine-like headaches. These headaches are different from “lupus headaches,” which are due to active lupus and require a lumbar puncture (spinal tap) or blood vessel study (MRA or CT-angiogram) for diagnosis. A true lupus headache usually requires corticosteroids for treatment. Non-lupus migraine headaches should be treated with a migraine prevention diet. [A copy of this diet can be found in the article “Migraine Prevention Diet” under this heading.] However, when diet alone becomes insufficient, medications such as nortriptyline can be used to reduce headache frequency and severity.

Fibromyalgia

Fibromyalgia is a chronic pain sensitization disorder characterized by widespread tenderness, general fatigue, and non-restful sleep. Doctors do not currently know the cause of fibromyalgia, but it is believed to result from a rewiring of pain pathways that lead to the spinal cord and brain. As a result, the central nervous system experiences an increased sensitivity to pain signals. Many people with lupus have fibromyalgia; in fact, much of the pain that people with lupus feel is due to this condition. To check for fibromyalgia, your doctor may touch several points on the muscles of your body. People with fibromyalgia often feel pain when light pressure is applied to these areas, whereas people without the condition feel little discomfort.

Three drugs are currently approved by the FDA for the treatment of fibromyalgia: pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran HCl (Savella). While these drugs can help to reduce discomfort by about 25%, there are many things that you can do on your own to help ease and manage the symptoms of fibromyalgia. Some people believe that limiting their daily activities helps to reduce pain and fatigue. In fact, doctors recommend that people with fibromyalgia continue to engage in regular daily activities. Scheduling short daily rest times may help you to keep a normal schedule. However, spending too many hours resting may make your symptoms worse.

In addition, since responses to stress can cause physical symptoms such as headache, increased pain, and muscle tension, try to practice stress management skills. There are some stressors that you can control, and there are some that are simply out of your hands. Focus on what you can control, and direct your energy toward future growth.

Try to practice a healthy lifestyle. Research has shown that light stretching activities such as Tai Chi and yoga can help to relax muscles and improve some of the pain associated with fibromyalgia. In addition, molecules called endorphins that are released by your brain after exercise—usually about 30 minutes of moderate or intense activity—help you to achieve a ‘natural high,’ and many people report that exercise simply makes them feel better overall. Other lifestyle elements, such as a supportive social network and a healthy diet, can also help to ease feelings of emotional and physical discomfort and promote an overall sense of well-being. If you feel you need more help in managing your fibromyalgia, your doctor can assist you in devising coping strategies.

Organic Brain Syndrome

Organic brain syndrome is a general term referring to physical disorders that cause impaired brain function. Other names are cerebritis, encephalopathy, and acute confusional state. This condition is usually diagnosed through lumbar puncture (spinal tap) or EEG (the recording of brain waves), and before the diagnosis is made, the doctor will likely rule out certain causes, such as drug use, infection, cancer, or metabolic problems. If the condition is confirmed to be caused by lupus, high dose steroids will be used to combat its effects.

CNS Vasculitis

CNS vasculitis is a very rare SLE complication caused by inflammation of the blood vessels of the brain. It is diagnosed by a blood vessel study (brain MRA or CT-angiogram) and requires treatment with high dose steroids.

Sources

Nervous System Involvement in Lupus

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I am studying up on this segment of lupus and the nervous system involvement. I have found several interesting sources of information and thought it would be nice to share them with you.

The first one is is from the LFA’s website. Here is the information they have:

The Nervous System

Lupus is an autoimmune disease that can affect almost any part
of your body, including your joints, skin, kidneys, heart, lungs, or blood.
Lupus can also affect the nervous system and brain. There are several terms
doctors use to describe this: neuropsychiatric lupus (NP-SLE), neurocognitive
dysfunction, or central nervous system lupus (CNS lupus). Your nervous system
has three parts, any of which may be affected by lupus.

    • The central nervous system (CNS) consists of the brain and the
      spinal cord.
  • The peripheral nervous system (PNS) is a network of nerves that connects the
    brain and spinal cord to the rest of the body, and gives skin and muscles the
    signals needed for sensation and movement.
  • The autonomic nervous system (ANS) allows communication between spinal and
    peripheral nerves and the brain and internal organs, and controls functions like
    breathing, blood flow, and heart rate.

People with lupus can experience a number of complications when
their nervous system is affected. The symptoms may come on suddenly or may come
and go, but they will vary depending upon the location and extent of the tissue
injury. These symptoms also can be present in other diseases, so diagnosing
lupus-related nervous system disorders is often difficult.

Neurologists are the physicians who specialize in the nervous
system. They may rely on a number of diagnostic tools to determine whether lupus
is involved in your cognitive problems:

    • x-rays
  • brain scans (magnetic resonance imaging (MRI) and computed tomography (CT)
  • electroencephalograms (to capture the electrical pattern of brain activity)
  • spinal tap (to examine fluid in the spinal column)

Behavioral and cognitive tests may also be done to find out if
your memory or other mental abilities have been affected.

Depending on the symptoms, a variety of medications are
available to treat lupus-related nervous system disorders, including
non-steroidal anti-inflammatory drugs, antimalarials, and steroids. Your
response to treatment may be rapid or gradual over several months. For many
people with lupus, nervous system involvement is completely
reversible.

Central Nervous System (CNS)

When lupus affects your central nervous system, many symptoms
may occur, including:

    • headaches
  • confusion
  • fatigue
  • depression
  • seizures
  • strokes
  • vision problems
  • mood swings
  • difficulty concentrating

Drugs used to treat lupus can cause side effects that are
similar to the symptoms of CNS lupus. If you have symptoms of CNS lupus you
should consult a neurologist who can determine which symptoms are side effects
of medication and which are due to lupus. The drugs most known for causing
symptoms like those of CNS lupus are:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) – may cause
    headache, dizziness, confusion, and in rare instances, meningitis-like
    symptoms
  • Antimalarials – in very high doses (not usually given for
    lupus) may cause manic behavior, seizures, psychosis
  • Corticosteroids – may cause agitation, confusion, mood swings,
    psychosis, depression
  • Anti-hypertensive medications – may cause depression or loss of
    sex drive

A serious form of lupus called CNS vasculitis may occur when
there is inflammation of the blood vessels of the brain. Characterized by high
fevers, seizures, psychosis, and meningitis-like stiffness of the neck, CNS
vasculitis is the most dangerous form of lupus involving the nervous system and
usually requires hospitalization and high doses of corticosteroids to suppress
the inflammation.

Peripheral Nervous System (PNS)

The nerves of your peripheral nervous system control your motor
responses and sensation, so symptoms of numbness or tingling, or inability to
move a part of your body, may be the result of lupus affecting these nerves.
Known as peripheral neuropathies, symptoms of PNS nerve damage are caused by
inflammation of the nerves or by compression of the nerves due to swelling in
the tissue around them. The types of symptoms you might experience
include:

    • vision problems
  • facial pain
  • ringing in the ears
  • dizziness
  • drooping of an eyelid
  • carpel tunnel syndrome

Autonomic Nervous System (ANS)

The autonomic nervous system regulates many of your body’s
functions that happen almost automatically: heart rate, blood pressure, feeling
hot or cold, bladder and bowel functions, release of adrenalin, breathing,
sweating, and muscle movement. Lupus can cause these nerve signals to be
overactive, which can lead to a wide range of symptoms:

    • numbness
  • burning
  • tingling
  • mental confusion
  • headaches
  • gastrointestinal problems such as nausea, vomiting, constipation, or
    diarrhea

Raynaud’s phenomenon

Raynaud’s phenomenon is a condition of ANS involvement caused by
inflammation of nerves or blood vessels. Blood vessels in your hands and feet go
into spasm and restrict blood flow, usually as a reaction to cold temperatures,
with the tips of the fingers or toes turning red, white, or blue. Raynaud’s can
also cause pain, numbness, or tingling in fingers and/or toes. People who have
Raynaud’s phenomenon are advised to avoid cold conditions when possible, and may
have to wear gloves or mittens when in air-conditioned surroundings.

Livedo reticularis and palmar erythema are two other skin
disorders that may affect you if you have autonomic nerve damage. Both of these
conditions can cause a bluish, lacelike mottling under your skin, especially on
your legs, giving your skin a “fishnet” look.

Cognitive Dysfunction

As many as half of all people with lupus describe feelings of
confusion, fatigue, memory loss, and difficulty expressing their thoughts. This
collection of symptoms is termed cognitive dysfunction, although many people
call it “lupus fog.”

Cognitive dysfunction most often affects people with mild to
moderately active lupus. The causes of these symptoms, and the reasons that the
symptoms tend to come and go, are not known. Living with cognitive dysfunction
can be very frustrating. However, you can learn to improve your concentration
and lessen confusion and memory loss with a variety of coping skills, including
puzzles, games, biofeedback, using a daily appointment calendar, and balancing
daily activities to reduce stress.

Lupus Headache

Compared with the general population, people with lupus may be
twice as likely to experience migraine-like lupus headaches, commonly known as
lupus headaches. The features of lupus headaches are similar to migraines and
may be seen more often in people who also have Raynaud’s phenomenon. However,
headaches can also be caused by vasculitis, a symptom of active lupus due to
inflammation of the blood vessels. If you are experiencing headaches that are
not improved by an over-the-counter headache medication, be sure to tell your
doctor
s.

MS, yet another autoimmune disease

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This post is about multiple sclerosis. It is an autoimmune disease which can overlap with lupus. Many people have this disease which means that we all could educate ourselves by reading about it. Apathy and ignorance are not excuses. We all have minds and we should exercise them by learning about serious problems outside of our own insular world. In the interest of doing just that, I have posted this post. The information comes from the website www.nationalmssocirty.org. Please go to their site for further information.

Multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another. Today, new treatments and advances in research are giving new hope to people affected by the disease.

MS is Thought to be an Autoimmune Disease

The body’s own defense system attacks myelin, the fatty substance that surrounds and protects the nerve fibers in the central nervous system. The nerve fibers themselves can also be damaged. The damaged myelin forms scar tissue (sclerosis), which gives the disease its name. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing the variety of symptoms that can occur.

Most people with MS learn to cope with the disease and continue to lead satisfying, productive lives.

The Four Courses of MS

People with MS can typically experience one of four disease courses, each of which might be mild, moderate, or severe.

  • Relapsing-Remitting MS
    People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks—which are called relapses, flare-ups, or exacerbations —are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS.
  • Primary-Progressive MS
    This disease course is characterized by slowly worsening neurologic function from the beginning—with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS.
  • Secondary-Progressive MS
    Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data are not yet available to determine if treatment significantly delays this transition.
  • Progressive-Relapsing MS
    In this relatively rare course of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.

Since no two people have exactly the same experience of MS, the disease course may look very different from one person to another. And, it may not always be clear to the physician—at least right away—which course a person is experiencing.

For more important information about MS, check out Just the Facts (.pdf)

Treatments for Lupus

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This information is from the Lupus Cleveland Website. It shows the types of things used to treat Lupus and all the different manifestations of the disease. It is well written and easy to read. If you would like to understand Lupus better, this is a good article to read. Enjoy!

TREATMENT

Currently, there is no cure for lupus; however, early diagnosis and proper medical treatment can significantly help to control the disease. Symptoms often vary from one individual to another and treatment is based on specific indications in each person. Still, a few general guidelines can be listed:

  1. Regular rest is important when the disease is active. When the disease is in remission, increased physical activity is encouraged to increase joint flexibility and muscle strength.
  2. For the individual who is photosensitive, the regular use of sunscreens will help prevent rashes and irritations. For those who develop rashes, treatment with cortisone creams is very helpful.
  3. Achy joints (arthralgia) and arthritis generally respond to aspirin or aspirin-like drugs (non-steroidal anti-inflammatory drugs).
  4. The anti-malarial drug hydroxcholorquin (Plaquenil) is often prescribed for more severe joint or skin involvement.
  5. Cortisone drugs (the most commonly prescribed is Prednisone) are often used for more severe organ involvement. Not everyone with SLE needs cortisone. Cortisone, particularly in higher doses, has possible hazardous side effects.
  6. If you have a fever (over 100 degrees F), call your doctor.
  7. Go to your doctor for regular checkups. Regular checkups usually include blood and urine tests.
  8. When in doubt, ask. Call a doctor.

Treatment plans should meet the individual patient’s needs and may change over time. To develop a treatment plan, the doctor tries to:

  • Prevent flares
  • Treat flares when they do occur
  • Minimize complications

The doctor and patient should reevaluate the plan regularly to ensure that it is as effective as possible.

Several types of drugs are used to treat lupus. For people with joint pain, fever, and swelling, drugs that decrease inflammation, referred to as nonsteroidal anti-inflammatory drugs, or NSAIDs, are often used.

While some NSAIDs are available over the counter, a doctor’s prescription is necessary for others.

Common side effects of NSAIDs include stomach upset, heartburn, diarrhea, and fluid retention.

Some lupus patients also develop liver and kidney inflammation while taking NSAIDs. It is especially important to stay in close contact with the doctor while taking NSAIDs.
Antimalarials are another type of drug commonly used to treat lupus. These drugs were originally used to treat malaria, but they are also useful in treating lupus.
Antimalarials may be used alone or in combination with other drugs to treat fatigue, joint pain, skin rashes, and inflammation of the lungs. Continuous treatment with anti-malarials may prevent flares from recurring.

Side effects of antimalarials may include stomach upset and, very rarely, damage to the retina of the eye.

The most common treatment for lupus is corticoid steroid hormones. Corticoid steroids are related to cortisol, a natural anti-inflammatory hormone. They hold back inflammation very quickly.

Corticoid steroids can be given orally, in creams applied to the skin, or by injection. Since they are potent drugs, the doctor will use the lowest dose with the greatest benefit.

Short-term side effects of corticoid steroids include swelling, increased appetite, weight gain, and emotional ups and downs. These side effects usually stop when the drug is stopped.

It can be dangerous to stop taking corticoid steroids suddenly, so it is very important that a doctor recommend changes for the corticoid steroid dose.
Sometimes doctors give very large amounts of corticoid steroid for a short time by vein. With this treatment, typical side effects are less likely and slow withdrawal is not necessary.

Long-term side effects of corticoid steroids can include stretch marks, excessive hair growth, weakened or damaged bones, high blood pressure, damage to the arteries, high blood sugar, infections, and cataracts.

Typically, the higher the dose of corticoid steroids, the more severe the side effects are. The longer corticoid steroids are taken, the greater the risk of side effects becomes.
People with lupus who use corticoid steroids should talk to their doctors about taking supplemental calcium and Vitamin D. These supplements reduce the risk of fragile bones called osteoporosis.
For patients whose kidneys or central nervous systems are affected by lupus, a type of drug called an immunosuppressive may be used. Immunosuppressive hold the immune system back by blocking the production of some immune cells.

Immunosuppressive may be given orally or by IV.

Side effects of immunosuppressive may include nausea, vomiting, hair loss, bladder problems, decreased fertility, and increased risk of cancer and infection. The longer the treatment with immunosuppressive, the higher the risk of side effects becomes.

Since some treatments may cause harmful side effects, it is important to tell the doctor about any side effects right away. It is also important NOT to stop or change treatment without asking the doctor first.