Lupus May Involve Brain Long Before CNS Symptoms

The brain manifestions of systemic lupus erthematosis can be quite variable.  Many patients do not experience any central nervous system symptoms.  Others can be quite disabled by their CNS symptoms including severe depression, psychosis and delirium.  This variability in the brain is not surprising given that lupus involves a variety of other organ systems (i.e. cardiac) with a range of effects specific to individuals with the disorder. 

A group of Chinese radiologists and rheumatologists have published some interesting work on lupus and the brain.  They wanted to answer the question: “Do patients with lupus without CNS symptoms truly have no evidence of CNS disease?”  To answer that question, they looked at a sensitive research marker of brain function known as the default network using functional magnetic resonance imaging.  Here are the key elements of their study:

• Cases=33 right-handed female subjects with no neuropsychiatric symptoms (two were later excluded due to obvious brain abnormalities on typical MRI images (T1 or T2)
• Controls=23 right-handed female subjects recruited from the community matched by age
• Resting brain images were compared for regional homogeneity—this default network strategy examines synchronicity between brain regions felt to indicate network connections

The Chinese research team found that multiple areas of the brain decreased homogeneity in the lupus group.  Areas noted to be impaired included the cerebellum, the left inferior frontal gyrus, the left precuneus area, the right limbic lobe and the cingulate gyrus.   Using a marker of brain lupus activity, they were able to identify involvement of disease activity in the cerebellum and the left anterior cingulate gyrus.  This suggests that these specific regions of interest (ROI) identified in the default -network study may indeed be involved in the CNS pathology of lupus.

The authors conclude that lupus may produce significant brain changes in the absence of overt CNS symptoms.  These changes appear to not be spotty focal effects but appear to involve multiple brain networks.  They note lupus may have specific detrimental effects involving the cerebellum that could play a role in the neuropsychiatric manifestions of the disease.

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Lin Y, Zou QH, Wang J, Wang Y, Zhou DQ, Zhang RH, Zhang YW, Lii HT, & Fang YF (2010). Localization of cerebral functional deficits in patients with non-neuropsychiatric systemic lupus erythematosus. Human brain mapping PMID: 21170956