title: Parkinsonian syndrome complicating systemic lupus erythematosus.
abstract: Two girls with florid extrapyramidal parkinsonism complicating systemic lupus erythematosus (SLE) are reported. One patient (15 years old) presented with extreme rigidity, irritability, and mutism initially diagnosed as acute psychosis. Examination revealed severe extrapyramidal akinetic mutism, along with marked restlessness. CT and MRI imaging of the brain were unremarkable. EEG revealed moderate generalized disturbance of background activity. 99mTc-HmPAO SPECT cerebral scanning detected decreased regional cerebral blood flow at the basal ganglia. Dopamine-agonist drugs led to complete recovery after 3 months, along with normalization of EEG and SPECT alterations. The second patient (16 years old) was assessed for progressive bradykinesia and apathy impeding her active daily activities, and she was suspected to have developed depression. Neurologic assessment revealed a parkinsonian syndrome that was less severe than that of the first patient. The EEG showed mild disturbance of background activity, and 99mTc-HmPAO SPECT demonstrated impaired regional cerebral blood flow over the basal ganglia. A parkinsonian extrapyramidal syndrome complicating SLE should therefore be taken into account in any patient with SLE presenting with marked behavioral alterations, rigidity, or akinetic mutism.
authors.affiliation: Child Neurology Unit, Rambam Medical Center, Technion School of Medicine, Haifa, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Shahar
authors.forename: E
authors.initials: E
authors.lastname: Goshen
authors.forename: Z
authors.initials: Z
authors.lastname: Tauber
authors.forename: E
authors.initials: E
authors.lastname: Lahat
mesh_terms: D000293:Adolescent; D000405:Akinetic Mutism / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001479:Basal Ganglia / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D010302:Parkinson Disease, Secondary / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000978:Antiparkinson Agents