Systemic lupus erythematosus with organic brain syndrome: serial electroencephalograms accurately evaluate therapeutic efficacy.
A 48-year-old man with systemic lupus erythematosus developed organic brain syndrome. High-dose prednisolone was ineffective, and somnolence without focal signs rapidly developed. Electroencephalogram (EEG) demonstrated a slow basic rhythm (3 Hz), but brain magnetic resonance imaging was normal. Somnolence resolved soon after performing plasma exchange (two sessions). However, memory dysfunction persisted, with EEG demonstrating mild abnormalities (7-8 Hz basic rhythm). Double-filtration plasmapheresis (three sessions) was done, followed by intravenous cyclophosphamide. Immediately after the first plasmapheresis session, memory dysfunction began to improve. After the second dose of cyclophosphamide, intellectual function resolved completely and EEG findings also normalized (basic rhythm of 10 Hz waves). Serial EEG findings precisely reflected the neurological condition and therapeutic efficacy in this patient. In contrast, protein levels in cerebrospinal fluid remained high and did not seem to appropriately reflect the neurological condition in this patient.
Department of Rheumatology, Kameda Medical Center, Kanagawa.
Takashi
T
Kato
Kyoji
K
Shiratori
Tsuyoshi
T
Kobashigawa
Yuji
Y
Hidaka
D001379:Azathioprine / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000737:chemistry; D003520:Cyclophosphamide / Q000627:therapeutic use; D006970:Disorders of Excessive Somnolence / Q000209:etiology / Q000628:therapy; D004569:Electroencephalography; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000150:complications / Q000628:therapy; D020945:Lupus Vasculitis, Central Nervous System / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008569:Memory Disorders / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D009220:Myositis / Q000150:complications / Q000628:therapy; D019965:Neurocognitive Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D010493:Pericarditis / Q000150:complications / Q000628:therapy; D010951:Plasma Exchange; D010956:Plasmapheresis; D011239:Prednisolone / Q000627:therapeutic use; D011506:Proteins / Q000032:analysis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D011506:Proteins; D003520:Cyclophosphamide; D011239:Prednisolone; D001379:Azathioprine