Accuracy of 133-xenon regional cerebral blood flow and quantitative electroencephalography in systemic lupus erythematosus

Abstract

Objective: comparative assessment of sensitivity and specificity of regional Cerebral Blood Flow (rCBF) by 133-Xenon inhalation and quantitative Electroencephalography (qEEG) in patients with Neuropsychiatric Systemic Lupus Erythematosus (NP-SLE).

Methods: Sixty-two combined rCBF and qEEG examinations were performed in fifty-two SLE patients. Group A: 27 SLE patients without NP-SLE; group B: 17 patients with florid (within 1 month) NP-SLE; group C: 12 patients with previous NP-SLE examined in the remission phase (four patients of which already considered in group B). The study also included data deriving from two sets of examinations in ten patients who were observed twice, in different phases of the clinical course of NP-SLE.

Results: in comparison to healthy controls, rCBF was lower (p < .001) in group B only, whereas qEEG showed similar increases of both δ and 0 relative powers together with a reduction of α relative power in groups A-C. As compared to group A, sensitivity and specificity in detecting cerebral abnormalities in group B were 76% and 78% for rCBF, and 59% and 44% for qEEG, respectively. In the ten patients examined twice, rCBF was consis tent with clinical course in 90% of cases and qEEG in 60%.

Conclusion: total accuracy in detecting cerebral functional abnormalities during florid NP-SLE is better by rCBF than by qEEG. rCBF and, in selected cases, qEEG examinations are reliable markers of NP-SLE.

Keywords

Systemic lupus erythematosus regional cerebral blood flow quantitative electro encephalography

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References

Hebra F. , Kaposi M. On diseases of the skin including the exanthemata. The New Sydenham Society, London, 1874 , IV.

Osler W. On the visceral manifestations of the erythema group of skin diseases . Am J Med Sci 1904; 127: 1-23.

Grigor R. , et al. Systemic lupus erythematosus. A prospective analysis. Ann Rheum 1992; 35: 1330-42.

West SG Neuropsychiatric Lupus. Rheum Dis Clin North Am 1994; 20(1): 129-58.

Hughes Gvr. Connective tissue diseases. 4th ed., Blackwell Publ., London, Wien , 1994.

Russell PW , Haserick JR , Zucker EM Epilepsy in systemic lupus erythematosus. Arch Intern Med 1951; 88: 51-61.

Singer J. Denburg JA , and the Ad Hoc Neuropsychiatric Lupus Workshop Group. Diagnostic criteria for neuropsychiatric systemic lupus erythematosus: the result of a consensus meeting. J Rheumatol 1990; 17: 1397-1402.

Bluenstein HG The central nervous system in systemic lupus erythematosus. In: Lahita RG (Ed.) Systemic Lupus Erythematosus, 2nd edition, Churchill Livingstone, New York , Edinburgh, London, Melbourne , Tokyo, 1992, 639-55.

McCune WJ , MacGuire A. , Aisen A. , Gebarski S. Identification of brain lesions in neuropsychiatric systemic lupus erythematosus by magnetic resonance scanning. Arthritis Rheum 1988; 31: 159-66.

10.

Praderio L. , et al. CT and MR neuroimaging in cerebral lupus . Lupus 1992; 1(Suppl 1): 174 (Abstract).

11.

Feinglass EJ , et al. Neuropsychiatric manifestations of systemic lupus erythematosus: diagnosis, clinical spectrum and relationship to other features of the disease. Medicine 1976; 55: 323-37.

12.

Grigor R. , et al. Systemic lupus erythematosus. A prospective analysis. Ann Rheum Dis 1978; 37: 121-28.

13.

Ritchlin CT , et al. Quantitative electroencephalography: a new approach to the diagnosis of cerebral dysfunction in systemic lupus erythematosus. Arthritis Rheum 1992; 35; 1330-42.

14.

Kushner MJ , et al. Cerebral blood flow in systemic lupus erythematosus with or without cerebral complications. Neurology 1987; 37: 1596-98.

15.

Awada HH , et al. Cerebral blood flow in SLE with and without central nervous system involvement. J Neurol Neurosurg Psychiatry 1987; 50: 1597-1601.

16.

Kushner MJ , et al. Cerebral blood flow variations in CNS lupus. Neurology 1990; 40: 99-102.

17.

Pinching AJ , Travers RL , Hughes Grv. Oxygen-15 brain scanning for detection of cerebral involvement in SLE. Lancet 1978; i: 898-900.

18.

Bresnihan B. , et al. The neuropsychiatric disorder in systemic lupus erythematosus: evidence for both vascular and immune mechanisms. Ann Rheum Dis 1979; 38: 301-6.

19.

Nossent JC , Hovestad A. , Schonfeld Dhw , Swaak Ajg. Single-photon-emission computed tomography of the brain in the evaluation of cerebral lupus. Arthritis Rheum 1991; 34: 1397-403.

20.

Emmi L. , et al. MRI and SPECT investigations of the CNS in SLE patients. Clin Exp Rheumatol 1993; 11: 13-20.

21.

Rogers MP , et al. I-123 iofetamine SPECT scan in systemic lupus erythematosus patients with cognitive and other minor neuropsychiatric symptoms: a pilot study. Lupus 1992; 1: 215-19.

22.

Rubbert A. , et al. Single photon emission computed tomography analysis of cerebral blood flow in the evaluation of central nervous system involvement in patients with systemic lupus erythematosus. Arthritis Rheum 1993; 36: 1253-62.

23.

Szer IS , et al. Cerebral perfusion abnormalities in children with central nervous system manifestations of lupus detected by single photon emission computed tomography. J Rheumatol 1993; 20: 2142-47.

24.

Colamussi P. , et al. Brain single-photon emission tomography with 99 mTc-HMPAO in neuropsychiatric systemic lupus erythematosus: relations with EEG and MRI findings and clinical manifestations. Eur J Nucl Med 1995; 22: 17-24.

25.

Stoppe G. , et al. Positron emission tomography in neuropschiatric lupus erythematosus . Neurology 1990; 40: 304-8.

26.

Carbotte RM , et al. Fluctuating cognitive abnormalities and cerebral glucose metabolism in neuropsychiatric systemic lupus erythematosus . J Neurol Neurosurg Psychiatry 1992; 55: 1054-59.

27.

Tan EM , et al. The 1982 revised criteria for the classification of Systemic Lupus Erythematosus. Arthritis Rheum 1982; 25: 1271-7.

28.

Obrist WD , Thompson HK Jr, Wang HS , Wilkinson WE Regional cerebral blood flow estimated by 133-Xenon inhalation. Stroke 1975; 6: 245-56.

29.

Rodriguez G. , et al. Regional cerebral blood flow in essential hypertension: data evaluation by a mapping system. Stroke 1987; 18: 13-20.

30.

Risberg J. , et al. Regional cerebral blood flow by 133 Xenon inhalation. Preliminary evaluation of an initial slope index in patients with unstable flow compartments . Stroke 1975; 6: 142-48.

31.

Blauenstein UW , et al. 133-Xenon method, analysis of reproducibility: some of its physiological implications. Stroke 1977; 8: 92-102.

32.

Nuwer MR Quantitative EEG: I. Techniques and problems of frequency analysis and topographic mapping. J Clin Neurophysiol 1988; 5: 1-43.

33.

Rosadini G. , et al. Brain functional mapping in senil psychopathology . Int J Psychophysiol 1991; 10: 271-80.

34.

Rodriguez G. , et al. Regional cerebral blood flow asymmetries in a group of 189 normal subjects at rest. Brain Topogr 1991; 4: 57-63.

35.

Downie NM , Heath RW Basic statistical method. New York, NY: Harper & Row Publishers, Inc; 1974.

36.

Hellman DB , Petri M. , Whiting-O'Keefe O. Fatal infections in systemic lupus erythematosus: the role of opportunisitc organisms. Medicine 1987; 66: 341-8.

37.

Young AB , et al. PET scan investigations of Huntington disease: cerebral metabolic correlates of neurologic features and functional decline. Ann Neurol 1986; 20: 296-303.

38.

Rosadini G. , et al. Evaluation of cerebral blood flow data in stroke patients using a mapping system. Stroke 1989, 20: 1182-9.

39.

Takano T. , et al. Effect of small deep hemispheric infarction on the ipsilateral cortical blood flow in man. Stroke 1985; 16: 64-69.

40.

Kahane P. , et al. Ocular deviation induced by intracerebral electrical stimulation of area 6 in epileptic patients. Proceedings of the fifth International Cleveland Clinic-Bethel Epilepsy Symposium, Cleveland, may 22-25, 1994; p. 84 (Abstract).

41.

Rosadini G. , et al. rCBF and quantitative EEG in correlations in epileptic patients . In: Baldy-Moulinier M , Ingvar DH , Meldrum BS (eds) Cerebral blood flow, metabolism and epilepsy, John Libbey, London, 1983, 26-32.

42.

Carbotte RM , Denberg SD , Denberg JA Prevalence of cognitive impairment in systemic lupus erythematosus. J Nerv Ment Dis 1986; 174 357-64.

43.

Levine SR , et al. Cerebral blood flow asymmetries in headache-free migraineurs . Stroke 1987; 18: 1164-5.

44.

Rodriguez G. , et al. Reduction of cerebral blood flow in subclinical hepatic encephalopathy and its correlation with plasma-free tryptophan . J Cereb Blood Flow Metab 1987; 7: 768-72.

45.

Nobili F. , et al. Regional cerebral blood flow in chronic hypertension: a correlative study. Stroke 1993; 24: 1148-53.

46.

Ginsburg KS , et al. A controlled study of the prevalence of cognitive dysfunction in randomly selected patients with systemic lupus erythematosus. Arthritis Rheum 1992; 35: 776-82.

47.

Hartmann A. Prolonged disturbances of regional cerebral blood flow in transient ischemic attacks. Stroke 1985; 16: 932-9.

48.

Raichle ME , et al. Correlation between cerebral blood flow and oxidative metabolism . Arch Neurol 1976; 33: 523-6.

49.

Powers WJ , Raichle ME Positron emission tomography and its application to the study of cerebrovascular disease in man. Stroke 1985; 16: 361-76.

50.

Markus HS , Hopkinson N. Migraine and headache in systemic lupus erythematosus and their relationship with antibodies against phospholipids. J Neurol 1992; 239: 39-42.

51.

Wolkowitz OM , Breier A. , Doran A. , et al. Prednisone-induced behavioral and biological changes in medically normal volunteers. Psychopharmacol Bull 1988; 24: 492-4.