Neuropsychiatric Manifestations in Antiphospholipid Syndrome (APS) – Prof Graham Hughes
Professor Graham Hughes is a Consultant Rheumatologist and the founder and editor of the international journal ‘LUPUS,’ and Head of London Lupus Centre. In 1983 he described the clotting disorder now known as Hughes Syndrome for which he received the World Rheumatology (ILAR) Research Prize in 1993.
One hypothesis could be that maybe a number of autonomic features including POTS could be associated with Hughes Syndrome.
So I think, in summary, that the ripples spread of antiphospholipid syndrome and they touch upon psychiatry as well as neurology – I am quite convinced as a clinician.
Professor Hughes begins this section of his presentation with a discussion of neuropsychiatric manifestations in SLE and APS, moving on to cognitive dysfunction in APS.
He presents research on antiphospholipid with dementia and psychosis, highlighting research on cognitive and antiphospholipid impairment. Discussing patients with dementia, he explains the MRI changes and their meaning.
Although stroke and transient ischemic attack are the most common neurologic manifestations of APS, both cognitive dysfunction and magnetic resonance imaging (MRI) white matter hyperintensities can occur in aPL-positive patients (with or without APS). [Erkan D et al., 2010]
Learn more about white matter hyperintensities and their significance.
He moves on to explain the relevance of cerebral blood flow may in APS and ends with the less recognized features of APS.
Prof Hughes takes a look at postural orthostatic tachycardia syndrome (POTS), discussing features common to both autoimmune and autonomic disorders, and presents the hypothesis that POTS might also be associated with Hughes Syndrome.
Concluding his presentation with a discussion of heparin as a treatment option, patients reported a considerable improvement in symptoms whereas they had not responded to conventional POTS treatment.
Read about the case of a young female diagnosed with conversion syndrome who was diagnosed with APS. She had complete remission of her symptoms after a heparin trial.
- Antiphospholipid antibodies are associated with recurrent stroke and dementia.
- Patients with POTS respond better to heparin than conventional POTS treatment.
- Cerebral blood flow may be the most relevant characteristic of Hughes Syndrome.
Dr Sanil Rege covers APS in Psychiatry.
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- Central Nervous System (CNS) Involvement in Antiphospholipid (Hughes) Syndrome – Prof Graham Hughes
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- Neuropsychiatric Lupus and The Curious Case of Molly – What Does This Case Teach Us? – Prof Hughes
- Pathogenesis of Neuropsychiatric Systemic Lupus Erythematosus – Prof Graham Hughes
- What is Lupus? – Prof Graham Hughes
- Prof Graham Hughes Introduces You To The World of Lupus and Antiphospholipid Syndrome – Prof Graham Hughes
- Hanly JG, Hong C, Smith S, Fisk JD. A prospective analysis of cognitive function and anticardiolipin antibodies in systemic lupus erythematosus. Arthritis Rheum. 1999;42(4):728-734.
- Asherson RA, Mercey D, Phillips G, et al. Recurrent stroke and multi-infarct dementia in systemic lupus erythematosus: association with antiphospholipid antibodies. Ann Rheum Dis. 1987;46(8):605-611.
- Medina G, Molina-Carrión LE, Angeles-Garay U, et al. Cerebral blood flow abnormalities in neurologically asymptomatic patients with primary antiphospholipid syndrome. Lupus. 2012;21(6):642-648.