Central nervous system disease in systemic lupus erythematosus: Therapy and prognosis

The effect of corticosteroid therapy in 28 patients with 52 episodes of neuropsychiatric disease in systemic lupus erythematosus (SLE) was evaluated. Categories of organic central nervous system disease were seizures (eight patients), organic brain syndromes (nine patients), aseptic meningitis (four patients) and a variety of focal neurologic findings (seven patients). Fourteen patients had 15 episodes of functional psychosis without other evidence of neurologic disease.Although there was a general correlation between clinical and serologic evidence of active SLE and the development of organic neurologic disease, there was no evidence that therapy with very large doses of corticosteroids was beneficial. Of the deaths in this series, two were due to probable active SLE involving the central nervous system whereas five were attributable to complications of therapy. The long-term morbidity, likewise, was high in the patients who received large doses of corticosteroids. In all, 12 patients had major complications of corticosteroid therapy.Functional psychosis was usually precipitated by corticosteroid therapy and responded to a reduction in steroid dosage and administration of psychotropic drugs.