Task force report on brain involvement in antiphospholipid syndrome

Abstract

Many neurological manifestations have been described in Antiphospholipid Syndrome (APS). More work is needed to identify those individuals with antiphospholipid antibodies (aPL) who are at greatest risk for nervous system manifestations. Antiphospholipid antibodies are established risk factors for a first ischemic stroke in patients with and without systemic lupus erythematosus (SLE), and recurrent cerebrovascular ischemia, particularly in adults with SLE; however, subgroups of these patients at high-risk for recurrent events have not been clearly identified. Persistently positive aPL are associated with cognitive dysfunction in adults with SLE. There is no evidence to support an association between aPL and headache. Antiphospholipid antibodies may be associated with a worse clinical course in adults with SLE who also have Multiple Sclerosis (MS) or an “MS-like” illness and anticardiolipin antibody IgM may be increased during an exacerbation in adults with definite MS, but without SLE. Antiphsopholipid antibodies are associated with seizures and epilepsy in patients with and without SLE. Particular attention needs to be paid to differentiating those manifestations that are mediated through a thrombotic mechanism and those that are mediated through another immune-mediated mechanism. Additional studies that help determine the pathophysiology of aPL-mediated nervous system effects are needed to target appropriate therapies.