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NEW YORK (Reuters Health) Jan 29 - Functional magnetic resonance imaging (fMRI) abnormalities are present in patients with childhood-onset systemic lupus erythematosus (SLE), according to a report in the December Arthritis & Rheumatism.
"Even children with SLE and seemingly normal cognition based on traditional testing have abnormal results on fMRI, suggesting that currently available (traditional) testing and diagnostic strategies are not sensitive enough to diagnose neuropsychiatric SLE effectively in its early stages," Dr. Hermine I. Brunner told Reuters Health.
Dr. Brunner from Cincinnati Children's Hospital Medical Center in Ohio and colleagues investigated activation patterns on fMRI in 10 patients with childhood-onset SLE who underwent formal neuropsychological testing using 3 paradigms.
Compared with healthy controls, the childhood-onset SLE group showed significantly increased activation of brain areas involved in the continuous performance task that evaluates attention, the N-Back task that assesses working memory, and verb generation tasks that evaluate language processing, the authors report.
In the absence of such stimuli, however, childhood-onset SLE patients consistently undersuppressed activity in the expected brain areas.
There were significant inverse correlations between neuropsychological test scores and fMRI activation, the investigators say, suggesting that lower cognitive scores result in stronger task-related brain activation.
"At present, the degree of sensitivity of fMRI does not permit its use as a diagnostic tool for cognitive function in individual SLE patients," the researchers conclude. "Nevertheless, based on the present findings, fMRI may be a promising approach to elucidate the areas and mechanisms involved in the development of cognitive dysfunction in SLE."
"We expect to contribute to finding the cause of neurocognitive SLE and, based on that, develop medication targeting the pathologic processes involved," Dr. Brunner said. "We hope to be able to diagnose neuropsychiatric SLE much earlier, prior to the patients with SLE having developed irreversible damage due to untreated neuropsychiatric SLE."
Arthritis Rheum 2007;56:4151-4163.
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