Electroconvulsive therapy and cyclophosphamide in combination for severe neuropsychiatric lupus with catatonia
Article Abstract:
About half of all patients with systemic lupus erythematosus (SLE), a chronic inflammatory disease affecting many systems of the body, develop central nervous system (CNS) complications. In 30 to 60 percent of these patients, these are psychiatric manifestations. Catatonia, a state of obvious motor disturbance that is usually characterized by immobility and muscle rigidity, may be caused by SLE. A case of lupus-induced catatonia is described. The patient, known to have SLE for three years, was admitted to the hospital with organic psychosis. Following admission, facial grimacing was noted. The results of an electroencephalogram were abnormal. Computed tomography of the brain revealed diffuse atrophy or wasting. On the patient's seventh day in the hospital she became catatonic. Treatment with steroids was ineffective, and on the 28th day the patient was given a trial of electroconvulsive therapy (ECT), and the catatonia improved. On day 59, high levels of IgG antibodies were found in the cerebrospinal fluid, indicating that CNS lupus was still active, and treatment with cyclophosphamide was begun. By day 90, following 10 ECT treatments, the patient improved and eventually, her catatonic state disappeared. Successful treatment was achieved with a combination of ECT and cyclophosphamide, and after a year of monthly cyclophosphamide treatments, there was no recurrence of psychomotor disease. The authors suggest that the SLE be treated aggressively when neuropsychiatric manifestations are present. It is also proposed that cyclophosphamide may be useful in treating severe nonfocal psychiatric disease in SLE patients. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Ketotifen-induced remission in progressive early diffuse scleroderma: evidence for the role of mast cells in disease pathogenesis
Article Abstract:
Scleroderma is characterized by thickening and stiffening of the skin, arthritis, and systemic disease including kidney dysfunction. Mast cells, a type of white blood cell, may be involved in the disease process, as the release of mast cell contents may activate cells in skin and other tissues. Two cases are described in which scleroderma was successfully treated with ketotifen, an agent that stabilizes and counteracts mast cells. The first patient was a 50-year-old man with an 18-month history of the disease which progressed to kidney insufficiency and high blood pressure. Following drug reactions and disease progression, the patient was treated with ketotifen, and improvement was apparent by the twelfth week. After six months, the itching and skin lesions were almost resolved, joint mobility improved, and lung function was normal. Other drugs were discontinued, and the patient remained well on ketotifen for two years. The second patient was a 45-year-old man with a 12-month history of the disease. Scleroderma was apparently limited to skin and joint dysfunction. Following six months of ketotifen treatment, skin and joint function improved, and progress continued through 14 months of therapy. Ketotifen is relatively free of side effects and appears to be beneficial in the treatment of scleroderma, for which there is sometimes little effective therapy. More extensive research on the effectiveness of this agent for the treatment of scleroderma is ongoing. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Interleukin-4 levels in the eosinophilia-myalgia syndrome
Article Abstract:
The eosinophilia-myalgia syndrome (EMS) is a condition associated with the ingestion of contaminated L-tryptophan in which several types of white blood cells infiltrate tissues, muscle pain develops, and fibrous tissue is deposited in the skin. The scleroderma (hardening of the skin) associated with EMS may be related to increased levels of interleukin-4 (IL-4), a substance produced by CD4-positive T lymphocytes and mast cells (cells found in connective tissue). IL-4 has a variety of physiological effects, including the abilities to attract human dermal (skin) fibroblasts and to cause mouse fibroblasts to replicate under laboratory conditions. The concentrations of IL-4 were assayed in 35 EMS patients and 57 healthy control subjects. No control subject had detectable blood levels of IL-4, while 5 EMS patients (14 percent) had levels ranging from just detectable to considerably higher. These differences were statistically significant. No differences were seen in IL-4 levels of EMS patients with and without fibrotic changes in the skin (cutaneous fibrosis), however. The results indicate that IL-4 may contribute to the proliferation of fibrous tissue and may, as well, be involved in the pathogenesis of EMS. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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