Please forgive me for my lack of knowledge of regarding lupus terminology and the disease in general. My sister was diagnosed with lupus about 10 years ago. Her symptoms have been mild and controlled by various drugs. I'm not really sure what her symptoms have been and how she has been treated - the butterfly rash and arthritis are the ones I know about. She has chosen to keep her disease to herself. Today she sent an email to the immediate family informing us of a new complication. She didn't give much detail and said she didn't want to talk about it. She said her rheumatologist did a spinal tap and found antibody production in her central nervous system separate from the antibody production in her bloodstream. If left untreated her longterm mental function could be in danger. She has already started taking steroids (this is not the first time on steroids) and will likely undergo a low-level chemotherapy treatment. Does this sound familiar to anyone? :?: I'd like to know how serious this new development really is. My sister does not want to be treated differently because of her disease and doesn't want to talk about it unless she brings it up. I trust God to take care of my sister however He wants and will accept that, but I deal with things better when I know what I'm dealing with.
06-06-2004, 01:30 PM
Hi Sis - I think that your desire to learn more about your sister's illness is courageous and there is nothing to forgive :-). Here is what I found out about CSF with SLE> SLE occurring in the central nervous system (CNS) can be difficult to diagnose because its symptoms are easily confused with other psychiatric and neurologic conditions. A study in this month's issue of the journal Nature Medicine offers the first real clue to the mental impairment commonly seen in lupus. Many lupus patients suffer from subtle but insidious losses in such critical mental functions as memory, information processing, and concentration. Until now the basis for these cognitive losses was completely unknown. Now research with mice by a group led by Dr. Betty Diamond of the Albert Einstein College of Medicine suggests the impairment is caused by antibodies that bind to nerve-cell receptors in the cerebral cortex of the brain and kill the cells.With the help of the LRI grant, Dr. Diamond hopes to begin testing lupus patients within the next few months, initially by brain-imaging studies combined with measures of cognitive function and tests for the presence in the bloodstream of the human equivalent of the mouse antibodies. Her group has already found such antibodies in the cerebrospinal fluid of a lupus patient who had experienced progressive cognitive decline.
It has been found that difficulties in the cognitive and affective areas of the brain are related to the presence of certain autoantibodies directed against the nervous system and present in the blood or cerebrospinal fluid. However, it has not been absolutely proved that these autoantibodies, or for that matter any other factors, directly cause cognitive and affective problems. The difficulty has been mainly in studying the brain, since it is more complicated to study this tissue than, for instance, the kidney, which can be biopsied.
Cerebrospinal fluid is the normally clear fluid that surrounds the brain and spinal cord. Examination of this fluid in patients with SLE may show elevated levels of protein in up to half of these patients. MRI (magnetic resonance imaging - a special type of radiological test) is the most sensitive radiographic test for showing changes consistent with SLE. The best screening test is the detection of immune substances (antibodies) directed against the nuclei of body cells (anti- nuclear antibodies or ANA's). Tests of the cerebrospinal fluid (CSF) for elevated levels of autoantibodies are the most reliable ways to detect CNS complications caused by a faulty immune system.
Spinal tap, or lumbar puncture, is performed to detect oligoclonal bands in cerebrospinal fluid. Oligoclonal bands result from elevated levels of the antibody immunoglobulin G (IgG) and myelin basic protein, which is a byproduct of demyelination. In this procedure, a needle is inserted between two lower spine (lumbar) vertebrae and cerebrospinal fluid is collected and analyzed.
The CSF is different from blood plasma (the fluid part of the blood, excluding the cells). Certain ions, such as sodium, potassium, and calcium, are very important to the brain because nerve cells use them to generate electrical signals. Nerve cells, for example, must have less potassium in the fluids that surround them than other cells, so CSF has less potassium than blood. Therefore, not only is CSF different from blood, there is a barrier to free movement of molecules between the two. This is called the "blood-brain barrier" and is very important, because a physician must know what drugs cross this barrier and get into the brain, and which ones don't. As an example, Parkinson's disease is a defect in a brain chemical called "dopamine", but it can't cross the blood-brain barrier. But dopamine is made from another chemical called L-DOPA, which can, so L-DOPA is used to treat the disease. Penicillin also cannot cross the blood-brain barrier, but we're lucky because in bacterial meningitis, the blood-brain barrier gets temporarily damaged and lets penicillin cross, so it can be used as an effective antibiotic. Good thing. The composition of the CSF can tell a doctor a lot about what's wrong, so that is why a "spinal tap" or "lumbar puncture" is done sometimes. You would think it very dangerous to do this, for fear that the needle will hit the spinal cord. But, fortunately the spinal cord itself ends fairly high up in the back, and there is a big space below it where there is backbone, and meninges, and CSF, but nospinal cord and that is where the needle goes in.
I hope that I have been able to answer your question about CSF...let me know if you need any more information!!
Best of Luck to you and my prayers for your sister and your family
Peace and Blessings