Neurological complexity in systemic lupus erythematosus: insights into autoimmune encephalitis

Abstract

Background: Autoimmune encephalitis (AE) is an inflammatory syndrome characterized by autoantibodies targeting the central nervous system (CNS), leading to a wide range of neurological and psychiatric manifestations. Objective: This systematic review aims to investigate the coexistence of AE and systemic lupus erythematosus (SLE) to shed light on potential underlying mechanisms. Materials and Methods: Following PRISMA guidelines, a comprehensive search was conducted using Boolean logic in research databases i.e., PubMed, ProQuest, ScienceDirect, and Web of Science to identify relevant studies on AE, SLE, and their potential correlation. After the initial screening, exclusion, and quality assessment using the Joanna Briggs Institute Critical Appraisal Checklist, 14 studies were included for analysis. Among 18 patients, 88.9% were female whose an average age was 31.9 ± 12.7 years. Clinical presentations were varied, including cognitive impairment (66.67%), seizures (61.1%), altered mental status (50%), and movement disorders. Neuroimaging and neurophysiological findings consistently aligned with encephalitis, with MRI abnormalities observed in 94.4% of cases. Various autoantibodies were identified, including anti-NMDAR, anti-AMPA-R2, and anti-GluR antibodies. Conclusion: The identification of neuronal antibodies is crucial, particularly in scenarios involving both neuropsychiatric SLE (NPSLE) and encephalitis. This investigation aims to reveal etiological insights. The ongoing debate revolves around whether SLE-related encephalitis is associated with NPSLE through SLE antibodies or involves distinct antibodies. Further clinical research is essential to clarify the pathogenic role of autoantibody in SLE-linked AE.