Brain and Central Nervous System with Lupus

Reviewed by: HU Medical Review Board | Last reviewed: January 2020

Complications of the nervous system are some of the most frequent issues caused by lupus. People with lupus often report a wide range of neurological issues such as seizures, depression, anxiety, trouble thinking, confusion, impaired memory, headaches, hearing loss, dizziness, and psychosis (most often mood swings, hallucinations, and delusions).1,2

These complications are common because inflammation of lupus frequently attacks the delicate structures of the central nervous system (brain and spinal cord) and peripheral nervous system (the nerves outside the brain and spinal cord). In addition, the steroids used to treat lupus can cause mania, depression, and psychosis when taken for a long time or in large doses.1,2

How does lupus cause complications of the nervous system?

Doctors believe that lupus harms the nervous system in several ways. It can create antibodies that bind to the nerve cells and disrupt their function. Or, these antibodies can bind to the blood vessels that feed nerves, stopping blood from flowing to the nerves which then results in malfunction. In addition, some lupus medications may directly contribute to or aggravate existing neuropsychiatric symptoms.

The most common manifestations of lupus in the central and peripheral nervous systems are:1

  • Cognitive issues (brain fog) – 49 percent
  • Headache – 23 percent
  • Psychosis (mood swings, delusions or hallucinations) – 12 percent
  • Seizures – 11 percent
  • Stroke, aneurysm, transient ischemic attack (pre-stroke) – 10 percent

While upsetting and frustrating, most of the complications of the nervous system are occasional and short-lived. However, in people with frequent neuropsychiatric symptoms, MRI scans tend to show the brain’s gray matter has been affected by lupus.1

Neuropsychiatric diagnosis

There is no one test that can diagnose a neuropsychiatric complication of lupus.1 The tests that your doctor may use include:2

  • X-rays
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT scan)
  • Electroencephalograms (EEG)
  • Spinal tap
  • Memory and behavior tests

X-rays, MRIs, and CT scans can reveal blockages, narrowing blood vessels, and other structural issues of the brain, nerve, and spinal tissue. An EEG will show electric patterns in the brain, or how the brain is “firing.” A spinal tap removes fluid from the spine so that it can be analyzed. Memory and behavior tests can tell the doctor whether these processes have been affected.2

It can be difficult for your doctor to determine whether some neuropsychiatric symptoms, especially depression and anxiety, are caused by structural or mechanical changes in the nervous system, or whether it is caused by the stress of a chronic illness, money worries, and isolation. In addition, people with lupus can have mental health issues such as bipolar disorder or schizophrenia just like the rest of the population.

To get an accurate diagnosis and treatment for lupus-related nervous system complications, you may need to see a neurologist. A neurologist is a doctor who specializes in conditions of the nervous system.2

Neuropsychiatric treatments

Because the causes of neuropsychiatric symptoms can be so different, the types of neuropsychiatric medicines you may be prescribed also vary widely. The drug your doctor prescribes will address your current symptoms and may include anticonvulsants, antidepressants, antipsychotics, and antithrombotic agents.1,3,4,5,6

Seizures treatments

  • Antiepileptics
  • NSAIDs or non-steroidal anti-inflammatory drugs (ibuprofen or naproxen)
  • Antimalarials
  • Steroids

Depression and anxiety treatments

  • Antidepressants
  • Anti-anxiety medicines such as diazepam (Valium)
  • Exercise
  • Psychotherapy
  • Practice good sleep habits
  • Find ways to reduce pain

Psychiatric treatments

  • Antipsychotics such as quetiapine (Seroquel) or olanzapine (Zyprexa)
  • Antidepressants

Blood clot treatments

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