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Neuropsychiatric manifestation in systemic lupus erythematosus
(NPSLE) is one of the most recalcitrant complications of the
disease. According to the 1999 ACR nomenclature and case
definitions, diffuse psychiatric/neuropsychological syndromes in
NPSLE (anxiety disorder, acute confusional state, cognitive
dysfunction, mood disorder, psychosis) (diffuse NPSLE) present
psychiatric manifestations unlike neurologic syndromes (focal
NPSLE) originating from focal CNS lesions, such as cerebrovascular
disease, demyelinating syndrome, headache, aseptic meningitis,
chorea, seizures and myelopathy. A number of studies have reported
that diffuse NPSLE is usually associated with the presence of
autoantibodies against neuronal cells in serum as well as in
cerebrospinal fluid (CSF). Moreover, IL-6 has been shown to be
elevated in CSF of patients with diffuse NPSLE. Recently, it has
been demonstrated that the severity of blood-brain barrier damages
plays a crucial role in the development of acute confusional state,
the severest form of diffuse NPSLE through the accelerated entry of
larger amounts of autoantibodies to NMDA receptor subunit NR2 into
the CNS. Since the importance of autoantibodies in the NPSLE has
been now evident, such an aggressive treatment, especially B cell
depleting therapy, would make sense in that it would reduce the
levels of pathogenic autoantibodies, leading to a better prognosis
of NPSLE. As far as we know, no single book specifically dedicated
to NPSLE alone has been published as yet. As mentioned above, NPSLE
constitutes a vastly expanding field of research with increasing
numbers of papers published annually. Therefore, we believe that an
effort to collect and critically review these publications is
invaluable. Such an effort will provide an important contribution
to basic researchers as well as clinicians working in the field of
neurology, rheumatology, psychiatry and internal medicine fields.
Neuropsychiatric manifestation in systemic lupus erythematosus
(NPSLE) is one of the most recalcitrant complications of the
disease. According to the 1999 ACR nomenclature and case
definitions, diffuse psychiatric/neuropsychological syndromes in
NPSLE (anxiety disorder, acute confusional state, cognitive
dysfunction, mood disorder, psychosis) (diffuse NPSLE) present
psychiatric manifestations unlike neurologic syndromes (focal
NPSLE) originating from focal CNS lesions, such as cerebrovascular
disease, demyelinating syndrome, headache, aseptic meningitis,
chorea, seizures and myelopathy. A number of studies have reported
that diffuse NPSLE is usually associated with the presence of
autoantibodies against neuronal cells in serum as well as in
cerebrospinal fluid (CSF). Moreover, IL-6 has been shown to be
elevated in CSF of patients with diffuse NPSLE. Recently, it has
been demonstrated that the severity of blood-brain barrier damages
plays a crucial role in the development of acute confusional state,
the severest form of diffuse NPSLE through the accelerated entry of
larger amounts of autoantibodies to NMDA receptor subunit NR2 into
the CNS. Since the importance of autoantibodies in the NPSLE has
been now evident, such an aggressive treatment, especially B cell
depleting therapy, would make sense in that it would reduce the
levels of pathogenic autoantibodies, leading to a better prognosis
of NPSLE. As far as we know, no single book specifically dedicated
to NPSLE alone has been published as yet. As mentioned above, NPSLE
constitutes a vastly expanding field of research with increasing
numbers of papers published annually. Therefore, we believe that an
effort to collect and critically review these publications is
invaluable. Such an effort will provide an important contribution
to basic researchers as well as clinicians working in the field of
neurology, rheumatology, psychiatry and internal medicine fields.
Behcet's disease is a chronic relapsing inflammatory disease of
unknown etiology involving multiple organs. Along with blindness,
other bodily functions are greatly affected by this disease;
conditions of the vascular, intestinal and central nervous systems
are usually life threatening and require aggressive therapy.
Recently, significant progress has been made in several areas of
this disease. The introduction of biological agents (such as
anti-TNF) have had a positive impact on the effectiveness of
treatments. However, there are still a number of unmet needs in
various fields of this disease. Despite this, there remains a
number of unaddressed issues concerning the treatments of this
disease. Several genes have been shown to be associated with this
disease, in addition to HLA-B51. Abnormalities in several subsets
of T helper cells have been implicated in the pathogenesis of
Behcet's disease. Recent advances in the field of innate immunity
have shed light on the new aspects of Behcet's disease; that is,
this disease has both autoimmunity and autoinflammatory aspects. On
the other hand, there are still controversies as to the diagnosis
and treatment of recalcitrant manifestations of the disease. This
publication highlights the most recent understanding of Behcet's
disease and raises several unanswered questions in both basic to
clinical treatment of this ailment. The contents of this book are
primarily based on the most up-to-date results of research programs
sponsored by the Japanese government as well as findings from
Korean researchers. In particular, novel classification for
neurological involvement (which has been discovered in Japan) led
to the establishment of diagnostic criteria and treatment
recommendation. Thus, this publication brings forth useful
information for a variety of specialists who are involved in the
management of this intractable disease.
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