Autoimmune diseases nervous system involvement

Autoimmune Diseases with Nervous System Involvement... 

In reviewing specific autoimmune diseases, the primary involvement is often not the nervous system. However, neurologic symptoms and involvement frequently accompany most autoimmune disorders (Table 21.2). 

SLE is a heterogeneous autoimmune disease that may affect virtually any organ, but predominant manifestations include non-deforming arthritis, serositis, photosensitivity, renal, hematological, and central nervous system involvement. Diagnosis is based on American Rheumatism Association criteria (273,274). The prevalence of SLE is estimated as 23.8/100,000 and there is a ninefold female excess (275), mostly occurring in the third to fifth decades. 

Most cells of the immune system are ordinarily kept apart from those of the nervous system by means of the blood-brain barrier. However, allergic encephalomyelitis, in which T cells attack the myelin sheath of brain neurons, can easily be induced in mice.506 A similar autoimmune process is thought to be involved in human multiple sclerosis (see Chapter 30, pp. 1769, 1808, and Fig. 30-9).507,508 High levels of circulating IgM are found in some demyelinating diseases of peripheral neurons.508 In Rasmussen s encephalitis, which causes brain inflammation and epilepsy, serum antibodies attack a glutamate receptor subunit GluR3.509... 

Prolonged TCE exposure has been associated with impairment of peripheral nervous system function, persistent neuritis and temporary loss of tactile sense and paralysis of the fingers after direct solvent contact. Chromosomal effects have been reported in those involved in the use of TCE for degreasing and symptoms of systemic lupus erythematosis have been reported after chronic TCE exposure. In addition, organic dementia has been noted after occupational exposure to TCE and there have been some reports of an association between exposure and scleroderma, an autoimmune disease. 

Cell surface receptors are clearly of great importance in understanding the function of the nervous system, the endocrine system, the immune system, cell proliferation, and targets for infection. The major chronic diseases such as cancer, diabetes, heart disease, arthritis, autoimmune disease, necrologic and psychiatric disorders, and endocrine dysfunction involve interactions with cell surface receptors. Understanding the structure and function of surface receptors has grown into one of the great thrusts of pharmaceutical R D, pursued in the belief it will uncover as yet unknown approaches to treatment of diseases hitherto intractable. 

Like ptosis and eyelid disorders, abnormal ocular movements in thyroid-associated eye diseases may be consequential to abnormalities at different levels of the nervous system. Apart from myasthenia gravis described under eyefid disorders, the association of exophthalmos with ophthalmoplegia in hypothyroidism has been described. Elevated titers of thyroid antibodies suggest a possible role of autoimmunity (Brownlie et ai, 1975), but concurrent mechanical factors related to exophthalmos cannot be entirely excluded. Hence, the neurological level of involvement remains uncertain. 

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